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Reportability--Lymphoma: Is a lymphoma diagnosed on a bone marrow biopsy reportable if the cytogenetics evaluation performed does not confirm the malignancy? See Discussion.
Bone marrow Bx: Marginal zone lymphoma/leukemia. The morphology of the lymphoma/leukemia cells and the immunophenotypic characteristics identified by flow cytometry are consistent with marginal zone lymphoma/leukemia.
Addendum Report: Cytogenetic evaluation revealed a 46,XY male karyotype. This is the normal male chromosome karyotype. Based on the limits of this methodology, no evidence of hematologic malignancy was observed in this specimen.
For cases diagnosed prior to 1/1/2010:
Yes, this case is reportable. The cytogenetic evaluation cited in the addendum report does not disprove the bone marrow biopsy diagnosis.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Date of Diagnosis/Histology--Hematopoietic, NOS: How are these fields coded if a 3/17/03 bone marrow biopsy diagnosis of "malignant proliferative disorder" is subsequently confirmed to be a "low grade lymphoma" per a bone marrow biopsy in early 2006? See Discussion.
3-17-03: Bone marrow biopsy from rt iliac crest: Hypercellular marrow (90%) with extensive involvement by lymphoproliferative disorder (see description). Micro: The bone marrow is diffusely (>90%) involved by a malignant lymphoproliferative disorder. This consists of small lymphocytes,histiocytes, and large atypical cells with prominent nucleoli.
12-22-05 Extensive bone marrow involvement by lymphoproliferative disorder, bone biopsy from femur.
1-27-06 Hem/Onc Physician Note:
following pt for a lymphoproliferative disorder. ...bone marrow biopsy 2003, suggestive of, but not truly diagnostic, a lymphoproliferative disorder. Therefore, I elected not to do anything, but just follow her.
3-23-06 Hem/Onc Note:
pt with a history of an apparently low-grade lymphoma involving the marrow, as well as, I believe, the liver and recently pathologically diagnosed as a T-cell-rich B-cell lymphoma. ...followed in the past by Dr. ___ and has never actually had any treatment for this lymphoma, although it is documented even three years ago by bone marrow biopsy.
For cases diagnosed prior to 1/1/2010:
Code the diagnosis date to 3/17/03. The histology code is 9970/3 [Malignant myeloproliferative disorder]. The bone marrow biopsy confirms a "Malignant" lymphoproliferative disorder. Apply ICD-O-3 rule F and assign /3 to histology code 9970.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Primary Site--Unknown & ill-defined site: Should the primary site be coded to C809 [Unknown primary site] or C761 [Thorax, NOS] if the patient died following a limited work-up that included on a cytology on pericardial fluid that was positive for poor differentiated adenocarcinoma?
Based on the information provided, code the primary site to C809 [Unknown primary site]. There is not enough information provided to suggest that the primary site is the thorax or any other location.
Histology (Pre-2007)--Kidney: How is a "mucinous tubular and spindle cell carcinoma" coded? See Discussion.
Literature search results: "The new WHO-classification of renal tumors includes new subtypes, one of which is the mucinous, tubular, and spindle cell carcinoma. Many of these tumors had been previously diagnosed as sarcomatoid carcinoma. There are areas of cord-like growth and spindle cell configuration, sometimes with a clear cell appearance."
For tumors diagnosed prior to 2007:
Code histology to 8255 [Adenocarcinoma with mixed subtypes]. ICD-O-3 does not have a code specific to this combination histology. 8255 is the best code available.
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.
Reportability--Melanoma: Is the following reportable? See Discussion.
PATH: Skin, Lt back exc bx: compound nevus with severe cytoarchitectural atypia and regression. Comment: due to overlap of morphology between MM and nevi with severe atypia, and since there's evidence of regression, consideration for re-excision may be considered if clinically indicated.
The final diagnosis, compound nevus with severe atypia, is not reportable. This diagnosis is not listed in ICD-O-3.
Reportability--Brain and CNS: Is Langerhans cell histiocytosis [9751/1] of the meninges [C709] reportable?
For cases diagnosed prior to 1/1/2010:Yes. The criteria for reportable benign/borderline CNS tumors is based on location (site) and behavior (benign/borderline). There is no caveat for histologic type. Therefore, this would be reportable as these tumors have been reported arising from the meninges or choroid plexus.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
CS Lymph Nodes/CS Mets at Dx--Melanoma: How are these fields coded for a melanoma primary when melanoma is identified in lymph nodes but no primary skin tumor is found? See Discussion.
Excisional biopsy of an inguinal lymph node revealed metastatic melanoma. Multiple skin biopsies did not reveal the primary site.
Subsequent lymph node dissection of superficial inguinal nodes showed microscopic focus of malignant melanoma in subcutaneous fat adjacent to previous procedure site. No evidence of metastatic melanoma in 7 lymph nodes. Dissection of external iliac lymph nodes showed no evidence of melanoma in 5 lymph nodes.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code CS Lymph Nodes 80 [Lymph nodes, NOS]. Code CS Mets at DX 00 [None]. Since it cannot be determined whether the lymph nodes are regional or distant, code CS Lymph Nodes to lymph nodes, NOS.
Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion.
This scenario occurs frequently and our QC staff is divided on which code to use.
03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs.
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate).
Ambiguous Terminology--Breast: Is a stereotactic biopsy that is "focally suspicious for DCIS" reportable if it is followed by a negative excisional biopsy? See Discussion.
Per the 2004 SEER manual page 4, 1.a, the case is reportable based on the ambiguous term "suspicious" for DCIS.
Per the 2004 SEER manual page 4, 1.c, use these terms when screening diagnoses on pathology reports, operative reports, scans, mammograms, and other diagnostic testing other than tumor markers.
Note: If the ambiguous diagnosis is proven to be not reportable by biopsy, cytology, or physician's statement, do not accession the case.
Do not accession this case. The needle localization excisional biopsy was performed to further evaluate the suspicious finding found on stereotactic biopsy. The suspicious diagnosis was proven to be false.
Reportability--Ovary: Is an "aggressive adult granulosa cell tumor with one of two lymph nodes positive for metastatic granulosa cell tumor" reportable?
Malignant granulosa cell tumor is reportable. The case described above is malignant as proven by metastasis to the lymph node.
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