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20130161 | Primary Site--Heme & Lymphoid Neoplasms: Is the primary site coded to C779 or C421 for a bone marrow that is positive for B-cell acute lymphoblastic leukemia, the peripheral blood demonstrates leukemic involvement and the PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones? See Discussion. | 1/11/13 Bone marrow bx: B-cell acute lymphoblastic leukemia. Flow cytometry of peripheral blood shows leukemia involvement.
PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones. The patient has an elevated WBC, anemia and thrombocytopenia.
The answer to SINQ 20120047 (which is no longer visible in the system) said to code B lymphoblastic leukemia/lymphoma to bone marrow for primary site if there is bone marrow involvement. The Heme/Lymph Manual Rule PH7 says to code bone marrow as the primary site if bone marrow is the only site involved.
Following the manual, the primary site would be C779. However, according to the answer to SINQ 20120047, the primary site would be C421. Which is correct? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per the Heme DB, the histology B-cell acute lymphoblastic leukemia is synonymous with B lymphoblastic leukemia/lymphoma, NOS. Per Rule PH8, for a neoplasm that can manifest as either leukemia lymphoma or leukemia lymphoma, one is to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. The Note 4 instruction states it is necessary to go to Module 7 (Rules PH18-PH27) to code the more specific primary site. In this case, use Rule PH22 to code primary site to C779 [lymph nodes, NOS] for the case you describe.
In this case, there is involvement of abdominal lymph nodes, spleen, bone marrow and bone. There is no indication of the primary site. Per the Heme DB, the most frequent sites of involvement for the lymphoma are bone and lymph nodes. This is a Stage IV lymphoma.
The now inactivated SINQ 20120047, stated that based on the sites of involvement, this histology could be coded as either leukemia or lymphoma. If the only involvement is the bone marrow, the site is coded to C421 [bone marrow]. The involvement of peripheral blood does not change the primary site because such involvement is part of the leukemic process.
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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20130160 | Histology--Heme & Lymphoid Neoplasms: Should the histology be coded to a therapy-related myeloid neoplasm when the physician states the diagnosis of acute myeloid leukemia is secondary to treatment with Imuran? See Discussion. | Patient has a diagnosis of AML for which the physician recommends a bone marrow transplant. The physician indicated the diagnosis is actually a secondary AML due to treatment with Imuran for polymyalgia rheumatica. The physician also stated this is a high risk type of AML. Imuran is not a chemotherapy agent per SEER*Rx. Can the histology be coded as 9920/3 (e.g., Therapy-related acute myeloid leukemia, NOS) when the patient has not been treated with chemotherapy for a reportable disease? The physician is a bone marrow transplant expert who states the AML is therapy-related disease. Bone marrow disease is a listed as a risk for treatment with Imuran. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code this histology to 9920/3 [therapy-related myeloid neoplasm] when the physician states the acute myeloid leukemia is therapy-related.
Therapy-related AML can result from any systemic therapy for benign or malignant diseases. In this case, AML resulted from immune system-suppressing therapy with Imuran for a benign disease, polymyalgia rheumatica. The drugs that induced the AML do not have to be listed in the SEER*Rx database.
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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20130157 | Primary Site--Heme & Lymphoid Neoplasms: What primary site code should be assigned and what rule justifies that code?
Scenario: Pleural effusion, underwent thoracentesis. Pleural fluid unexpectedly showed Large B-Cell Lymphoma. Extensive workup including CT & PET was done and all findings were within normal limits. No evidence of lymphoma was seen and no palpable adenopathy was found. The only indication of lymphoma was the malignant pleural effusion. |
Code to pleura, C384.
Per the Hematopoietic database, Diffuse Large B-Cell Lymphoma can originate in the pleural cavity. |
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20130156 | Other therapy--Heme and Lymphoid Neoplasms: Based on the hematopoietic manual instructions, is plasmapheresis coded as treatment for Waldenstrom macroglobulinemia? See Discussion. | A patient, who was diagnosed with Waldenstrom macroglobulinemia at another facility, presented to our facility for plasmapheresis on 12/27/2012. No other treatment was given.
How is the plasmapheresis coded for treatment? |
Do not code plasmapheresis as treatment. It does not modify the neoplasm. | 2013 |
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20130155 | Diagnostic confirmation--Heme & Lymphoid Neoplasms: How do we code diagnostic confirmation if the pathology report states the diagnosis of a skin biopsy is "low-grade B cell lymphoma, most compatible with marginal zone lymphoma," genetic data includes positive rearrangement for immunoglobulin heavy chain gene favor a diagnosis of "B cell lymphoma," and the physician's clinical diagnosis is "cutaneous marginal zone lymphoma"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code diagnostic confirmation to 3 [positive histology AND positive immunophenotyping studies (9590/3 - 9992/3)].
Immunoglobulin heavy and light chain genes rearranged is listed under Genetics Data in the Heme DB for 9699/3 [extranodal marginal zone lymphoma]. Given the documentation of this positive genetic finding and the positive bone marrow, code diagnostic confirmation to 3.
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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20130152 | Primary site/Histology--Brain and CNS: How is the primary site and histology coded for a 2013 diagnosis of squamous cell carcinoma arising in a dermoid cyst of the third ventricle? See Discussion. | Patient has a dermoid cyst of the third ventricle of the brain diagnosed in 1998. In 2013 the cyst was removed and was diagnosed as squamous cell carcinoma. An internet search revealed a journal article in the Journal or Neuro-Oncology that states, "Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis." The combination of site C715 [third ventricle, NOS] and histology 8070/3 [squamous cell carcinoma] fails SEER Edit IF 38_3: Primary site and Morphology Impossible. | According to the literature, intracranial squamous cell carcinoma is very rare with most cases arising from a preexisting benign epidermoid cyst. The combination of C71_ and 8070/3 should be allowed. We will submit a request to have this edit revised. | 2013 |
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20130151 | Primary site--Heme & Lymphoid Neoplasms: What is the primary site when a splenectomy shows "T large granular lymphocytic leukemia" and the peripheral blood flow cytometry is negative? See Discussion. | The physician note states there is no evidence of leukemia on peripheral blood. The disease is localized to the spleen. Is the primary site coded to the bone marrow [C421] or can it be coded to the spleen [C422]? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C421 [bone marrow]. Leukemias are coded to the bone marrow per the Heme DB.
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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20130150 | MP/H Rules/Histology--Bladder: What is the histology code histology code for a bladder TUR that demonstrates mixed invasive urothelial and small cell carcinoma? See Discussion. |
SINQ 20041104 (prior to 2007 MP/H rules) states to code histology to 8045. The MP/H rules do not address this combination of urothelial and small cell carcinoma. The current MP/H rule that applies is Rule H8, code the higher histology (8120/3). However, if the histology is coded to 8120/3, the fact that small cell carcinoma exists will be lost. If the small cell carcinoma drives the treatment plan/prognosis, shouldn't this situation be reflected in the rules for coding histology? |
Code the histology to 8045/3 [mixed small cell carcinoma]. The presence of small cell carcinoma drives the treatment decisions for this case.
This issue will be addressed in the next revision of the MP/H rules. |
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20130149 | MP/H Rules/Histology--Testis: What is the histology code for a testis primary with embryonal carcinoma (70%), yolk sac tumor (30%), and a focus of seminoma (<1%)? See Discussion. | The right orchiectomy specimen showed a mixed histology tumor. The retroperitoneal lymph nodes showed teratoma, NOS only. Does the presence of teratoma in the lymph nodes change the histology coding?
The MP/H Rules for Other Sites, Table 2 (Mixed and Combination Codes) does not include the combination of embryonal carcinoma, yolk sac tumor and seminoma. SINQ 20110013 does state the combination of embryonal carcinoma and yolk sac tumor should be coded to histology 9065/3 [germ cell tumor, nonseminomatous]. In this case, is the focus of seminoma comprising <1% included when coding the histology? If the seminoma is included, Table 2 still does not address this combination. |
Code the histology to mixed germ cell tumor [9085/3] per Rule H16; code the appropriate combination/mixed code when there are multiple specific histologies.
According to the WHO Classification of Tumors of the Male Genital Organs, tumors of more than one histologic type (mixed forms) can occur in any combination of various germ cell histologies including embryonal, yolk sac, teratoma, and choriocarcinoma. Mixed teratoma and seminoma is included under histology code 9085/3 [mixed germ cell tumor] in the ICD-O-3. The revised MP/H rules will expand on these mixed testicular histologies.
Priority for coding histology is using the diagnosis from the primary site (when possible) over the histology from a metastatic site. The presence of teratoma, NOS in the retroperitoneal lymph nodes does not change the histology code. |
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20130148 | Reportability--Brain and CNS: Are "spinal" schwannomas reportable if stated to be extradural, vertebral nerve sheath, or of specific vertebrae? See Discussion. | Are any of the following cases reportable?
Example 1: Clinical Diagnosis: Extradural spinal cord tumor compatible with schwannoma. What assumptions should be made about reportability if the tumor is described as being extradural? The extradural spinal cord includes epidural fat surrounding the thecal sac and exiting nerve roots. Does this mean there are not nerve roots in the extradural spinal cord?
Example 2: Final Pathologic Diagnosis: Designated "C3-4 nerve sheath tumor" excision: Morphologic and immunohistochemical findings consistent with cellular schwannoma. When stated to be a "nerve sheath tumor" does that mean peripheral nerve (C47_) involvement or nerve root (C72_) involvement?
Example 3: Final Pathologic Diagnosis: T-8 vertebral tumor resection: Schwannoma with degenerative changes (calcification, cyst formation) - ganglion and nerve are identified. There is no mention clinically or pathologically whether this tumor is "intradural" or "of the nerve root." In the absence of information about whether the location of the tumor is intradural or involving the nerve root, is it assumed that it does involve this part of the spinal cord when a specific vertebrae is removed? |
Extradural schwannomas are not reportable. Neither vertebral nerve sheath nor a location of/on a specific vertebrae confirm the origin as being either extradural or intradural. Do not report a schwannoma if it cannot be determined to be "intradural" or "of the nerve root." | 2013 |
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