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20100082 | Ambiguous terminology/Reportability--Heme & Lymphoid Neoplasms: Should a case be accessioned as MDS, NOS when a consult uses ambiguous terminology (e.g., probable MDS) to describe the disease process and the bone marrow does not confirm the consult diagnosis? See Discussion. | A patient is stated to have "probable MDS" by a hematology oncologist consult during an admission. A bone marrow biopsy was also performed during this admission, the final diagnosis on the pathology report is, "anemia and thrombocytopenia." The patient was not seen again by a hematology oncologist; however the patient's cardiology states, "BM biopsy was not clear whether this is MDS or another etiology." | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is not reportable. In effect, the original diagnosis was a rule/out MDS diagnosis. The bone marrow biopsy performed as part of the initial workup, proved that rule/out diagnosis was not valid. The subsequent statement confirms the diagnosis is not clear.
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. |
2010 |
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20100086 | Multiple primaries/Primary site/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed with mycosis fungoides in February 2010 and in May 2010 is diagnosed with peripheral T-cell lymphoma consistent with CD 30+ large cell transformation of mycosis fungoides? See Discussion | Patient was diagnosed with mycosis fungoides on 2/10/2010. On 5/11/2010 the patient underwent lymph node biopsies lymph nodes that were diagnosed as peripheral Tcell lymphoma consistent with CD 30+ large cell transformation of mycosis fungoides. There is no data on the ALK protein. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession two primaries per Rule M15 which instructs you to use the Multiple Primaries Calculator to determine the number of reportable primaries. The result is that mycosis fungoides [9700/3] and peripheral T-cell lymphoma [9702/3] represents two primaries.
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. |
2010 |
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20100057 | First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease? | Clobetasol is not cancer-directed treatment at this time.
Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides. |
2010 | |
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20100012 | Date of diagnosis--Breast: How is the date of diagnosis coded when a mammogram describes only "suspicious calcifications" with a BIRADS category of 4 assigned and the suspicious calcifications are subsequently proven to be malignant on biopsy? See Discussion. | The date of diagnosis is the date when cancer was first diagnosed by a recognized medical practitioner, whether clinically or microscopically confirmed. Ambiguous terminology used to determine reportability is listed in part I of FORDS pages 3-4. No BIRADS categories are included and, therefore, should not be used by the registrar to determine the earliest date of diagnosis. In addition, the term "suspicious for calcification" is not reportable, because calcification is benign condition, unless the physician describes it as malignant. Reference 46637, 12/29/2009 FORDS - In the last paragraph there is a statement that no BIRAD categories are listed...cannot be used to determine earliest date of diagnosis. Does the SEER Program follow this guideline? | The date of diagnosis for this case is the date of the biopsy. There is no reportable diagnosis on the mammogram. | 2010 |
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20100045 | Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for for DLBCL.
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. |
2010 | |
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20100105 | Surgery of Primary Site--Brain and CNS: Is "debulking" of a primary brain tumor coded to 21 [subtotal resection of tumor] or 30 [gross resection of tumor]? | Assign code 21 [subtotal resection of tumor, lesion, or mass]. Debulking removes as much of the tumor volume as possible in cases where it is not possible to remove the entire tumor. Debulking should improve the effectiveness of subsequent radiation therapy and/or chemotherapy. | 2010 | |
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20100032 | First course treatment--Prostate: Is Degarelix coded as hormonal treatment for prostate cancer? | Code the administration of Degarelix in the "Hormone Therapy" field. Assign code 01 [Hormone therapy administered as first course therapy]. This drug will be added to the next update of SEER*Rx. | 2010 | |
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20100056 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a case with pathologic diagnosis of "anaplastic large cell lymphoma, ALK-negative" involving the brain and a clinical statement of involvement in the right inguinal lymph nodes and the right lower extremity by a cutaneous lymphoma? See Discussion. |
The final diagnosis on the pathology report for a brain biopsy is "Anaplastic large cell lymphoma, ALK-negative." Per a progress note: right inguinal lymphadenopathy. CT scan is consistent with multiple lymph node groups enlarged. Right lower extremity cutaneous nodular lesion; cutaneous lesions likely cutaneous lymphoma.
Should the histology be coded 9702/3 [anaplastic large cell lymphoma, ALK-negative], and the primary site C447 [skin of leg]? Or is the physician using "cutaneous lymphoma" as a general term indicating infiltration and the primary site is really C779 [lymph nodes, NOS]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code to primary site to C447 [skin of leg]) per Rule PH25 and histology to 9702/3 [anaplastic large cell lymphoma, ALK-negative]. Per the Abstractor Notes section in Heme DB, these are the usual presentations for this disease. It also states this disease presents with peripheral node involvement and is often generalized with infiltrates in the bone marrow, liver, spleen, and extranodal tissue. Less frequently involved sites are lung, salivary gland and CNS.
Per PH25, code the primary site to the organ when the lymphoma is present in an organ (skin, right leg) and that organ's regional lymph nodes (inguinal). Distant lymph nodes or other organs may also be involved, but should be disregarded for coding primary site.
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. |
2010 |
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20100035 | MP/H Rules/Multiple primaries--Colon: How many primaries are accessioned for a patient with two colon carcinomas in different segments of colon when there is no documentation that either tumor arose in a polyp, there is no statement indicating the presence of adenomatous polyposis coli and the resected pathology specimen indicates the presence of over 200 polyps? See Discussion. | The first MP/H rule that applies for this case is M4 [tumors in different segments of the colon]. Following rule M4, the case would be counted as two primaries and the histology would be coded per Rule H11. As these are multiple primaries, Rule H17 [Code 8220 (adenocarcinoma in adenomatous polyposis coli) when there are > 100 polyps identified in the specimen] would never apply, because H17 applies to multiple tumors abstracted as a single primary. However, Rule H17 seems to fit this case. Should Rule M3 be expanded to include a statement about > 100 polyps so these cases are not accessioned as multiple primaries?
Example: Total colectomy: 1) Distal tumor: - ulcerating moderately differentiated colonic adenocarcinoma, 3.2 cm in greatest dimension. Tumor invades through the muscularis propria into the subserosa (pt3). 2) Proximal tumor: exophytic moderately differentiated colonic adenocarcinoma, 2.9 cm in greatest dimension. Tumor invades submucosa (pt1). Multiple tubular adenomas present throughout the colon, approximate count greater than 200. |
For cases diagnosed 2007 or later, use rule M3 for this case and abstract as a single primary. The case information makes it clear that this is adenomatous polyposis coli. Clarification will be added to rule M3 in the next revision of the rules. | 2010 |
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20100009 | MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion. | A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.
Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma? |
For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. | 2010 |
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