| Report | Question ID | Question | Discussion | Answer | Year |
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20071022 | Reportability--Hematopoietic, NOS: If the bone marrow biopsy diagnosis is not reportable and cytogenetics studies indicate no clonal abnormality, is a case reportable if only the flow cytometry results show a "small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia"? See Discussion. | Bone marrow bx final diagnosis: Markedly hypercellular marrow consisting primarily of erythroid hyperplasia and, also, diffusely distributed small lymphocytes. Addendum comment: Flow cytometry demonstrated a small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom's Macroglobulinemia. Addendum comment: Cytogenetic analysis states no clonal abnormality was apparent. Normal female karyotype. Question 1: Is this case reportable, and if so, what histology? Question 2: Is there a hierarchy when flow cytometry and cytogenetics are done, but do not agree? |
For cases diagnosed prior to 1/1/2010:This case is not reportable at this point. A lymphoid component is not equivalent to a diagnosis of a reportable disease. In order to be a malignant, reportable disease, the condition must be monoclonal and irreversible. Cytogenetics were negative for malignancy (i.e. no monoclonal abnormality identified which is the criteria used to establish this diagnosis). Use all information available when determining reportability. For cases diagnosed 1/1/10 and later, 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. |
2007 |
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20071017 | CS Extension--Prostate: Can the phrase "hard, fixed prostate" be interpreted as clinical extracapsular extension and coded to 50 [extension or fixation to other structures]? See Discussion. | Patient had a "hard, fixed prostate" with needle core bx positive for Gleason grade 4+5=9 adenocarcinoma extensively involving gland. PSA was 87.5. Lymphadenectomy showed 3 positive pelvic/obturator lymph nodes. No prostatectomy was done and no physician TNM staging documented. Do we need a specific clinical description of other organs to which the prostate is fixed in order to code CS Clinical Extension 50, or does the statement "hard, fixed prostate" qualify? If not, how would we code extension for this seemingly advanced cancer? |
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.Assign extension code 50 [extension or fixation to adjacent structures] based on the term "fixed." Fixation to a particular structure(s) does not have to be specified in order to use code 50. Do not use the statement "hard" to determine CS extension. |
2007 |
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20071085 | CS Tumor Size/CS Extension--Prostate: Because prostatectomy results are excluded from the CS Extension field for prostate, is code 95 [No evidence of primary tumor] accurate to reflect bilateral lobe involvement of prostate cancer when it is incidentally found following a radical cystectomy for a bladder primary? Why must tumor size be 000 when the CS Extension code is 95? | 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 prostate CS Extension to 99 [Extension unknown] and code CS Tumor Size according to the information available from the surgery. CS Extension code 95 [No evidence of primary tumor] should be used only in that rare situation when the only evidence of disease is distant mets or lymph node involvement, no primary tumor found. That is why CS tumor Size must be 000 when CS Extension code 95 is used. |
2007 | |
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20071006 | Primary Site: Is an "angiosarcoma" stated as arising in the skin of the breast and treated with a mastectomy, coded to the primary site of skin or breast? | Code the primary site as skin of breast when skin of breast is documented as the site of origin. According to the WHO classification of soft tissue tumors, the majority of angiosarcomas "develop as cutaneous tumors...less than one quarter present as a deep soft tissue mass." |
2007 | |
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20071035 | CS Extension--Prostate: Should CS Clinical Extension always be coded to 99 [Extension unknown] for prostatic adenocarcinoma found incidentally during surgery for another primary or at autopsy? See Discussion. | Patient had a cystoprostatectomy for bladder cancer. Pathology report states only 2 microscopic foci of prostate adenocarcinoma found on LEFT side of gland. Physician notes state patient has been followed for 4 years with a nodule in the RIGHT prostate and has refused biopsy despite rising PSA. There was no definite statement of suspected cancer.
Should CS Clinical Extension be coded 99 because prostate cancer wasn't clearly stated to have been suspected until cystoprostatectomy? Or could we code the right-sided "nodule" as clinically apparent (CS Extension 20), even though path found tumor only on the left (which is how we would code a standard prostate case)? |
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 extension 99 [Extension unknown]. This prostate cancer was not clinically evident; it cannot be clinically assessed based on the information provided. Note: This is an unusual case. A DRE was performed and a nodule was palpated on the right that was not cancer. The other lobe is presumed to have been negative because it was not mentioned. |
2007 |
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20071107 | MP/H Rules/Recurrence--Breast: If the pathologist and oncologist call a 2007 lobular carcinoma that appears in a skin nodule of a mastectomy scar a recurrence of a patient's 1975 primary breast duct carcinoma, should we abstract this as a new primary? See Discussion. |
According to the pathologist and oncologist, the change in histology is attributed to the present availability of E-cadherin, which was not available in 1975. | For cases diagnosed 2007 or later, abstract the 2007 diagnosis as a separate primary using rule M5. Rule M5 applies to this case because it comes before rule M12. Furthermore, based on your statement, the answer presumes that the original tumor was duct carcinoma only, there was no lobular carcinoma present. This must be a new primary because there are two different histologies. The 2007 MP/H rules were developed with input from clinicians. They advised that a subsequent breast tumor more than five years later is a new primary. It is important to apply the rules so that these cases are handled in a consistant manner across all registries. |
2007 |
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20071046 | Ambiguous Terminology: Why was 60 days chosen for ambiguous terminology? | The Histology Task Force approved a 60 day time frame for ambiguous terminology. The majority of cases are first identified by ambiguous terminology; for example, a patient has a mammogram that shows a lesion suspicious for cancer. That first indication of cancer prompts a work-up to either confirm or rule-out the cancer diagnosis. The data item "Ambiguous terminology" is not intended to capture information on this routine method of detecting and diagnosing cancer. The 60 day time frame should keep these cases out of the ambiguous terminology data item. The data item is intended to identify those cases where the cancer diagnosis is NOT confirmed during the work-up, but the case is still entered into the database. For example a patient who has a TRUS because of elevated PSA. The pathology from the TRUS says "Suspicious for adenocarcinoma of the prostate." The physician only documents that the patient is to return in 6 months for another PSA and TRUS. The registrar would enter this case into the data base because the word "suspicious" is on the ambiguous terminology list. |
2007 | |
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20071044 | Date of Conclusive Terminology: Is there an applicable timeframe when coding this field? |
There is no strict timeframe for Date of Conclusive Terminology. The diagnosis using conclusive terminology could be made any time following the diagnostic work-up. The date of conclusive terminology is related to code 2 [ambiguous term followed by conclusive term] in the data item "Ambiguous terminology." Assign code 2 when a conclusive diagnosis is made 60 days or more after a diagnosis using ambiguous terminology. Record the date of the conclusive diagnosis in "Date of Conclusive Terminology." |
2007 | |
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20071030 | Reporting Source: If the only patient record available for a physician office biopsy is the pathology report identified from a freestanding laboratory, is reporting source coded to 3 [Laboratory Only (hospital-affiliated or independent)] or 4 [Physicians office/Private Medical Practitioner (LMD)]? See Discussion. | A case was identified through a pathology report from a freestanding lab. The doctor who submitted the specimen left the state. His records cannot be located. Because the patient had the specimen removed at a physician's office, not at a path lab, is Type of Reporting Source field coded to the physicians office? | Reporting Source is the source that provided the best information used to abstract the case. For this case, assign code 3 [Laboratory Only (hospital-affiliated or independent)]. Reporting source should reflect the lab where this case was identified. The MD office added nothing to the case, not even a confirmation of malignancy. |
2007 |
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20071056 | Reportability/Terminology--Prostate: Is the diagnosis of "atypical glands suspicious for adenocarcinoma" sufficient to report a prostate cancer if a note states that there is "insufficient atypia to establish a definitive diagnosis of malignancy"? See Discussion. | Date of report is July 2005. One positive specimen of 12. Specimen 6: Diagnosis = Prostate tissue with a small focus of atypical glands suspicious for adenocarcinoma. Note. There is insufficient cytologic and/or architectural atypia to establish a definitive diagnosis of malignancy. Negative basal cell staining with cytokeratin... in atypical glands is consistent with the diagnosis of suspicious for adenocarcinoma. In addition, the diagnosis is suppported by a positive staining for alpha-methyl COA racemase (P504S), a recently discovered marker that is preferentially expressed in prostate cancer... |
This case is reportable. The diagnosis states "suspicious for adenocarcinoma." "Suspicious for" is a reportable ambiguous term.
The additional stains supported this "suspicious" diagnosis. A more definitive diagnosis could not be made based on this specimen. |
2007 |
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