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20120059 | Primary site/Reportability--Breast: Is a "right nipple skin" biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See Discussion. | In the 2011 SEER Manual Reportability Examples, example 3, it states a "biopsy-proven squamous cell carcinoma of the nipple" is reportable when the subsequent resection shows "no evidence of residual malignancy in the nipple epidermis." However, this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500. | Because the site is specifically stated to "skin" of nipple [C44.5], this case is not reportable.
If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain a full-thickness of skin and subcutaneous breast (nipple) tissue. If that is the case, this tumor would likely be a reportable squamous cell carcinoma of nipple [C50.0]. If, however, this was a punch biopsy it is more likely a non-reportable squamous cell carcinoma of the skin [C44.5]. |
2012 |
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20120058 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when the patient is diagnosed with an acute neoplasm (diffuse large B-cell lymphoma) per a pathology report and is subsequently diagnosed clinically with a chronic neoplasm (chronic lymphocytic leukemia/small lymphocytic lymphoma) less than 21 days later? See Discussion. | The patient was diagnosed with an extranodal DLBCL on a biopsy of the stomach. A bone marrow biopsy performed 16 days later showed no DLBCL, but demonstrated an abnormal CD5-positive B-cell population that was subsequently referred to as CLL/SLL by the physician. The peripheral blood was negative and showed only moderate thrombocytopenia.
Does rule M10 apply in this case? Abstract the acute neoplasm as a single primary (DLBCL) as there was only one pathology specimen (stomach biopsy) proving DLBCL and the bone marrow did not definitively identify CLL/SLL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as two primaries per Rule M11. Code the histology of one primary to 9680/3 [diffuse large B-cell lymphoma], the acute neoplasm. Code the histology for the second primary to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma], the chronic neoplasm.
Per Rule M11, abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach biopsy).
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. |
2012 |
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20120057 | Reportability--Appendix: Is a low grade mucinous neoplasm of uncertain malignant potential with an in situ mucinous cystadenoma component reportable? See Discussion. | The patient was diagnosed with pseudomyxoma peritonei and the pathology report final diagnosis stated, "Low grade mucinous neoplasm, of uncertain malignant potential, involving a dilated appendix (5cm) with the following features: In situ mucinous cystadenoma component is identified, with low-grade cytology of neoplastic epithelium." Does the presence of an in situ component make this mucinous cystadenoma of the appendix reportable based on the ICD-O-3 matrix rule? | This diagnosis is not reportable. Cystadenoma is not reportable. The "in situ" description in this case does not make cystadenoma reportable.
According to our expert pathologist consultant, this is a "non-invasive, low grade, epithelial proliferation in an often cystic appendiceal tumor, 8480/1. If this has leaked or ruptured it can seed the peritoneal cavity causing pseudomyxoma peritonei." |
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20120056 | First course treatment--Corpus Uteri: Should Arimidex be coded as hormone therapy for an endometrioid adenocarcinoma? See Discussion. | Per the SEER Manual, endometrial cancers may be treated with progesterone which is coded as hormone therapy for these primaries. As endometrioid adenocarcinomas are hormonally-dependent carcinomas, should an aromatase inhibitor or anti-estrogen agent also be coded as hormone therapy? | Arimidex has not been approved to treat endometrial cancer. It is not prescribed for pre-menopausal women. Clarify with the physician why the drug was being used. If the physician states Arimidex was given to reduce tumor burden, code as hormone therapy.
See the SEER*Rx interactive database, http://seer.cancer.gov/seertools/seerrx/ |
2012 |
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20120055 | Surgery of Primary Site--Kidney, renal pelvis: How do you code a laparoscopic renal mass core biopsy followed by cryoablation of the tumor? See Discussion. | The note under the local tumor destruction codes states "No specimen sent to pathology from this surgical event 10-15." The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted? | Code for Surgery of Primary Site to 13 [Cryosurgery]. While the core biopsy provided a pathology specimen, it is not coded as surgery of the primary site. | 2012 |
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20120054 | Histology/Behavior--Brain and CNS: What is the histology and behavior code for a "giant cell astrocytoma"? See Discussion. | The pathology report stated, "The giant cell astrocytoma should be considered at least grade 3." There is not a code in the ICD-O-3 for giant cell astrocytoma, NOS; there are only codes for astrocytoma, NOS [9400/3] and subependymal giant cell astrocytoma [9384/1]. | Code the morphology as giant cell glioblastoma [9441/3]. Glioblastoma and astrocytoma are both types of astrocytic tumors per the Brain and CNS Terms and Definitions, Chart 1, in the 2007 MP/H Rules Manual. | 2012 |
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20120052 | Ambiguous Terminology/Histology--Heme & Lymphoid Neoplasms: What is the histology code if the final diagnosis is "non-Hodgkin lymphoma NOS," but after further genetic and immunohistochemistry studies were performed the pathology report diagnosis COMMENT section stated the immunohistochemistry findings were "compatible with follicular lymphoma"? See Discussion | Ambiguous terminology is not to be used to code a more specific histology. However the immunohistochemistry results (the definitive diagnostic method for follicular lymphoma) seem to clarify the non-specific diagnosis of non-Hodgkin lymphoma. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Ambiguous terms are not used to code a specific histology. This includes ambiguous terminology used as a result of immunophenotyping or genetic studies. However, a definitive clinical diagnosis can be used to code a more specific histology.
In this example, the histology is coded to non-Hodgkin lymphoma, NOS [9591/3] because the pathology final diagnosis was non-Hodgkin lymphoma, NOS even though it was followed by further genetic and immunohistochemistry studies that were "compatible with" (ambiguous terminology) follicular lymphoma.
However, if there was a subsequent non-ambiguous clinical diagnosis, the histology would be coded to the more specific diagnosis. For example, if the pathology final diagnosis was non-Hodgkin lymphoma, NOS, and there was a subsequent clinical diagnosis of follicular lymphoma or the patient was treated for follicular lymphoma, then the histology should be coded to 9690/3 [follicular lymphoma, NOS]. Document either of these in a text field to support the histology code chosen. Follicular lymphoma is a specific type of non-Hodgkin lymphoma. If you do have a confirmed diagnosis of follicular lymphoma, code that specific cell type per rule PH29.
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. |
2012 |
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20120051 | MP/H Rules/Histology--Breast: What histology code for a diagnosis of pleomorphic lobular carcinoma in situ? | For cases diagnosed 2007 or later, code the histology as lobular carcinoma, in situ [8520/2].
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Breast Histo rules because site specific rules exist for this primary.
Start at the SINGLE TUMOR: IN SITU CARCINOMA ONLY module, Rule H1. The rules are intended to be reviewed in consecutive order. Stop at the first rule that applies to the case you are processing. Code the histology to lobular carcinoma in situ [8520/2] because this is the only histologic type identified.
Pleomorphic lobular carcinoma is a variant of lobular carcinoma which does not have an ICD-O-3 code. It is still a lobular carcinoma. The identification of the variants of lobular carcinoma was a relatively recent discovery and the information was not available when the 2007 MP/H Rules were written. All of the lobular variants will be included in the next revision of the MP/H Rules. |
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20120050 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what histology codes apply if a patient has a 1998 diagnosis of essential thrombocythemia and a recent clinical diagnosis of secondary myelofibrosis? See Discussion. | The patient has a history of essential thrombocythemia (ET) since 1998. This has been treated daily with aspirin. A recent bone marrow biopsy was consistent with myeloproliferative disorder with excess blasts, marked extensive reticulin marrow fibrosis with osteosclerosis, excess blasts (11%) in the marrow aspirate and peripheral blood. JAK2 mutation was present in a small minority of cells. The physician stated patient was, "considered to have secondary myelofibrosis and was started on Jakafi." | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, a secondary myelofibrosis is not a reportable case.
Secondary myelofibrosis is not listed as a synonym for primary myelofibrosis in the Heme DB. The term "secondary myelofibrosis" means that the myelofibrosis was caused by, in this case, the essential thrombocythemia.
The diagnosis "consistent with myeloproliferative disorder" is also not a new reportable diagnosis. "Myeloproliferative disorder" refers to a group of diseases (an NOS category) that includes essential thrombocythemia, which was originally diagnosed in 1998, prior to reportability for this disease type.
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. |
2012 |
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20120049 | Reportability--Heme & Lymphoid Neoplasms: Is polycythemia vera secondary to volume depletion reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Secondary polycythemia vera is not reportable. See Appendix F.
Primary polycythemia vera is a condition in which there is an overproduction of blood cells due to a neoplastic process. Secondary polycythemia vera is an over production of red blood cells caused by a co-morbidity, in this case, volume depletion.
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. |
2012 |
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