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20130180 | Histology--Pancreas: What is the difference between pancreatic endocrine neoplasm (PanNETs) [8240/3] and the new ICD-O-3 terms pancreatic endocrine tumor, benign [8150/0] and pancreatic endocrine tumor, malignant [8150/3]? See Discussion. | SEER Inquiry 20120035 discusses the reportability of pancreatic endocrine neoplasm (PanNETs) tumors. | The difference is that 8150 is for islet cell tumors. The preferred name was changed by WHO/IARC to reflect the current language used by pathologists to describe islet cell tumors [8150].
The 8240 histology code added the neuroendocrine tumor, grade 1, low or well differentiated terms to the carcinoid ICD-O name.
Islet cell tumors are more aggressive than the pancreatic NET tumors. Treatment and prognosis are determined by the histologic type. While the histology code 8150 is not new, the histology name has been updated. |
2013 |
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20130096 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a mantle cell lymphoma found in the sigmoid colon on colonoscopy with biopsy? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to the sigmoid colon [C187] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ. Based on the information provided, the lymphoma is present only in the sigmoid colon.
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. |
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20130210 | Primary site--Heme & Lymphoid Neoplasms: Does Rule PH27 apply meaning that primary site is coded to C809 or would it be more appropriate to code to C269 GI Tract NOS since all disease involves the GI tract and this is more specific?
Extranodal lymphoma first diagnosed in the stomach (fundus and antrum) which upon further investigation also involved the small bowel (MALT Lymphoma) in the absence of lymph node findings. MD staged this IIE. Initial thought was Gastric, but PET/CT indicated abnormal uptake involving loop of distended small bowel in the pelvis. |
Assign C269 for Gastrointestinal tract, NOS. Apply Rule PH24, code to the organ when only an organ is involved. This rule can be used for NOS sites such as GI tract, NOS.
Based on the information provided, this lymphoma is confined to the GI tract -- stomach and small bowel. |
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20130097 | Reportability--Heme & Lymphoid Neoplasms: Are either heparin-induced thrombocytopenia or heparin-induced thrombocytopenia that becomes refractory thrombocytopenia reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Heparin-induced thrombocytopenia is not reportable.
If the diagnosis is changed to refractory thrombocytopenia, then this case is reportable.
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. |
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20130005 | Reportability--Brain and CNS: Are spinal schwannomas and neurofibromas reportable or non-reportable? | The most accurate and most current instruction is to report these spinal tumors when they arise within the spinal dura or spinal nerve roots, or when they are stated to be "intradural" or "of the nerve root." Do not report these tumors when they arise in the peripheral nerves. The peripheral nerves are the portion of nerve extending beyond the spinal dura. | 2013 | |
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20130024 | MP/H Rules/Histology--Bladder: How many primaries are accessioned and what rule applies when the patient has a mixed tumor with a urothelial carcinoma, NOS and a more specific histologic type followed by a diagnosis of urothelial carcinoma? See Discussion. |
The MP/H Rules do not specifically cover how to process urothelial carcinomas with a more specific type of carcinoma. Patient 1: Diagnosed in April 2010 with invasive urothelial carcinoma with signet ring features of the bladder. Site and histology are coded as C679 [bladder] and 8490/3 [signet ring cell carcinoma]. In January 2012 a subsequent diagnosis of invasive urothelial carcinoma of the bladder is made [C679, 8120/3]. Patient 2: Diagnosed in November 2009 with invasive papillary urothelial carcinoma with micropapillary and mucinous features of the bladder. Site and histology are coded C679 [bladder] and 8480/3 [mucinous carcinoma]. In April 2012 a subsequent diagnosis of high grade papillary and flat urothelial carcinoma without evidence of invasion is made [C679, 8130/2]. Does rule M9 apply and these are new primaries? |
For cases diagnosed 2007 and later, accession two primaries for each patient, signet ring cell carcinoma of the bladder and invasive urothelial carcinoma of the bladder for patient 1 and mucinous carcinoma of the bladder and non-invasive papillary urothelial carcinoma of the bladder for patient 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 Urinary MP rules because site specific rules exist for this primary. Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. For both patients, rule M9 applies because the tumors have histology codes that are different at the second (xxx) number. This guideline will be reviewed for the next version of the MP/H Rules. |
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20130040 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what rule applies when a patient has a history of chronic myeloid leukemia diagnosed in 1993 followed by a diagnosis of acute myeloid leukemia arising in chronic myelogenous leukemia, blast phase? See Discussion. |
12/1993 Bone marrow biopsy: Chronic myeloid leukemia t(9;22) (q34;q11).
09/2011 Bone marrow biopsy: Abnormal cytogenetic & FISH support persistent involvement by chronic myelogenous leukemia.
12/2011 Peripheral blood, flow cytometry: Involvement by acute myeloid leukemia arising in chronic myelogenous leukemia (CML, blast phase, 30% blasts by manual diff.).
Is the 12/2011 diagnosis a new primary? If not, why don't Rules M8-M13 apply when the Heme DB Abstractor Notes section for CML indicates that when there is a chronic, accelerated and blast phase that develops later in the course of the disease, change the histology code to the more specific diagnosis?
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For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as a multiple primary: chronic myelogenous leukemia t(9;22) (q34;q11) [9863/3] diagnosed in 1993 and acute myeloid leukemia [9861/3] diagnosed in 2011 per Rule M15.
Use the diagnosis date to determine the appropriate manual and rules to follow to determine the histologies for this case. To determine the histology of the 1993 diagnosis, use the ICD-O-2. The Heme Manual & DB will be used to determine the number of primaries and the histology of the 2011 diagnosis of AML.
Rules M8-M13 in the Heme Manual cannot be applied to this case because no transformation occurred. CML does not transform to another neoplasm.
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. |
2013 |
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20130116 | Histology/Primary site--Heme & Lymphoid Neoplasms: How are the histology and primary site coded if a pleurocentesis is compatible with plasmablastic plasmacytoma/lymphoma when no further information is available? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9735/3 [plasmablastic lymphoma] and the primary site to C809 [unknown] per Rule PH27.
Code the histology specified when the only histology for the case is preceded by ambiguous terminology. For this case, code the histology to plasmablastic lymphoma because it is the only histology mentioned in the diagnosis.
Per the Heme DB Abstractor Notes section for plasmablastic lymphoma, most patients present with Stage III-IV disease. The positive pleural fluid is likely due to advanced disease. In the absence of any other information for this case, Rule PH27 applies, "Code primary site to unknown primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR multiple organ involvement without any nodal involvement."
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. |
2013 | |
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20130098 | Histology--Heme & Lymphoid Neoplasms: Why did the hematopoietic histology rule change regarding the coding of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) from the lymphoma code (9670/3) to leukemia (9823/3) when both tissue and bone marrow are involved? See Discussion. | The answer in SINQ 20110035 that instructs us to code the primary site to bone marrow [C421] is the opposite of what has been coded for years. After all the years of coding SLL/CLL as a lymphoma when both tissue and bone marrow/blood are involved, why has the change to coding this to the leukemia code (9823/3) been made? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
There has been a change in coding practice based on a change in clinical classification of leukemia/lymphomas. In the past, we did, indeed, default to lymphoma when both tissue and bone marrow were involved. The problem was that when only bone marrow was involved, the case was coded to leukemia with a primary site of bone marrow. When lymphoma symptoms developed later, there was a lot of inconsistency in how registries handled these cases. Some coded a new primary "lymphoma;" while others ignored the lymphoma calling it progression.
The clinical world, including the hematopoietic experts in the World Health Organization and the Inter-Lymph Consortium, agreed that for certain neoplasms (CLL/SLL being one of them) it was not useful or practical to code the leukemia and lymphoma separately OR to capture only one of the neoplasms (because these neoplasms almost always progress to lymphoma); so new codes for the leukemia/lymphoma were developed. According to the experts, 9823/3 most accurately portrays the neoplastic process for the neoplasms assigned to a lymphoma/leukemia code.
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. |
2013 |
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20130023 | Reportability--Brain and CNS: Why has reportability changed for "intradural extramedullary schwannomas"? Are all "spinal" schwannomas reportable or only those stated to be "intradural"? See Discussion. |
If intradural schwannomas are to be collected for cases diagnosed 2011 and later, why were they not included in the 2012 SEER Manual? Should collection of spinal schwannomas be postponed until the next revision of the MP/H Rules? |
The reportability of schwannomas was not initially agreed upon by the standard setters. After the issue was discussed by the CoC, NPCR and SEER Technical Workgroup and an agreement was reached. See #2 under Reportability in the Data Collection Answers from the CoC, NPCR, SEER Technical Workgroup http://www.seer.cancer.gov/registrars/data-collection.html#reportability.
The most accurate and most current instruction is to report these spinal tumors when they arise within the spinal dura or spinal nerve roots, or when they are stated to be "intradural" or "of the nerve root." Do not report these tumors when they arise in the peripheral nerves. The peripheral nerves are the portion of nerve extending beyond the spinal dura.
Spinal cord intradural schwannomas originate in spinal nerve roots. Spinal nerve root is best classified as spinal cord, C720. |
2013 |
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