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SEER Inquiry System - Report
Produced: 11/28/2024 10:05 PM
Question 20100053
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
Patient was diagnosed with Myeloid Sarcoma (granulocytic sarcoma) by chest wall biopsy. This is an extramedullary manifestation of acute leukemia and is not in the bone marrow (bone marrow is negative).
How should primary site be coded? The Heme DB states that almost any part of the body can be involved. It also states to not code primary site to C421. In this case the only involvement is the chest wall [C493]. However, use of the primary site code C493 triggers an edit error questioning this site/histology combination. If the primary site is coded to C421 [bone marrow], there is no edit error. Please explain the site code and rationale.
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Unless there are scans showing involvement of a lymph node or tissue other than the chest wall, the histology should be coded myeloid sarcoma [9930/3] and the primary site to C493 [soft tissue of chest wall]. Per Rule PH 30, use the Heme DB to determine primary site and histology when rules PH1-PH29 to not apply. Override the edit.
Per the Abstractor Notes section in Heme DB, for myeloid sarcoma [9930/3] the most frequently affected sites are skin, lymph nodes, gastrointestinal tract, soft tissue, and testis.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
History:
This SINQ question has been updated to the Hematopoietic & Lymphoid Neoplasm Manual & Database published January 2014.
The original answer below was written based on the rules in 2010
Unless there are scans showing involvement of a lymph node or tissue other than the chest wall, the histology should be coded myeloid sarcoma [9930/3] and the primary site to C493 [soft tissue of chest wall]. Override the edit.
The steps taken to resolve this issue are:
For cases diagnosed 2010-2011, find the provisional ICD-O-3 histology code and confirm site/histology by searching the 2010 Hematopoietic Database for myeloid sarcoma. The DB shows myeloid sarcoma as the first result. There is a "warning note" that says see Module 5 PH15. Write this module and rule number down. Next get the ICD-O-3 code 9930/3. Click on Display Abstractor Notes button to confirm the site/histology combination. The notes state that the most frequently affected sites are skin, lymph nodes, gastrointestinal tract, soft tissue, and testis.
Reportability Instructions: The proposed ICD-O-3 code fits in the range of reportable neoplasms.
Multiple primary rules: M2 says a single histology is a single primary
PH Rules: Go to Module 5 PH15 as the warning module in the 2010 Hemato DB instructed. The rule says code the primary site to the site of origin. Note 1 reinforces that the common primary sites are skin, lymph node, gastrointestinal tract, bone, soft tissue, and testis. Code primary site to C493 [soft tissue of chest wall].
The answers for SINQ questions with 2010 ID numbers were written using the 2010 Heme & Lymph Manual & DB. The instructions for using the 2010 Hematopoietic Database were written for the version of the software in use as of 5/24/2011. The user interface of the web-based 2010 Hematopoietic Database available from the SEER website varies slightly from the 5/24/2011 version in that the web-based version provides all the disease information in one scrollable window.
For cases diagnosed 2010-2011, access the 2010 Hematopoietic Database at http://seer.cancer.gov/tools/heme/. Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. For 2010-2011 diagnoses, click on the "use the 2010 database" label in the upper right corner of the screen. The 2010 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.
