CS Extension--Prostate: How do you code clinical extension for prostate primaries diagnosed at autopsy? See discussion.
A patient was not diagnosed prior to autopsy. The autopsy diagnosis states that this is adenocarcinoma of the prostate without capsular invasion.
Should clinical extension be coded to clinically inapparent, NOS (10) and pathologic extension be coded to no prostatectomy done within first course of treatment (97)?
Code CS Extension (clinical) to 99 [Unknown]. Code SSF 3 according to the amount of tumor found using the information from the autopsy.
Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant?
Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9.
Primary site: What is the correct primary site code for angiosarcoma of the spleen with mets to bone marrow C42.2 vs C49x? See Discussion.
Robbins Pathology states the following about liver angiosarcomas: Hepatic angiosarcomas are rare but of interest because they are associated with distinct carcinogens, including arsenic (exposure to arsenical pesticides), Thorocast (a radioactive contrast medium previously widely used in radiology), and polyvinyl chloride (PVC) (widely used in plastics). The increased frequency of angiosarcomas among works in the PVC industry is one of the truly well-documented instances of chemical carcinogenesis in humans. With all these agents, there is a very long latent period of many years between exposure and the development of tumors.
Could the same apply to the spleen?
Code C422 [Spleen] as the primary site for angiosarcoma of spleen with metastasis to bone marrow.
Immunotherapy/Chemotherapy: Are monoclonal antibodies, such as Avastin and Erbitux, coded as immunotherapy or chemotherapy? See Discussion.
In review of the "FDA-approved oncology agents not listed in SEER Book 8" provided in 5/02, it appears "monoclonal antibodies" are coded as immunotherapy.
Code Avastin and Erbitux as chemotherapy because both of these drugs are growth inhibitors. Code growth inhibitors (cytostatic agents) as chemotherapy. Do not assume that monoclonal antibodies are coded as immunotherapy.
MP/H Rules/Histology--Brain and CNS: How is histology coded for a left occipital parietal area tumor stated to be a "low grade neuroectodermal neoplasm most consistent with neuronal tumor but lacking classic features of ganglioma" if the pathologist states the tumor is not malignant?
Code 9505/0 [Ganglioglioma, benign] is the best option according to our pathology expert. He states, "There recently has been a spate of tumors called low grade glio-neuronal tumors that are not PNETs and have no propensity to become malignant."
Date of Multiple Tumors--Breast: How is this field coded when a second breast tumor is found at mastectomy two months after the original breast cancer was diagnosed, but during initial workup and treatment? See Discussion.
Breast cancer was diagnosed on core biopsy on 02-27-07. It was not known that the breast was harboring 2 tumors until mastectomy was done on 4-01-07. Both tumors are counted as one primary.
Code "Date of Multiple Tumors" field to the date of the mastectomy. That is the date that multiple tumors were discovered.
Reportability--Lung: Is carcinoid tumorlet of the lung a reportable disease? See Discussion.
The literature on this is rather ambiguous as to whether these tumorlets (defined as <0.5 cm) are benign, such as atypical hyperplasia, or actual carcinoid tumors.
Carcinoid tumorlets are not reportable. The histology can be similar to typical carcinoids; however, they are <5 mm in diameter and are benign/nonreportable.
Reportability--Appendix: Is a metastatic low-grade appendiceal mucinous neoplasm reportable if the pathologist states that it is a borderline tumor of the appendix? See Discussion.
Low-grade appendiceal mucinous neoplasm; Lt ovary, cul-de-sac, omentum, and small bowel: Metastatic low-grade appendiceal mucinous neoplasm. Per pathologist this is a borderline tumor of the appendix.
Borderline tumors (other than brain and CNS) are not reportable to SEER. In the case of borderline tumors, the term "metastatic" does not automatically make them reportable. When the "metastatic deposits" are also borderline, the case is not reportable. For this case in particular, the "metastases" are actually (benign) implants and not malignant or invasive mets.
Multiplicity Counter/Type of Multiple Tumors--Breast: How are these data items coded for a single breast primary composed of both in situ and invasive disease when measurements are provided for both the invasive and in insitu components? See Discussion.
Breast cancer, invasive duct carcinoma with DCIS, 1.3 cm, DCIS 3.7 cm. "The in situ carcinoma is very extensive in this lumpectomy. It is present contiguously from sides 1A through 1L sparing only the final 8 mm of medial margin. In situ and invasive carcinoma are prominently present along almost the entire superior margin." Is the mult counter 02 with Type of mult tumor 30, or one tumor?
Because there are individual measurements for each of these tumors, code the multiplicity counter 02 [Two tumors present]. Code Type of Multiple Tumor as 30 [In situ and invasive].
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