Laterality: Why is a code 5 for laterality midline only allowed for certain sites of brain and skin? I have a nasal cavity tumor and the path report specifically says "Tumor laterality: midline". What is the correct laterality code here?
Assign laterality code 9 for midline nasal cavity tumor. We will investigate this issue further.
MP/H Rules/Multiple primaries--Thyroid: How many primaries should be reported when a complete thyroidectomy specimen shows two tumors: 1.8 cm papillary carcinoma with tall cell features (8344/3) and a 0.4 cm papillary thyroid carcinoma (8260/3)? See discussion.
Is papillary thyroid carcinoma an NOS histology qualifying for rule M16, thus leading to a single primary, or would M17 apply (multiple primaries) because the histology codes are different at the second digit (8260 and 8344)? While rule M16 doesn't include papillary thyroid carcinoma in the listed histologies, it seems like it may be an NOS histology for the thyroid. In addition, code 8260/3 is listed as NOS in the ICD-O-3.
Apply rule M16 and abstract a single primary. These two thyroid tumors, one papillary carcinoma with tall cell features (8344/3) and one papillary thyroid carcinoma, fit the criteria for rule M16, although not explicity listed there. We will clarify this in the next version of the rules.
Primary site: If text supports a pancreatobiliary primary with no other information what primary site code would be assigned? C249 biliary tract NOS, or C269 GI tract nos, or C809 unknown?
Assign C269 in the absence of any additional information.
First course treatment: When a patient has a Haplo bone marrow transplant, is this coded as an allogenic bone marrow transplant since part of his marrow was used in addition to a donor?
Use code 12 in the Hematologic Transplant & Endocrine Procedures data field. Per the NCI, this procedure is an allogeneic transplant.
Rather than wiping out a patient’s immune system before transplanting donor bone marrow, doctors administer just enough chemotherapy to suppress the immune system, which keeps patients from rejecting the donated marrow without harming their organs. The procedure requires just a half-match, meaning that a patient’s parents or children could be suitable donors. AKA: Half-match transplants.
MP/H Rules/Histology--Breast: What is the correct histology code for this final diagnosis of a breast tumor: INVASIVE POORLY DIFFERENTIATED DUCTAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION (METAPLASTIC FEATURES)?
Code the histology to 8575/3.
The instruction for coding duct and another non-duct histology not listed in Table 3 was inadverantly left out of the rules. The default is to code to the histology with the numerically higher ICD-O-3 code which is 8575/3.
Reportability/Histology--Heme & Lymphoid Neoplasms: Is primary erythrocytosis equivalent to primary polycythemia and thus reportable? See discussion.
Per the Heme Manual, Appendix F - Non-Reportable list for Heme Diseases, under Polycythemia, the Comment states that polycythemia is also known as erythrocytosis. Because polycythemia is equivalent to erythrocytosis, can we assume that "primary erythrocytosis" is equivalent to "primary polycythemia" and thus reportable as 9950/3 per the Heme DB? Or is the case nonreportable because the exact term of "primary erythrocytosis" is not listed as an alternate name for polycythemia vera, only "primary polycythemia" is listed?
Primary erythrocytosis is not equivalent to primary polycythemia and is not reportable. This will be clarified in a future revision. Thank you for point it out to us.
Multiple primaries--Heme & Lymphoid Neoplasms: Is this one primary or two? Follicular lymphoma grade 1 (9695/3) on 8/23/12 from an abdominal lymph node. On 1/6/14 an abdominal lymph node biopsy showed diffuse large b cell lymphoma arising from high grade follicle center cell lymphoma. Patient has been on observation.
1st primary, 8/23/12: Follicular lymphoma, grade 1 2nd primary, 1/6/14: Diffuse Large B Cell Lymphoma
Apply the multiple primary rules twice for this case. The 2012 diagnosis is follicular lymphoma. There are two histologies in 2014: diffuse large b cell lymphoma and follicle center cell lymphoma diagnosed at the same time in the same location. This is one primary per rule M4.
Then compare the 2012 diagnosis to the 2014 diagnosis.
Per the Hematopoietic Database, follicular lymphoma (all types) transforms to DLBCL. Per Rule M10, the DLBCL would be a second primary.
MP/H/Multiple Primaries--Urinary: Is this one primary with a C689 primary code and morphology 8130/3? Or is this 2 primaries: 1. C679 8130/3 and 2.C680 8120/2. See discussion.
Urinary: Transitional Cell Carcinoma and open prostatectomy: Path from Bladder: Papillary and solid transitional cell carcinoma of bladder - grade II and III Stage A.
Path from prostatectomy: The prostatic tissue samples shows areas of urothelia carcinoma in situ - related to the tumor present in the bladder.
Conclusion: Prostatectomy showing foci of transitional cell carcinoma in situ of prostatic urethra.
Abstract a single primary, C679 8130/3. Rules M2 and H4 apply. Transitional cell/urothelial carcinoma in the prostatic urethra is likely an extension from the known bladder TCC in this case, not a separate primary. See prostatic urethra on page 63 in the Urinary Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
Multiple Primaries--Heme & Lymphoid Neoplasms: 2012 path report for removal of an "axillary mass" which consists of 80% diffuse large B-cell lymphoma (DLBCL) and 20% follicular lymphoma. In the original manual, Module 6 instructed us to code as a single primary, DLBCL. However, the multiple primary calculator says each disease is a separate primary. When I looked them up in the data base, I did not get an option to review a current manual. Can you please advise?
Code as a single primary with histology Diffuse Large B-Cell Lymphoma.
In this case, there are two NHLs in the same location at the same time. Apply Rule M4, this is one primary. Per Note 5 under Rule M4, go to Rules PH11and PH15 to assign primary site and histology.
Rule PH11 states to code to the site of the origin (axillary mass) and to diffuse large b-cell lymphoma (9680/3) when DLBCL and any other non-Hodgkin lymphoma (follicular in this case) are present in the same location at the same time.
Using the multiple primaries calculator in this situation will give you two primaries, which is the wrong answer. Use the rules before using the calculator.
To get to the manual, go to the "Help me code for dx year." section. Choose 2010 or later and the most current manual will appear. We recommend that you save a copy of the PDF on your computer.
Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246?
Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma.
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