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Welcome to the SEER Inquiry System (SINQ). SINQ is a collection of questions that cancer registrars have had while coding cancer cases. Click Search to look for specific questions or to select questions for a Report.


Recent Questions
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20140011 MP/H Rules/Multiple primaries--Breast: Is the diagnosis of Paget disease two years after a diagnosis of infiltrating duct carcinoma of the same breast a new primary? See discussion. Final Jan 24 2014
20140007 Surgery of Primary Site--Lung: How is surgery coded when a patient undergoes a mediastinoscopy with mediastinal lymph node sampling and then a later upper lobectomy? See discussion. Final Jan 15 2014
20140006 Date Therapy Initiated--Corpus Uteri: How should this field be coded for an endometrial primary when the patient undergoes a hysteroscopic polypectomy on 01/08/2014 (Surgery code 25), followed by a TAH/BSO on 02/07/2014 (Surgery code 50)? See discussion. Final Jan 15 2014
20140005 Primary site--Testis: In the absence of a specific statement that the patient's testicle(s) are descended, should the primary site for a testicular tumor be coded as C621 (Descended Testis) when the mass is palpable on physical exam or demonstrated on scrotal ultrasound? See discussion. Final Jan 15 2014
20140004 Grade--Liver: How should grade be coded for a liver lesion treated with radio frequency ablation (RFA) followed by a transplant showing moderately differentiated hepatocellular carcinoma? See discussion. Final Jan 15 2014
20140003 Surgery of Primary Site/Surgical Procedure of Other Sites--Endometrium: How are these fields coded for an endometrial primary when the patient undergoes a radical tumor cytoreduction including modified radical hysterectomy, BSO, omentectomy, resection of intra-abdominal and intrapelvic implants, and partial cystectomy? See discussion. Final Jan 15 2014
20140002 Reportability--Appendix: Is a pathologic final diagnosis of an appendix with "well-differentiated neuroendocrine tumor (carcinoid)" reportable? See discussion. Final Jan 15 2014
20140001 Grade--Brain and CNS: How should grade be coded for a pineal parenchymal tumor of “intermediate differentiation”? See discussion. Final Jan 10 2014
20130222 MP/H Rules/Histology--Bladder: What code should be assigned to this tumor? A single bladder tumor removed via TURB. Final Dx: Invasive urothelial carcinoma with extensive divergent differentiation including small cell carcinoma, micropapillary carcinoma, and squamous cell carcinoma features.

MP/H rules seem to lead to H8 - code the numerically higher ICD-O-3 code. Out of this diagnosis, it appears that 8131, micropapillary urothelial carcinoma would be the code. That would ignore the small cell carcinoma, which seems prognostically more significant.

Final Dec 16 2013
20130221 MP/H Rules/Multiple Primaries--Prostate: Is a metastatic small cell (neuroendocrine) carcinoma following a prostate adenocarcinoma a new primary when the physician states “patient has Stage 4 small cell carcinoma of the prostate” or “metastatic small cell carcinoma, likely prostate origin”? See discussion. Final Dec 12 2013
20130220 Reportability--Thyroid: Is a hyalinizing trabecular neoplasm of the thyroid reportable? Pathology comment states: Hyalinizing trabecular neoplasm is considered by some to represent a variant of papillary thyroid carcinoma because of the similar nuclear cytology, immunoprofile and RET-oncogene rearrangements. Final Dec 12 2013
20130219 Date of diagnosis/Ambiguous terminology--Breast: I have 3 scenarios for which we disagree on whether this is the date of diagnosis or not. Mammogram - nothing in body of mammogram for any suspicion or malignancy. See discussion. Final Dec 10 2013
20130215 Reportability--Heme & Lymphoid Neoplasms: Is this case reportable? See discussion. Final Dec 09 2013
20130214 Primary site--Heme & Lymphoid Neoplasms: Would PH20 apply to bilateral axillary and bilateral inguinal LN involvement as well, or do we code C778 (LN multiple regions)? The rule states: "Code the primary site to the specific lymph node region when multiple lymph node chains within the same region as defined by ICD-O-3 are involved. Note: Use this rule when there is bilateral involvement of lymph nodes." Final Dec 09 2013
20130213 Primary site--Heme & Lymphoid Neoplasms: What is the correct primary site code for the following scenario, and what rule does it fall under?

Patient is found to have marginal zone lymphoma which involves bilateral axillary LN, inguinal LN, bone marrow and bilateral orbits. The physician says the patient has bilateral orbital lymphoma, Stage IV.

None of the rules seem to apply when the lymphoma is present in an organ and in distant lymph nodes and bone marrow only. No regional nodes are involved.

Does rule PH22 infer that the organ should be coded primary site because it has been named by the physician? This case seems to fall between the cracks.

Final Dec 09 2013
20130212 Reportability--Heme & Lymphoid Neoplasms: When there is a clinical diagnosis from a physician stating a patient has plasmacytoma, but the path report dated before this clinical diagnosis is negative for plasmacytoma, would this case still be reportable? Final Dec 09 2013
20130211 Multiple primaries--Heme & Lymphoid Neoplasms: Should this be abstracted as one or 2 primaries? See discussion. Final Dec 09 2013
20130209 Multiple primaries-Heme & Lymphoid Neoplasms: Should this case be interpreted as 9950/3 and 9861/3 which makes it two primaries?

Polycythemia vera diagnosed elsewhere in March of 2007, treated and positive for Jak 2. Now in our facility, bone marrow biopsy positive for acute myelogenous leukemia.

Final Dec 06 2013
20130208 Histology--Heme & Lymphoid Neoplasms: How is this histology coded using the rules?

Bone marrow shows slightly hypercellular marrow with acute myeloid leukemia non-M3 type. The flow cytometry is also consistent with acute myeloid leukemia, non-M3 type.

Final Dec 06 2013
20130207 Multiple primaries--Heme & Lymphoid Neoplasms: Is the current diagnosis a new primary?

Multiple myeloma diagnosed >5 years prior to admission, underwent multimodality treatment. Currently suffered a fracture - path report described "plasmacytoma". The discharge summary states "multiple myeloma advanced with multiple lytic lesions".

Is this a single primary dating back to the original diagnosis? Or plasmacytoma by biopsy - new primary due to >21 day lapse since original diagnosis?

Final Dec 06 2013
20130206 Primary site--Heme & Lymphoid Neoplasms: What is the primary site and why? Which rule applies?

Marginal zone lymphoma found on peripheral blood with positive flow cytometry/FISH analysis. No bone marrow or biopsy of any lymph nodes done. PET scan revealed no spleen or lymph node uptake, no uptake anywhere in the body, and no lymph nodes palpable on exam. Doctor states "marginal zone lymphoma, unspecified site, stage 1."

Final Dec 06 2013
20130205 MP/H Rules/Multiple primaries--Breast: For a case of infiltrating duct and lobular carcinoma of the breast (8522) and Paget disease of the same breast, is this one primary or two? If it is just one primary, what is the histology code? Final Dec 05 2013
20130204 MP/H Rules/Histology--Kidney, renal Pelvis: What histology code applies to a “tubulocystic renal cell carcinoma” ? See discussion. Final Dec 04 2013
20130203 MP/H Rules/Multiple Primaries--Brain and CNS: How many primaries are reported for a patient diagnosed with cerebral cavernous malformation disorder (CCM1) and MRI evidence of dozens of cavernous angiomas/malformations throughout the supra and infratentorium? See discussion. Final Feb 27 2014
20130202 Multiple primaries--Heme & Lymphoid Neoplasms: Is this case one or two primaries?

I find reference in the hematopoietic manual to abstract a second primary when a solitary plasmacytoma (chronic) is followed by a plasma cell meyloma (acute) greater than 21 days. However, I find nothing regarding same vs multiple primary if a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013. The physician specifically stated the patient does not have multiple myeloma.

Final Dec 03 2013
20130201 Multiple primaries--Heme & Lymphoid Neoplasms: Would this be two primaries because the MALT lymphoma and the follicular cell lymphoma are in different anatomic sites?

06/05/12 RUL biopsy positive for MALT lymphoma. 06/07/12 cervical lymph node biopsy positive for follicular cell lymphoma.

Final Dec 03 2013
20130200 Primary Site--Heme & Lymphoid Neoplasms: What is the primary site for a diffuse large B cell lymphoma involving the testicles, stomach, and rectum, but no lymph nodes are involved? The bone marrow is also positive. The doctors just call it lymphoma. The manual really doesn't address this issue. Final Dec 03 2013
20130199 MP/H Rules/Multiple primaries--Breast: Does breast Rule M10: 'Tumors that are lobular (8520) and intraductal or duct are a single primary' apply if you have twp tumors in the same breast, one ductal and the other tubulolobular (8524)? If not, then rule M12 makes these separate primaries, correct? Final Nov 14 2013
20130198 MP/H Rules/Multiple primaries--Other sites: A patient has a total colectomy showing neuroendocrine carcinoma of the rectosigmoid junction, as well as a separate adenocarcinoma arising in a villous adenoma, also arising in the rectosigmoid junction. Is this a single primary per rule M17 (a frank adenocarcinoma and an adenocarcinoma in a a polyp) or per rule M16 (adenocarcinoma and a more specific adenocarcinoma) or is this 2 primaries? Final Nov 14 2013
20130197 MP/H Rules/Histology--Urinary system: Is code 8130 is the only valid code for papillary carcinoma cases dx 2007 forward? If this is correct, then should we have any 2007 cases forward coded to 8050 in our database?

The MP/H rules for ureter, renal pelvis, and bladder H4 states to code papillary carcinoma to 8130, yet code 8050 is also listed in M6 for papillary carcinoma.

The IARC publication Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs uses code 8130 only for papillary carcinoma.

Final Nov 13 2013
20130196 Reportability--Heme & Lymphoid Neoplasms: Is heparin induced thrombocytopenia reportable? Final Nov 01 2013
20130195 Laterality--Heme & Lymphoid Neoplasms: Is the correct code 0 for laterality unless it is a paired organ? Example: Right or Left Kidney/Breast etc? Is there documentation for this? Final Nov 01 2013
20130194 Reportability--Brain and CNS: Are blood vessel tumors arising in CNS sites reportable? See discussion. Final Oct 31 2013
20130193 Sex: How is sex coded for the following?

Primary site is testes. The Physical Exam states patient is male. The remarks states patient is transsexual. There is no indication that the orchiectomy was part of gender reassignment surgery.

Final Oct 30 2013
20130192 MP/H Rules/Histology--Pleura: How is histology coded when a Final Diagnosis is “malignant neoplasm, compatible with malignant mesothelioma” if the COMMENT section of the pathology report indicates the tumor has a mixed epithelial and sarcomatoid pattern? See discussion. Final Oct 22 2013
20130191 Systemic/Surgery Sequence--Bladder: How is the systemic treatment/surgery sequence field coded for a 2013 case if the patient has a TURBT followed by multi-agent chemotherapy, and then a cystoprostatectomy followed by post-operative multi-agent chemotherapy? Final Oct 22 2013
20130190 Reportability--Is a thymoma, B3 type malignant? Recent information received from a registrar/pathologist states that the WHO classifies well-differentiated thymic carcinoma (8585/3) as a synonym for Type B3 thymoma. Final Oct 22 2013
20130189 Reportability--Brain and CNS: Do the terms 'mass' and 'lesion' constitute reportability for brain and CNS diagnostic findings? The SEER Manual mentions 'tumor' and 'neoplasm' but not mass and lesion. The SEER MP/H Manual calls tumor, mass, lesion, and neoplasm equivalent terms for determining multiple primaries, but does this apply to reportability? If not, what is the distinction? Final Oct 17 2013
20130188 Reportability/Histology--Heme & Lymphoid Neoplasms: Is plasma cell neoplasm reportable? I submitted a question in 2012 and was told that it was reportable. Recently I heard that it was not reportable. Could you please clarify. Final Oct 17 2013
20130187 Reportability: Is this case reportable?

A thymoma is described by the medical oncologist at initial diagnosis as a malignant thymoma, Stage III. The patient has neoadjuvant chemotherapy with CAP beginning that day, followed by resection. At resection, the pathologist gives a diagnosis of spindle cell thymoma.

Final Oct 16 2013
20130186 Grade: Can the FIGO grade be used for coding the morphology grade? FIGO Grade is coded in CS SSF 7 in the Corpus Uteri schema. The SEER Program Coding and Staging manual does not address using FIGO grade for coding grade in morphology. Final Oct 03 2013
20130185 Reportability/Behavior: Is HGSIL (high grade squamous intraepithelial lesion) of the vulva or vagina reportable? Is this a synonym for 8077/2 -- Squamous intraepithelial neoplasia, grade III? Final Oct 03 2013
20130184 Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable? Final Sep 27 2013
20130183 Reportability--Heme & Lymphoid Neoplasms: Is this case reportable? If so, please give instructions used in determining. See discussion. Final Sep 27 2013
20130182 Primary site--Head and Neck: Should the primary site be coded to floor of mouth because site of invasive disease? Or is primary site C148 because invasion doesn't translate into determining primary site?

Patient with overlapping lesion of tongue and floor of mouth. Initial biopsy of floor of mouth reveals microinvasive squamous cell cancer. Definitive resection reveals in situ squamous cell cancer. Path report states unifocal tumor, tumor site on path documented as tongue and floor of mouth.

Final Sep 27 2013
20130181 Multiple Primaries--Heme & Lymphoid Neoplasms: Should I use M4 or Heme DB? The Heme DB identifies these as new primaries.

2012/10/12 Large intestine, biopsy - diffuse large B-cell lymphoma.

2012/10/22 Bone marrow - peripheral T-cell lymphoma.

Final Sep 27 2013
20130180 Histology--Pancreas: Please explain the difference in coding of pancreatic endocrine neoplasm, PanNETs 8240/3 (SEER Inquiry 20120035) and the new ICD-O-3 pancreatic endocrine tumor, benign or malignant 8150/0 or 3 Final Sep 27 2013
20130179 Multiple primaries--Heme & Lymphoid Neoplasms: For this case, what rule is applicable because of the transformation? See discussion. Final Sep 27 2013
20130178 Reportability--Heme & Lymphoid Neoplasms: Is refractory iron deficiency anemia reportable? Final Sep 27 2013
20130177 MP/H Rules/Histology--Bladder: What rule and histology code should we use? 6 cm tumor arising in posterior-lateral bladder extends to prostate, obliterates seminal vesicle, and invades pelvic wall. TURB Final DX: Small Cell Neuroendocrine Carcinoma. 10% of tumor is high grade Urothelial Carcinoma. The single tumor rules appear to lead us to H8, the numerically higher code of 8120. This does not seem like a true representation of the tumor. Final Sep 26 2013
20130176 Reportability--Ovary: Is an adult granulosa cell tumor of the right adnexa reportable if the left adnexa, diaphragm and paratubal tissue are reported to be consistent with metastasis? See discussion. Final Apr 03 2014
20130174 Histology--Breast: How should invasive pleomorphic lobular carcinoma be coded? As it is "a very rare and distinct morphological variant of invasive lobular carcinoma," (ncbi.nim.nih.gov) Should it be coded pleomorphic carcinoma (8022/3) or lobular carcinoma (8520/3)? The MP/H rules do not seem to recognize specific lobular carcinomas. Final Sep 13 2013
20130173 Histology/Primary site--Heme & Lymphoid Neoplasms: My interpretation of heme rules would be to use primary site of bladder with code 9930/3 for myeloid sarcoma. Is this correct? See discussion. Final Sep 13 2013
20130172 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries and what is/are the histology/ies for the following case? See discussion. Final Feb 21 2014
20130171 Reportability--Heme & Lymphoid Neoplasms: Is "plasma cell neoplasm" a synonym for multiple myeloma and is it reportable? Path report in the comment section states "plasma cell neoplasm such as monoclonal gammopathy of undetermined significance (MGUS)". Final Sep 13 2013
20130170 MP/H Rules/Histology--Breast: What is the histology code for invasive carcinoma of the breast, no special type? See discussion. Final Sep 13 2013
20130168 Date of diagnosis--Heme and Lymphoid Neoplasms: Is the date of diagnosis the bone marrow biopsy or the date of discharge summary stating myeloma? Bone marrow biopsy pathology states Plasma Cell Neoplasm. The plasma cells are < 10%. The discharge Summary states Myeloma. Patient has hypercalcemia with negative bone marrow surveys. Final Sep 13 2013
20130167 Multiple primaries--Heme & Lymphoid Neoplasms: Is there a new primary? History of multiple myeloma (MM) diagnosed by biopsy 2-20-07 status post chemo / ht. Found to have right leg skin nodules consistent with plasmacytoma / plasma cell myeloma. Final Sep 13 2013
20130166 Reportability--Heme & Lymphoid Neoplasms: Is INDOLENT MULTIPLE MYELOMA reportable as INDOLENT/SMOLDERING MYELOMA? Pt initially diagnosed with Monoclonal gammopathy of undetermined significance (MGUS) (7/10/2012) then MGUS/smoldering myeloma (7/27/2012, no intervention at this time) and eventually smoldering myeloma (about Oct/Nov 2012). Final Sep 13 2013
20130165 MP/H Rules/Multiple primaries--Thyroid: Is this one primary or two primaries of the thyroid? Here is the path report from a complete thyroidectomy: Tumor Focality: Multifocal (bilateral) Dominant Tumor: Tumor Laterality: Right lobe Tumor Size: Greatest dimension: 9 cm Histologic Type: Papillary carcinoma Variant, specify: Classical Architecture: Follicular Cytomorphology: Classical SECOND TUMOR: Tumor laterality: Left lobe Tumor Size: Greatest dimension: 6 cm Histologic Type: Papillary carcinoma, columnar cell variant Architecture: Solid, follicular, and papillary Cytomorphology: Columnar cell The answer seems to hinge on whether or not the two tumors differ at the third digit of histology. Can we code based on the terms listed for variant or architecture? Final Sep 11 2013
20130163 Multiple primaries--Heme & Lymphoid Neoplasms: Is a diagnosis of "post-essential thrombocythemia myelofibrosis" equivalent to Myelofibrosis as a result of myeloproliferative disease, which is listed as an Alternative Name for primary myelofibrosis, code 9961? See discussion. Final Sep 06 2013
20130162 Reportability--Heme & Lymphoid Neoplasms: Is erythrocytosis of unknown cause a reportable disease? Final Sep 06 2013
20130161 Primary Site--Heme & Lymphoid Neoplasms: What is the primary site for this case?

1/11/13 bone marrow bx: B cell acute lymphoblastic leukemia. Flow cytometry of peripheral blood shows leukemia involvement. PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones. The patient has an elevated WBC, anemia and thrombocytopenia.

If I follow the manual the primary site would be C779, but according to the answer to SINQ 20120047, the primary site would be C421. Which is correct?

See discussion.

Final Sep 06 2013
20130160 Histology--Heme & Lymphoid Neoplasms: How do I determine whether this case should be coded as a therapy-related neoplasm? See discussion. Final Sep 06 2013
20130159 Diagnostic confirmation--Heme & Lymphoid Neoplasms: What is the diagnostic confirmation code for an acute myeloid leukemia (AML)diagnosed through immunophenotyping? See discussion. Final Sep 06 2013
20130156 Other therapy--Heme and Lymphoid Neoplasms: Based on the hematopoietic manual instructions, is plasmapheresis abstracted as treatment?

The patient was diagnosed with Waldenstrom macroglobulinemia at another facility, presented to our facility and had plasmapheresis on 12/27/2012. No other treatment.

Final Sep 06 2013
20130155 Diagnostic confirmation--Heme & Lymphoid Neoplasms: What do we code for diagnostic confirmation?

Path report skin biopsy: Low-grade B cell lymphoma, most compatible with marginal zone lymphoma. Positive rearrangement for mmunoglobulin heavy chain gene favor a diagnosis of B cell lymphoma.

Physician notes say patient has diagnosis of cutaneous marginal zone lymphoma.

Final Sep 06 2013
20130152 Primary site/Histology--Brain and CNS: How would you code the site/morphology for this situation? Patient has a dermoid cyst of the 3rd ventricle of the brain, diagnosed in 1998. In 2013, the patient has the cyst removed and it is diagnosed as squamous cell carcinoma. In an internet search, we found a journal article in the Journal of Neurooncology that says, "Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis ...". The combination of C715 and 8070/3 fails SEER Edit IF 38_3: Primary site and Morphology Impossible. Final Sep 06 2013
20130151 Primary site--Heme & Lymphoid Neoplasms: Path report from splenectomy says 'T large granular lymphocytic leukemia.' Physician notes say, "No evidence of leukemia on peripheral blood flow cytometry; disease localized to spleen." Is the primary site C421 (per the hemato database) or can it be C422 (spleen)? Final Sep 04 2013
20130150 MP/H Rules/Histology--Bladder: How is histology coded for a bladder TUR that demonstrates mixed invasive urothelial and small cell carcinoma? See discussion. Final Sep 03 2013
20130149 MP/H Rules/Histology--Testis: How is histology coded for a right orchiectomy specimen with embryonal carcinoma (70%), yolk sac tumor (30%) and a focus of seminoma (<1%)? If there were also retroperitoneal lymph nodes with teratoma (NOS), would that change the Histology code? See discussion. Final Sep 03 2013
20130148 Reportability--Brain and CNS: Are “spinal” schwannomas described as extradural or vertebral nerve sheath or of specific vertebrae considered reportable? Final Sep 03 2013
20130147 Primary site--Heme & Lymphoid Neoplasms: What is the primary site for langerhans cell histiocytosis multifocal multisystem involvement (skin, chest, cns and thyroid)?

bone scan – negative

Final Sep 03 2013
20130146 Histology--Heme & Lymphoid Neoplamsm: What is the best histology for a diagnosis of Myeloproliferative neoplasm/Myelodysplastic syndrome overlap? Final Sep 03 2013
20130145 Histology--Heme & Lymphoid Neoplasms: Which histology code is used for a case of follicular lymphoma WHO Grade 1/2 -- Grade 2 (9691/3) or Grade 1 (9695/3)? The mixed codes are now obsolete. Final Sep 03 2013
20130143 Reportability--Heme & Lymphoid Neoplasms: When did smoldering and evolving myeloma become reportable? I don't believe cases described as smoldering or evolving were reportable in the past. In addition, for casefinding, when do we begin reporting these patients that have a long term history of smoldering myeloma? Should we go back to 2010 when they appeared in the Hematopoietic DB? Final Sep 03 2013
20130142 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are there and what is the histology for this case?

Follicular lymphoma, grade 1 diagnosed in 2010 in the left inguinal lymph node, with no other suspicious lymph nodes in the body. 2012 biopsy of a large axillary mass and the result was 50% follicular, grade 3 and 50% diffuse large B-cell.

According to the rules, transformation to B-cell would be a new primary, so I imagine the mixed is as well.

Final Sep 03 2013
20130141 Reportability/Ambiguous terminology--Heme & Lymphoid Neoplasms: Is this reportable since they use ambiguous terminology with the CLL? Flow cytometry from peripheral blood revealed a lambda-bearing, monoclonal lymphocytosis that has an immunophenotype consistent with common chronic lymphocytic leukemia (B-CLL). Final Sep 03 2013
20130140 Reportability/Ambiguous terminology--Heme & Lymphoid Neoplasms: Would an immunophenotype of a peripheral blood sample that used the terminology, "characteristic of…" be reportable? Example: "This immunophenotype is characteristic of B-cell chronic lymphocytic leukemia." Final Sep 03 2013
20130139 Histology--Heme & Lymphoid Neoplasms: How do I handle a case in which the original slides are reviewed at a later time and a revised diagnosis is provided? See discussion. Final Sep 03 2013
20130138 Multiple primaries--Heme & Lymphoid Neoplasms: What is the correct way to handle a preleukemic condition that now has a specific leukemia diagnosis? See discussion. Final Aug 30 2013
20130137 Histology--Heme & Lymphoid Neoplasms: Our pathologists seem to be getting away from identifying follicular B-cell lymphomas as grade 1, grade 2 etc. They are using follicular lymphoma low-grade. Should these be coded as follicular lymphoma, NOS? I noted that this code is usually used for death certificate cases. Final Aug 30 2013
20130136 Multiple primaries--Heme & Lymphoid Neoplasms: Where are the instructions for coding transformations?

Diagnosed in 2000 with Chronic Lymphocytic Leukemia (CLL). In 4/26/12 biopsy of stomach mass path is Diffuse Large B Cell Lymphoma which is listed under transformations for CLL.

Is a disease listed under transformations a new primary? The calculator says its a new primary. MD's are calling it a transformation.

Final Aug 30 2013
20130135 Multiple primaries--Heme & Lymphoid Neoplasms: Is this a multiple primary? Case was abstracted in 2011 as small lymphocytic lymphoma of vallecular area. Primary site C100 was used and histology code was 9670/3-SLL. There is a now a path report for the same person with biopsy of abdominal mass, same histology SLL. Do I report this as a recurrence because it is the same histology or because it is SLL of a different extranodal site. CT scan states right upper quadrant, extrahepatic solid mass, mesenteric and periaortic soft tissue masses/lymphadenopathy noted. Final Aug 30 2013
20130134 Reportability--Heme & Lymphoid Neoplasms: According to the hematopoietic database, systemic mastocytosis is reportable; does that include INDOLENT systemic mastocytosis (which is not listed in the list of alternative names)? Final Aug 30 2013
20130132 Diagnostic confirmation--Heme & Lymphoid Neoplasms: What is the diagnostic confirmation code for a DCO diagnosis of Aute Myeloid Leukemia? Final Aug 30 2013
20130131 Histology/Primary site--Heme & Lymphoid Neoplasms: Having trouble understanding PH5 vs PH6 when Chronic Lymphocytic Lymphoma/Small Lymphocytic Lymphoma (CLL/SLL) is diagnosed both in the lymph node(s) by positive biopsy and also in the bone marrow by positive biopsy (same time). Final Aug 30 2013
20130129 Histology--Heme & Lymphoid Neoplasms: What histology code should be assigned to this case?

Diagnosis of composite lymphoma (follicular lymphoma and small lymphocytic lympohoma BCL-2 pos). As best as I can determine, histology code would be 9596/3.

Final Aug 30 2013
20130128 Multiple primaries--Heme & Lymphoid Neoplasms: How should leukemia cutis be coded? This patient has a history of chronic myelomonocytic leukemia and has been under treatment for three years with Dacogen. Patient had a biopsy of left leg 12-8-11 with a diagnosis of leukemia cutis. Final Aug 30 2013
20130127 Reportability--Heme & Lymphoid Neoplasms: When did we start reporting smoldering myeloma? Final Aug 30 2013
20130126 Primary site--Heme & Lymphoid Neoplasms: What primary site should I use? Left pleural fluid cytology is primary effusion lymphoma. Final Aug 30 2013
20130125 Reportability--Heme & Lymphoid Neoplasms: Is self-healing Langerhans cell histiocytosis (LCH) reportable? This case is self-healing LCH of skin. Final Aug 30 2013
20130124 Reportability--Heme & Lymphoid Neoplasms: Is Rosai-Dorfman's syndrome (histiocytosis) a malignant and reportable condition? Final Aug 30 2013
20130123 Primary site--Heme & Lymphoid Neoplasms: What is the correct primary site code based on the following path report?

Clinical History- Lesion maxillary left soft tissue vestibule and entire left maxilla. Destructive lesion, lesion growing quickly intra-orally illegible.

Path Final Dx: Oral Cavity, Left maxilla, incisional bx: Malignant lymphoma, non-hodgkin, diffuse large b-cell type, immunoblastic variant.

Final Aug 30 2013
20130122 Multiple primaries--Heme & Lymphoid Neoplasms: Is this case a single primary or multiple primaries? See discussion. Final Aug 30 2013
20130121 Reportability--Heme & Lymphoid Neoplasms: Is "early essential thrombocythemia" reportable? See discussion. Final Aug 30 2013
20130120 Primary site--Heme & Lymphoid Neoplasms: What is the primary site for a Langerhans cell Sarcoma of the lower extermity? Final Aug 30 2013
20130119 Reportability--Heme & Lymphoid Neoplasms: Would this case be reportable? Patient with a myelodysplastic syndrome secondary to a copper deficiency. Final Aug 30 2013
20130118 Primary site--Heme & Lymphoid Neoplasms: We are trying to decide what primary site to use for this interesting case. A patient diagnosed with Langerhans cell histiocytosis by biopsy of right femur. Xrays show extensive bony metastatic disease, extensive infiltrative perinephritis, encasement of both kidneys, renal hilar, retroperitoneal, and periarotic lymphadenopathy. The path report of the right femur biopsy does not state metastatic. Final Aug 30 2013
20130117 Reportability--Heme & Lymphoid Neoplasms: Is thrombocythemia, NOS the same as essential thrombocythemia or primary thrombocythemia? Final Aug 30 2013
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