Reportability--Pancreas: Is this reportable? Is this benign? If reportable, what histology code and behavior code should be used? A final pathology diagnosis reads: "Cystic pancreatic endocrine neoplasm (CPEN)".
"Cystic pancreatic endocrine neoplasm (CPEN)" is reportable. Assign 8150/3 based on the information provided. We consulted our expert pathologist and he states "Since metastases have been reported in a few, and all the rest of the pancreatic endocrine tumors are now designated malignant, …we are safe considering them /3 until proven otherwise. Since most of them are non-functioning, [assign code] 8150/3 unless specified as to G1 (8240/3) or G2 (8249/3)."
MP/H Rules/Histology--Sarcoma: What would be the morphology code for a low grade myofibroblastic sarcoma of the left distal forearm? I tried several different combinations but the closest I could come up with is myosarcoma.
Assign code 8825/3. Apply the ICD-O-3 Matrix Concept, Rule F, page 29 of the hardcover ICD-O-3. The WHO Classification of Soft tissue and Bone, page 85, lists low grade myofibroblastic sarcoma, also called myofibrosarcoma, 8825/3.
Reportability--Heme & Lymphoid Neoplasms: Is this a reportable case and if so what codes would be used for the primary site and histology?
Lymph node flow cytometry and bone marrow biopsy revealed involvement by a low-grade B-cell lymphoproliferative disorder. Medical oncologist states monoclonal gammopathy, question marginal zone B cell lymphoma versus lymphoplasmacytic lymphoma/lymphoproliferative disorder.
Based on the information provided, this case is not reportable. Low grade B-cell lymphoproliferative disorder is not reportable, nor is monoclonal gammopathy. There is no definitive diagnosis for marginal zone or lymphoplasmacytic lymphoma. The terminology used includes "question" and "versus" which are not acceptable ambiguous terms for reportability. If possible, follow up with the physician regarding the definitive diagnosis.
Reportability--Pancreas: Is a solid pseudopapillary neoplasm of the pancreas reportable?
Solid pseudopapillary neoplasm of the pancreas is reportable. According to the WHO classification, it is a "low-grade malignant neoplasm…[which] frequently undergoes hemorrhagic-cystic degeneration and occurs predominantly in young women."
Assign topography code C25 with the appropriate 4th digit. Code the histology as 8452/3.
Histology--Heme & Lymphoid Neoplasms: Should the 1995 diagnosis be changed to plasmacytoma? A 1995 case on the central registry database indicates that MRI and bone surveys revealed a pubic ramus lesion that was biopsied. There are no other bone lesions. A bone marrow biopsy was negative. The pathologist's diagnosis at that time was "Plasma Cell Myeloma". In 2013 there was a positive bone marrow biopsy and a diagnosis of Plasma Cell Myeloma. In 2013, a history of "sequential plasmacytomas since 1995" was mentioned. Since the 1995 diagnosis was only a solitary bone lesion with no marrow involvement, it certainly seems to fit a diagnosis of plasmacytoma better than myeloma.
Do not change the 1995 diagnosis in this case. It is best to code the histology according to information from the time of the diagnosis. Using information obtained many years later is less reliable.
MP/H/Multiple primaries--Urinary: In Aug 2008 Patient was diagnosed with Noninvasive Bladder Cancer. In Oct 2013 Patient was diagnosed with Transitional Cell Carcinoma of Right Ureter involving lamina propria, Noninvasive Transitional Cell Carcinoma Left Ureter and Invasive Transitional Cell Carcinoma of Prostatic Urethra. Is this a new primary and what is the primary site?
Rule M7 applies when comparing the 2008 diagnosis to the 2013 diagnosis: multiple primaries.
Rule M8 applies to the tumors identified in 2013: single primary.
Based on the information provided, code the primary site for 2013 to C689 because there is no indication of the site of origin among the involved sites.
Primary site--Brain and CNS: How should primary site be coded for a medulloblastoma described as a "posterior fossa mass" and "centered within the fourth ventricle"? See discussion.
The associated site code for medulloblastoma in the ICD-O-3 is C716. However, the SEER Manual specifically instructs to ignore the associated site code if a different primary site is noted. Although most medulloblastomas appear to arise in the cerebellum, when described as "centered within the fourth ventricle" can we assume that is the primary site and not simply invasion of the fourth ventricle from the cerebellum?
Code the primary to C717 for this case.
Code the primary site according to the origin of a particular medulloblastoma when it differs from the site code listed in ICD-O-3. The description "centered within the fourth ventricle" suggests that this medulloblastoma originated in the fourth ventricle.
MP/H Rules/Multiple Primaries--Lung: Does lung MP/H Rule M6 apply to synchronous tumors only, metachronous tumors only, or both? See discussion.
How many primaries should be reported when a patient has a history of RLL adenocarcinoma diagnosed on 10/8/2009 followed by diagnoses of LUL adenocarcinoma on 10/5/2012 and a RUL adenocarcinoma on 3/26/2014?
We applied Rule M6 to the 10/5/2012 diagnosis of LUL adenocarcinoma and reported an additional primary. However, we are unsure how to apply the MP/H rules for the 3/26/2014 RUL adenocarcinoma.
Should we apply Rule M8 because the RUL adenocarcinoma was diagnosed more than 3 years after the original RLL adenocarcinoma and then apply M6 because the RUL and LUL indicate a single tumor in each lung (resulting in a third primary); or does Rule M12 apply because there has been more than a single tumor in each lung (no new primary)?
Assuming each of the three diagnoses is a single tumor and there are no other tumors in either lung, abstract two primaries: 1 in the RLL diagnosed on 10/8/2009 and 1 in the LUL diagnosed on 10/5/2012. Do not abstract the 3/26/2014 diagnosis as a new primary.
Rule M6 applies to the 2009 and 2012 diagnoses. Rule M12 applies to the 2012 and 2014 diagnoses. Do not compare the 2014 diagnosis to the 2009 diagnosis. Always compare the latest diagnosis to the most recent previous diagnosis in cases like this.
Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion.
The SEER Coding and Staging Manual instructs one to code the primary site to the location where the tumor originated, in this case the liver. However, there is no CS Extension code for in situ tumors found in the CS Manual Liver Schema.
Based on the information provided, the primary site is liver. Submit the CS question to the CoC CAnswer Forum, http://cancerbulletin.facs.org/forums/content.php
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