Domain 2 Abstracting Open Book Flashcards by Kacie Vazquez

A patient was diagnosed as having centroblastic malignant lymphoma in April of last year. A biopsy five months later in the same area
shows diffuse large B-cell lymphoma. What is the histology code for this case?

9680/3, it is the same disease process

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A moderately differentiated squamous cell carcinoma of the right upper lobe of lung would be histology and site coded as:

8070/32, C34.1

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A poorly differentiated squamous cell carcinoma of the glottis (NOS) would be histology and site coded as:

8070/33, C32.0

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A well differentiated adenocarcinoma of the cecum would be histology and site coded as:

8140/31, C18.0

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A well to moderately differentiated infiltrating ductal carcinoma of the upper outer quadrant of the right breast would be histology and
site coded as:

8500/32, C50.4

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An anaplastic astrocytoma of the temporal lobe would be histology and site coded as:

9401/34, C71.2

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An infiltrating urothelial carcinoma, moderately differentiated, of the lateral wall and dome of the bladder would be histology and site
coded as:

8120/32, C67.8

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An undifferentiated endometrioid carcinoma of the ovaries would be histology and site coded as:

8380/34, C56.9

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A patient is admitted for high dose chemotherapy for a “cancer” of her left breast; the histology and site code is:

8000/39, C50.9

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Code the primary site and histology in ICD-O-3 for the following diagnosis: Infiltrating duct carcinoma, cribriform type, multifocal in the
upper inner and lower outer quadrants of right breast.

C50.9 8201/39

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Which of the following diagnoses is the exception to the rule that all leukemias should be coded to C42.1 bone marrow?

9930/3 myeloid sarcoma

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The term “histioreticulocytoma” should be coded to:

8831/0 reticulohistiocytoma

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The diagnosis is “undifferentiated NK-cell leukemia.” What is the grade/differentiation?

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Code the primary site and histology in ICD-O-3 for following diagnosis: “atypical heavily pigmented melanoma of the right forearm.”

C44.6 8720/39

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Code the primary site and histology of neuroblastoma of the abdomen.

C47.4 9500/39

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Code the primary site and histology of CLL/SLL that is in the bone marrow and lymph nodes.

C42.1 9823/36

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What is the histology code for Hodgkin AND non-Hodgkin lymphoma diagnosed synchronously in the same anatomic location?

9596/36

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Code the primary site and histology of plasmacytoma of the bone of the femur with no bone marrow involvement.

C40.2 9731/39

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Code the primary site and histology of glioblastoma multiforme WHO Grade 4 of the left frontal lobe.

C71.1 9440/39

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The histology code for renal cell carcinoma (conventional type) is:

8312/39

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A patient is diagnosed with prostate adenocarcinoma in February 2007 treated with radiation therapy. He returns in March 2010
following a prostate biopsy showing adenocarcinoma. This is:

Adenocarcinoma of the prostate is always a single primary.

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The codes for infiltrating ductal carcinoma and lobular carcinoma in situ of the upper outer quadrant of the left breast is:

C50.4 8500/39

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Clinical Staging:

Includes any information obtained about extent of cancer before the start of definitive treatment.

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A patient is diagnosed with invasive papillary urothelial carcinoma of the bladder in May 2010. In February 2012 he returns with
invasive urothelial carcinoma of the bladder. This is:

The same primary and the histology code is 8130/39.

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Summary Stage 2018 defines Localized cancer by what code(s)?

Coding and Staging Case Study: Prostate Pt had PSA 12, elevated. Physical exam, DRE negative. Adenoca, Gleason 4+4=8, Grade Group 4, three cores lt side. Three cores rt side negative on prostate biopsy. Adenoca, Gleason 4+3=7, Grade Group 3, involving most of lt lobe, prostatectomy. 12 nodes negative. What is the pathological T category?

pT2

The timing of SEER Extent of Disease coding is limited to:

All information available through completion of surgeries in the first course of treatment or four months, whichever is longer.

PSA 8.2. DRE negative. TRUS biopsy in doctor’s office showed hypoechoic area and adenocarcinoma of prostate in all six specimens with Gleason score 5. Bone scan in Feb was negative. Feb radical prostatectomy: tumor in both lobes, no other extension, 5 regional nodes negative, Gleason score 8. What is the clinical and pathological T categories?

Clinical T1c, pathological T2c

The patient had a 2cm adenocarcinoma in the main bronchus almost at the carina, with involvement of hilar and mediastinal nodes. What is the T category?

T2a

The patient had a hemicolectomy which showed a 5cm adenocarcinoma, moderately differentiated, with extension through the muscularis propria. There was 1/13 nodes positive, and a tumor deposit in the mesentery. What is the N category?

N1a

In a bladder cancer case, a T2a indicates:

The tumor invades the inner half of the superficial muscularis propria.

In a case of colon cancer: cancer has grown through the mucosa and has invaded the muscular layer of the colon or rectum. It has not spread into nearby tissue or lymph nodes: T1, N0, M0. What stage is this colon cancer?

Stage I

The patient had a large tumor and dimpling of the skin of the breast. She had a modified radical mastecotmy which showed infiltrating ductal carcinoma, Bloom Richardson score 6, 3cm tumor with invasion of the pectoralis muscle. The 4 sentinel nodes were negative. What is the T category?

The patient had a radical cystectomy which showed squamous cell carcinoma, poorly differentiated, involving the deep muscularis propria. What is the T category?

T2b

Pathological stage determined following prostate surgery and after a review of the laboratory results indicates the tumor is on one side in less than 5% of the tissue resected. The T for this staging case would be:

Patient with newly diagnosed breast cancer. Tumor was 3 cm in size, with five positive lymph nodes on axillary dissection. ER+, PR+, HER2-, Grade 2. No other sites of cancer spread. According TNM staging system what stage of breast cancer is this?

Stage IB

The patient's physical exam was negative. Thyroid resection showed poorly differentiated medullary carcinoma, 1.8cm, with mets to 2/4 paratracheal nodes. Margins negative. What is the anatomic stage/prognostic group?

III

The patient had a 2cm tumor resected from the ampulla of vater. The pathology report was mucinous adenocarcinoma with invasion to the pancreatic parenchyma up to 0.4 cm. What is the T category?

T3a

Scans showed a tumor that involved the mediastinal and diaphragmatic pleura. The tumor extends into the mediastinal adipose tissue. It was determined to be a mesothelioma. What is the T category?

The patient had a scan showing a soft tissue sarcoma in the retroperitoneum that was 6cm. What is the T category?

The patient had a 2.3cm Merkel cell carcinoma resected from her arm. No lymph nodes were palpable, but a sentinel node procedure detected 1/3 nodes positive. There was another lesion between the primary tumor in the arm and the sentinel nodes. What is the N category?

The patient had a surgical resection for a 5.5cm endometrial stromal sarcoma. The tumor extended to the parametrium. The regional nodes were negative. What is the T category?

T2a

The right kidney was resected showing a 7cm clear cell carcinoma. Tumor extends into a segmental branch nearing the renal vein. Margins were negative. The renal hilar nodes were negative. What is the T category?

T3a

The patient was diagnosed with a tumor in the small bowel and superior mesenteric nodes. It was biopsied and proven to be non- Hodgkin lymphoma. There was also involvement of the inguinal nodes. What is the anatomic stage/prognostic group?

IIE

A patient was diagnosed as having centroblastic malignant lymphoma in April of last year. A biopsy five months later in the same area shows diffuse large B-cell lymphoma. What is the histology code for this case?

9680/3

What is the colon site-specific surgery code for the following: 50+ resection of contiguous organ. *Example: small bowel, bladder.

What is the site-specific surgery code for the following: Local or partial pancreatectomy and duodenoctomy with partial gastrectomy.

What is the site-specific surgery code for the following: Total or radical laryngectomy NOS.

What is the site-specific surgery code for the following: Colectomy, NOS

What is the site-specific surgery code for the following: Total proctocolectomy (removal of colon from cecum to the rectosigmoid junction, including the entire rectum).

What is the site-specific surgery code for the following: Extended pneumonectomy plus pleura or diaphragm.

What is the cervix uteri site-specific surgery code for the following: Dilatation and curettage; endocervical curettage (for in situ only).

What is the site specific surgery code for the following: Resection of ovary (wedge, subtotal, or partial) only, NOS; unknown if hysterectomy done.

What is the site-specific surgery code for the following: Total simple mastectomy with removal of uninvolved contralateral breast?

What identifies the anatomic extent of disease based on the T, N, M elements categories known prior to the start of any therapy?

Clinical Stage Group

True or False: Pathological N identifies the presence or absence of nodal metastasis of the tumor prior to the completion of surgical therapy

False

What is the liver site-specific surgery code for the following: Extended lobectomy (extended: resection of a single lobe plus a segment of another lobe).

A patient is diagnosed with adenocarcinoma of the cecum in April 2010. He is diagnosed with adenocarcinoma of the ascending colon in April 2012. The clinician says this is recurrent carcinoma. The pathologist does not review the original pathology from the cecal primary. Is this a single or multiple primary and what is the correct site code?

C18.2, multiple

What is the site specific surgery code for the following: Any colectomy (partial, hemicolectomy or partial) with a resection of any other organs in continuity with the primary site. Other organs may be partially or totally removed.

A breast cancer patient undergoes a lumpectomy. What is the Site-Specific Surgery Code?

A patient with parotid gland cancer underwent a right superficial parotidectomy with facial nerve dissection/total parotidectomy. What is the correct Site-Specific Surgery Code?

A patient undergoes the following procedure: Re-excision of melanoma wound from left ear with reconstruction and split-thickness skin grafting. The margin surrounding the wound is 1.5 cm. What is the correct Site-Specific Surgery code?

Lumpectomy, LOQ rt breast shows DCIS measuring 1cm and lobular carcinoma 0.5cm. Is this a single or multiple primary & what is the histology?

8520 Rule M10 duct and lobular (includes in situ & invasive) Rule H22 – code invasive when both invasive and in situ are present

The patient has a colonoscopy and a large tumor in the colon is identified. Biopsy shows adenocarcinoma in adenomatous polyp. What is the histology?

8140 | Rule H2 – code histology and ignore the polyp when it originates in a polyp

For Phase I External Beam Radiation Planning Technique data item, use this code if there is no radiation treatment.

A bilateral mastectomy for a single tumor involving both breasts as for bilateral inflammatory carcinoma is site-specific surgery code:

Nephrectomy shows two tumors: papillary renal cell carcinoma and a clear cell renal cell carcinoma. Is this a single or multiple primary and what is the topography code?

Multiple, 64.9 Rule M7 – different subtypes of renal cell are multiple primaries C64.9 - kidney

A patient with Stage III prostate carcinoma received pelvic irradiation to 5000 cGY over 25 fractions followed by a Phase II (boost) prostate irradiation to 7000 cGY. The Phase I dose per fraction is recorded as 0200(5000/25). What is the Phase I dose per fraction coded as?

00200

A patient with Stage IIIB bronchogenic carcinoma received 25 treatments to the left hilum and mediastinum, given in 25 daily fractions over five weeks. What is the code for the Phase I Number of Fractions data item?

025

What is the site-specific surgery code for total colectomy with portion of rectum, small bowel, and bladder?

The patient has a colonoscopy and a large tumor in the colon is identified. Biopsy shows adenocarcinoma in adenomatous polyp. What is the histology?

8140 | Rule H2 – code histology and ignore the polyp when it originates in a polyp

Patient has an oophorectomy which showed a Krukenberg tumor. How is the primary site and histology coded?

C80.9, 8490/39 Registries code to the primary site, this is a metastatic tumor to the ovary, usually from a GI site Since the primary site is unknown, it is C80.9 Registries never use /6, as we deal with the primary site, not the metastatic site Rule H9 – code histology from metastatic site when no specimen from primary site

Prostate adenoca diagnosed in 2016, treated with TURP 5/2018: prostate biopsy shows small cell carcinoma of prostate Is this a single or multiple primary and what is the histology?

Multiple, 8140, 8041 Rule M10 – tumors dx >1 yr apart are multiple Second histology is new prostate primary, small cell carcinoma is not adenocarcinoma, not covered by Rule M3 (adenoca of prostate is always single primary) Rule H11 – code the histology when only one type identified

Coding and Staging Case Study: Colon 8/18 CT abdomen/pelvis: 5cm tumor in ascending colon 8/18 CEA: 4.5 elevated. 9/4 Surgical path report: Right hemicolectomy • Invasive mucinous adenocarcinoma, low grade. • Tumor extends through the bowel wall into the serosa. • Tumor size 4.5cm. • 3 of 8 regional nodes are positive for metastatic adenocarcinoma. • Right lobe liver biopsy: Metastatic adenocarcinoma consistent with colonic primary What is the best code classification for AJCC Pathological M?

pM1a There was a biopsy of liver that was positive for metastatic adenocarcinoma consistent with colonic primary. The metastasis was confined to one organ. A biopsy was done and was positive which meets the requirements for pathological assignment.

Coding and Staging Case Study: Breast Bx 5:00 & 10:00 rt breast – infiltrating lobular ca, Nottingham gr 2/3, ER/PR pos, HER2 unamplified. >2cm Lobular ca, Nottingham 3+2+1=6 Gr2, marg neg, rt mastectomy. 1/3 sentinel nodes with macromets. 17 axillary nodes negative. What is the pathological T category?

pT2 | Tumor >20mm but <50mm, confined to breast

IIC | pT2 pN0 cM0 PSA12 Grade Group 4 is stage IIC

A patient was diagnosed as having centroblastic malignant lymphoma in April of last year. A biopsy five months later in the same area shows diffuse large B-cell lymphoma. What is the histology code for this case?

9680/3

pN1a | Mets in 1 axillary node, >2mm which is macromets

Regional nodes Tumor confined to breast Regional nodes are involved No distant metastasis

Coding and staging Case Study: Melanoma Pt has dark ulcerated lesion on arm and confusion. No palpable axillary nodes on exam. MRI brain – mets. Arm skin mass excisional biopsy showed melanoma, 3.8mm thick. LDH is not elevated.

cT3 3.8mm thick, ulceration status unspecified Ulceration is only based on histopathologic exam Ulceration is defined as full‐thickness absence of intact epidermis with associated host reaction above primary melanoma based on microscopic exam

cN0 | Axillary nodes were negative on physical exam

4/18/2018 Bx of lung nodule: adenocarcinoma, papillary predominant What is the histology and the H Rule?

8260/3, H6 | Rule H6: Code the subtype/variant when there is a NOS and a single subtype/variant of that NOS

1/17/2018 Bx of lung nodule: non small cell carcinoma, favor squamous cell carcinoma; patient treated for squamous cell carcinoma What is the histology and the H Rule?

8070/3, H3 Rule H3 Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma (such as adenocarcinoma, squamous cell carcinoma, etc.)

Domain 2 Abstracting Open Book Flashcards

(84 cards)