Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved?
Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.
Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).
Primary Site: For malignant gastrointestinal tumors (GISTs), how should the primary site be coded and which Collaborative Stage and TNM staging schemes should be used for disease found in the stomach, small intestine or other locations?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code the primary site to the location where the GIST originated. If the primary site cannot be determined, assign code C809 [Unknown primary site].
GIST of gastrointestinal hollow viscera cannot be staged in TNM.
In Collaborative Staging, use the stomach scheme for GIST of the stomach. Use the small intestine scheme for GIST of the small intestine. For GIST of other primary sites, use the CS scheme for the specific site.
Primary Site: How do we code site when endometrioid carcinoma arises in "endometriosis"?
Code the Primary Site to where the endometriosis implanted, which may or may not be the endometrium. Endometrioid carcinoma can arise in the ovary, endometrium and other internal genital sites. The site/histology edit for endometrioid and ovary has been removed from the SEER edit set.
Primary Site: How do we code the primary site for a malignancy that occurs in parenchyma located in an ectopic site? See discussion.
1. Patient presented with a subcutaneous nodule in right axilla. Pathologic impression by initial and reviewing pathologists is that the lesion represents a breast adenocarcinoma arising in ectopic mammary parenchyma. Subsequent breast biopsies were negative.
2. Patient presented with right branchial cleft cyst. The pathologist states the cyst is a primary thyroid adenocarcinoma arising in an ectopic focus of thyroid tissue. The subsequent total thyroidectomy is negative.
Code the primary site to the location of the malignancy.
1. Code the Primary Site field to C76.1 [Axilla NOS].
2. Code the Primary Site field to C10.4 [Branchial cleft].
Primary Site: How do you code the primary site when the tumor is identified in a bladder that was reconstructed using a stomach augmentation procedure and the pathology report states, "Bladder/prostate: adenocarcinoma arising within gastric mucosa, with the following features: highly infiltrative through the bladder wall"?
Code the Primary Site field to bladder [C67.9]. Code the location of the tumor as the primary site.
Primary Site: How is this field coded for a mass involving the gastroesophageal junction and lower third of the esophagus? See Description.
We have an EGD report describing an ulcerated and infiltrative circumferential non-bleeding 10 cm. mass of malignant appearance found at the gastro-esophageal junction and lower third of the esophagus. The mass caused a partial obstruction. Biopsies were taken from the the gastroesophageal junction and lower third of esophagus. Pathologic diagnosis: Adenocarcinoma. Would this be coded C26.8?
Search for a statement indicating the site of origin. If the site of origin cannot be determined, and there is evidence of Barrett's esophagus, code the topography in the example above to C15.5 [Lower third of esophagus]. If there is no evidence of Barrett's esophagus, assign code C16.0 [Gastroesophageal junction]. Either C15.5 or C16.0 would be preferable to C26.8, which is very non-specific and includes GI tract, pancreas and biliary tract.
Primary Site: How is this field coded for cholangiocarcinoma involving the intrapancreatic bile duct?
Code the primary site as C24.0 [Extrahepatic bile duct, includes Common bile duct] for a cholagiocarcinoma originating in the common bile duct. A portion of the common bile duct is within the head of the pancreas: The intrapancreatic segment of the common bile duct.
Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast?
Code the primary site as skin of breast when skin of breast is documented as the site of origin.
According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass."
Primary Site: Should we code C80.9 [unknown primary] or code C34.9 [Lung] according to the terminology, "most likely site of origin is lung"? See Description.
We have a case of metastatic keratinizing squamous cell ca. The work-up shows small densities in the lung that may represent inflammatory or chronic changes. No other imaging that shows origin. Physical exam states 2 months of left axillary mass. H/O SCCA of the skin involving chest wall.
Path reads: Metastatic w/d keratinizing SCCA. This lesion almost undoubtedly represents mets. The most likely site of origin is lung followed by esophageal primary or head & neck. The final discharge states, "Metastatic SCCA to Left Axilla".
Code the primary site according to the physicians' opinion, especially the treatment decision. If the physician treats the patient for a lung primary, code primary site as lung. If the primary site cannot be determined, code C80.9.
According to the pathologist, the most likely primary site for the example above is lung. The final discharge diagnosis does not reflect the pathologist's opinion, and does not contradict it either. If there is no conflicting medical opinion, code primary site to C34.9 [lung].
Primary Site: What code should be used to represent the site for an "extraovarian" papillary serous adenocarcinoma located in the "rectal muscle sheath"? See discussion.
The location of the tumor in the rectus muscle sheath is unusual and suggests an origin within a preexisting mullerian.
Code the Primary Site field to C49.4 [connective, subcutaneous and other soft tissues of the abdomen].
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