MP/H Rules/Recurrence--Skin: If a pathologist does not review the August 2008 slides, how many primaries are accessioned for a patient diagnosed and treated for a dermatofibrosarcoma protuberans of the left upper inner arm in August 2008 who subsequently had a "recurrence" noted in October 2010 located in the scar of the original primary?
Abstract as a single primary: dermatofibrosarcoma protuberans [8832/3] of the left upper inner arm [C446] diagnosed in August 2008.
The rationale for this answer was provided by subject matter experts. The physician specialists for soft tissue and bone replied as follows:
Low-grade sarcomas tend to recur locally. Because this tumor recurred in same area, i.e. scar of prior surgery, and recurred in this period of time, this is a local recurrence. Dermatofibrosarcoma Protuberans is a low grade tumor which can recur many years following tumor excision.
First course of treatment/Radiation therapy--Kidney: Patient has a CT-guided biopsy of a right renal mass with procedure details under the Interventional Radiology Procedure Note stating "Gelfoam tract embolization." Is this particular embolization treatment?
Gelfoam tract embolization for a CT-guided renal biopsy is not treatment. It is a method to plug the biopsy track to reduce the risk of hemorrhage.
Reportability/Histology--Liver: Are primary hepatic neuroendocrine neoplasm and primary hepatic neuroendocrine tumor (PHNET) reportable? What are the specific histology codes?
Primary hepatic neuroendocrine tumor (PHNET) is reportable as are other digestive system NETs. There is no specific histology code for PHNET. We suggest you assign 8240/3. Use text fields to document the details.
Unless you can obtain clarification, do not report primary hepatic neuroendocrine neoplasm with no further information. If this term is being used as a synonym for PHNET, document this in the registry's policies and procedures, and report these cases.
Histology--Leukemia: How is a "plasmacytoid dendritic cell leukemia/lymphoma" coded when it is discovered on a bone marrow biopsy for a patient who presented with multiple enlarged lymph nodes and the discharge diagnosis was Type 2 plasmacytoid dendritic cell leukemia?
For cases diagnosed prior to 1/1/2010:
The best code currently available for this entity is 9727/3 [precursor cell lymphoblastic leukemia].
The WHO classification refers to this as "Blastic NK-cell lymphoma." The 2005 WHO-EORTC classification for cutaneous lymphomas states that blastic NK-cell lymphoma may be derived from a plasmacytoid dendritic cell precursor. They suggest more appropriate terms for this condition may be "CD4+/CD56+ hematodermic neoplasm," and "early plasmacytoid dendritic cell leukemia/lymphoma." According to WHO, this is a rare form of lymphoma.
Willemze, et al. WHO-EORTC classification for cutaneous lymphomas. Blood, 15 May 2005. Volume 105, Number 10.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
First course treatment/Radiation Therapy--Prostate: How do you code fiducial markers for prostate cases?
Do not code fiducial markers as a form of radiation treatment; rather, code the radiation therapy in the radiation treatment section. Fiducial markers are small metal spheres, coils, or cylinders that are placed in or near a tumor to help guide the placement of radiation beams during treatment.
MP/H Rules/Histology--Appendix: What is the histology for an appendix resection diagnosis of "Malignant neoplasm of the appendix with the following features: Histologic type: Adenocarcinoma ex goblet cell carcinoid with mucin production (adenocarcinoma arising from goblet cell carcinoid)"? Is this histology best coded to a mixed adenocarcinoma/carcinoid tumor (8244/3)?
Code histology to combined carcinoid and adenocarcinoma (8244/3). The tumor is a mix of adenocarcinoma and carcinoid.
Reportability--Brain and CNS: Is a thalamic amyloidoma reportable if so what histology code is used?
Thalamic amyloidoma is not reportable. Amyloidoma (tumoral amyloidosis, amyloid tumor) is a tumor-like deposit of amyloid. It is not neoplastic. Amyloid is a protein derived substance deposited in various clinical settings.
Multiple primaries--Heme & Lymphoid Neoplasms: Could you please clarify Note 2 found in Rule M10, which is " 'Transformations to' (acute neoplasms) and 'Transformations from' (chronic neoplasms) are defined for each applicable histology in the database." Do the neoplasms being considered have to contain the words 'chronic' and/or 'acute'?
Hematopoietic neoplasms that transform generally don't have 'chronic' or 'acute' as part of their preferred name. The 'chronic' and 'acute' designations are determined by the usual course of the neoplasm. Chronic neoplasms are generally slow growing while acute neoplasms grow fast and are more widespread. Not all Hematopoietic neoplasms transform. Each neoplasm that has the ability to transform has the transformations listed under the 'Transformations to' and/or 'Transformation from' sections in the Hematopoietic database.
For example, Diffuse large B-cell lymphoma (histology code 9680/3) has no histologies/neoplasms listed under 'transformations to.' This means that this neoplasm does not transform to any other neoplasm. There are multiple histologies/neoplasms listed under 'Transformations from' indicating the neoplasms listed under the Transformations from are the chronic neoplasms, and DLBCL is the acute neoplasm. If DLBCL (9680/3) occurs at the same time, within 21 days, or greater than 21 days of any of the histologies listed under 'Transformations From,' rules M8-M13 apply. If DLBCL (9680/3) occurred at the same time as a neoplasm not listed in the Transformations sections, the acute and chronic rules do not apply.
Primary Site/EOD-Size of Primary Tumor--Lung: If the only lung mass described in CXR is a "hilar mass," is the primary site coded to C34.9 [Lung, NOS] or C34.0 [Main Bronchus; incl. Carina]? Also, can the size of the hilar mass be used to code the size of tumor field?
Because the only description available is "hilar mass," code primary site as C34.0.
For cases diagnosed 1998-2003: Use size of mass for EOD-Size of Primary Tumor.
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