Histology--Heme & Lymphoid Neoplasms: How is histology coded if the pathology report final diagnosis is "plasma cell dyscrasia, consistent with multiple myeloma" when no further work-up is performed because the patient either refuses additional testing or dies?
Ambiguous terminology is used to accession cases (determine reportability) because it has been used for over 30 years to do so. Any deviation from using ambiguous terminology to determine case reportability would cause the reporting of incidence counts to vary. In this case, there was a reportable, ambiguous terminology diagnosis of multiple myeloma on the pathology report.
The instruction "Do not code histology based on ambiguous terminology" is intended to be used when there is a reportable and reportable stated in the diagnosis. Ambiguous terminology cannot be used to report the more specific diagnosis in cases of Heme & Lymphoid neoplasms. For example, if the pathology report final diagnosis was "Myeloproliferative neoplasm, probably Polycythemia Vera" the histology would be coded as myeloproliferative neoplasm, unclassifiable [9975/3]. The ambiguous terminology indicates that the genetic testing, immunophenotyping, etc., probably are not complete or are not diagnostic of the more specific disease. Wait to code the histology until there is a definite diagnosis given.
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.
MP/H/Histology--Lung: What is the histology code for "heterologous biphasic sarcomatoid carcinoma of the lung with prominent rhabdomyoblastic and adenoca differentiation"?
The expert pathologist recommends coding histology to 8980/3 [Carcinosarcoma] for this combination histology.
Expert consultation: The designation "carcinosarcoma" is given when the pathology shows differentiation in both the sarcomatous (rhabdomyoblastic) and carcinomatous (adenoca) elements. This is emphasized in the path for this case with the term "biphasic." The term "heterologous" mean that the sarcomatous component is of a type not normal to lung. Rhabdomyoblastic means skeletal muscle differentiation. Because skeletal muscle is not normally found in lung it is heterologous. If it were smooth muscle, it would be homologous because smooth muscle is found in lung (as a part of the bronchi).
Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case?
Code the primary site to C421 [bone marrow]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow.
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.
Reportability--Brain and CNS: Are hemangioma, NOS (9120/0), cavernous hemangioma (9121/0) or venous hemangioma (9122/0) reportable when they arise in the brain or CNS?
Hemangioma, NOS (9120/0) and cavernous hemangioma (9121/0) arising in the dura and parenchyma of the brain/CNS are reportable.
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous hemangioma arising in the brain is blood vessel (C490). The combination of 9122/0 and C490 is not reportable. This is a venous abnormality. Previously called venous angiomas, these are currently referred to as a developmental venous anomalies (DVA).
Grade, Differentiation--Prostate: Has SEER officially changed the conversion code for Gleason score 7 to grade 3 [poorly differentiated] for cases diagnosed in 2003 or later?
For prostate cases diagnosed in 2003 and forward: convert Gleason score 7 to grade 3 [poorly differentiated].
EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: What codes are used to represent these fields when only a regional lymph node (positive) aspiration is performed?
For cases diagnosed 1998-2003:
With the exception of those sites/histologies that require 99 in these fields, code the Number of Regional Lymph Nodes Positive field to 97 [Positive nodes but number of positive nodes not specified]. Code the Number of Regional Lymph nodes Examined field to 95 [No regional Lymph nodes removed, but aspiration of regional Lymph nodes was performed].
Other Therapy/Immunotherapy--Hematopoietic, NOS: How should erythropoietin be coded for leukemia or other hematopoietic diseases?
Do not code Erythropoietin as treatment, it is used as an ancillary drug for leukemias or other hematopoietic diseases. Record information about erythropoietin in the text field.
Terminology: Do focus, focal, foci and chips mean the same thing?
Focus, focal, and foci are variations of the same word. Focus (noun) describes an area or point of disease, either grossly or microscopically. Focal (adjective) relates to the area/focus of disease; an example is a prostate with focal adenocarcinoma. This means that the majority of the prostate is benign and the adenocarcinoma is confined to one small area/point. Foci (plural) describe more than one area/focus of disease. A prostate with foci of adenocarcinoma means the disease is multifocal (several areas/points of disease).
Chips are microscopic amounts of either tissue or tumor. A pathologist might examine several chips of prostate tissue, one of which contains a focus of adenocarcinoma.
Histology (Pre-2007)--Breast: Should the histology "non-invasive papillary carcinoma" along with the comment "solid intraductal papillary proliferation includes cytologically atypical cells with scattered mitotic figures" be coded to 8503/2 [intraductal papillary carcinoma] or 8050/2 [papillary carcinoma in situ]?
For tumors diagnosed prior to 2007:
The best histology code for this breast case is 8503/2 [Noninfiltrating intraductal papillary carcinoma]. According to the WHO Classification of Tumors for Breast, Papillary carcinoma, non-invasive is a synonym for Intraductal papillary carcinoma. Further, code a more specific histologic type when found in the microscopic description, according to the SEER Program Code manual.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
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