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20110088 | Chemotherapy/Neoadjuvant treatment: Should neoadjuvant chemotherapy be coded for an incidental second primary discovered at the time of surgery? If so, how is the diagnosis date coded? See Discussion. |
The patient had neoadjuvant chemotherapy for rectal carcinoma. An AP resection revealed an incidental second primary intramucosal carcinoma in adenomatous polyp in the descending colon. Is the chemotherapy coded as therapy for the intramucosal carcinoma of the descending colon? |
Record the neoadjuvant therapy only for the first primary and do not record the neoadjuvant therapy for the incidental new primary found on surgery. |
2011 |
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20110151 | Reportability--Heme & Lymphoid Neoplasms: Is "common variable immunodeficiency" which is also known as acquired hypogammaglobulinemia reportable? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Common variable immunodeficiency (acquired hypogammaglobulinemia) is not a reportable condition. Common variable immunodeficiency represents a group of approximately 150 primary immunodeficiencies that have a common set of symptoms but different underlying causes, both benign and malignant. The case is not reportable unless this immunodeficiency diagnosis is accompanied by a diagnosis of a cancer or a reportable hematopoietic or lymphoid neoplasm. See Appendix F: Non-Reportable List for Hematopoietic Diseases. 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. |
2011 | |
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20110110 | MP/H Rules/Multiple primaries--Head & Neck: If a 1991 neuroesthesioblastoma [9522/3] of the nasal cavity has subsequent recurrences of the same histology but later "recurs" in 2008 with "sarcoma, NOS, high grade" on a biopsy and a "high grade fibrosarcomatous transformation of esthesioneuroblastoma" [8810/3] on resection, should the subsequent tumor be reported as a new primary if the clinician continues to refer to the tumor as a "recurrence"? See Discussion. |
Are histologic transformations always recurrences of the original tumor? |
Assuming the same primary site for the 2008 lesion, according to the current MP/H rules the high grade fibrosarcoma [8810/3] is a new primary per Head & Neck MPH rule 11 because it is a different histology. The revised MP/H rules will include tables to define tumors that de-differentiate (transform) and recur with what is seemingly a different histology. Although the rules will be changed in the future, we must use the rules in place at this time for this case. |
2011 |
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20110074 | First course treatment/Date therapy initiated--Breast: How is the Date of Initiation of Hormone Therapy field coded when a patient undergoes "Tamoxifen blunting" to achieve better MRI imaging after a biopsy but prior to definitive surgery which is followed by adjuvant Tamoxifen therapy? See Discussion. | Patients are prescribed two weeks of "Tamoxifen blunting" to achieve better MRI imaging after biopsy confirmation of an ER/PR positive breast carcinoma. The Tamoxifen is subsequently discontinued and the patient has definitive surgery. Following surgery, maintenance Tamoxifen is initiated. Which date should be recorded for the Date of Initiation of Hormone Therapy field? Is it the first date when Tamoxifen blunting started or the post-surgical date when maintenance Tamoxifen is initiated? | Use the post-surgical start date of maintenance Tamoxifen to code the Date of Initiation of Hormone Therapy field. The actual hormone treatment begins after surgery when Tamoxifen blunting was performed. The low dose administered prior to surgery does not affect the cancer. | 2011 |
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20110073 | MP/H Rules/Multiple primaries--Sarcoma: Does a prior clinical diagnosis of a metastatic deposit for a previously diagnosed sarcoma have priority if the diagnosis on a subsequent resection (18 months later) indicates it is also a sarcoma but does not state it represents metastasis from the original sarcoma primary? See Discussion. |
1/28/08 Patient was diagnosed with spindle cell sarcoma in the right gluteus muscle. Metastatic tumors were found in a vertebral body and in the lung. Chemotherapy was started.
4/22/08 PET scan done to evaluate response to chemo. The primary tumor had increased in size. New mass in the left thigh that was highly suspicious for metastasis found. (The left thigh tumor was not accessioned at that time as it was described as a metastatic tumor.)
7/3/09 Left thigh tumor was resected and path revealed spindle cell sarcoma. There was no mention that it represented metastasis.
Does the left thigh tumor represent a new primary per rule M12? Or does the previous clinical description of the left thigh tumor representing metastasis have priority? |
this is a single primary per Rule M1. According to our expert pathologist, "if multiple solid tissue tumors are present (sarcomas), then almost always there is one primary and the rest are metastases. There are infrequent occasions of multifocal liposarcoma or osteosarcoma occurring, but the patient would be treated as a patient with metastatic disease."
The steps used to arrive at this answer are:
Open the Multiple Primary and Histology Coding Rules manual. For a soft tissue primary, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites MP rules to determine the number of primaries because soft tissue primaries do not have site specific rules.
Go to the UNKNOWN IF SINGLE OR MULTIPLE TUMORS module, Rule M1.
Rule M1 states, "It is not possible to determine if there is a single tumor or multiple tumors, opt for a single tumor and abstract a single primary." Given the information from the expert pathologist, this case should be reported as a single primary applying this rule. |
2011 |
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20110132 | Reportability/Histology--Heme & Lymphoid Neoplasms: Is a diagnosis of "small B-cell non-Hodgkin lymphoproliferative disorder" reportable? If so, how is the histology to be coded? See Discussion. | The final diagnosis of a bone marrow biopsy dated 10/99/2010 was "small B-cell non-Hodgkin lymphoproliferative disorder." The differential diagnosis includes atypical small lymphocytic lymphoma/chronic lymphocytic leukemia and marginal zone lymphoma. Mantle cell lymphoma is very unlikely based on BCL1 negativity. Lymphoplasmacytic lymphoma is also excluded due to the absence of a plasma cell component (CD138 negative). | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Yes. The term "small B-cell non-Hodgkin lymphoproliferative disorder" is reportable. Code the histology to 9591/3 [non-Hodgkin lymphoma, NOS] per Rule PH28. When there is a diagnosis of lymphoproliferative disorder and any lymphoma, code the lymphoma histology.
The information in the discussion is reflective of the difficulty in diagnosing hematopoietic and lymphoid neoplasms. The differential diagnosis indicates that a number of possible specific lymphoma/leukemia diagnoses that have been ruled out, which explains why the final diagnosis is non-Hodgkin, NOS.
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. |
2011 |
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20110091 | MP/H Rules/Histology--Bladder: How is this field coded for a patient with ureter specimen with "high grade urothelial carcinoma with adenocarcinoma differentiation" and a TURB specimen with "urothelial ca, high grade, a biphasic pattern with cautery-distorted urothelial carcinoma and adenocarcinoma"? | According to the MP/H rules, code histology to 8120/3 [urothelial carcinoma] for cases diagnosed 2007 or later. The term "glandular differentiation" is equivalent to adenocarcinoma differentiation. 8120/3 [urothelial carcinoma] would be the best way to code a "biphasic pattern with cautery-distorted urothelial carcinoma and adenocarcinoma" according to a pathologist consultant.
The steps used to arrive at this decision are as follows:
Go to the Urinary Histo rules found in the Multiple Primary and Histology Coding Rules Manual.
Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, rule H9. Code the histology to 8120 [transitional cell/urothelial carcinoma] when there is transitional cell carcinoma with glandular differentiation. |
2011 | |
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20110143 | Multiple primaries--Heme & Lymphoid Neoplasms: How many and what primary site(s) are to be accessioned when biopsies of clavicular and neck skin lesions are both consistent with mycosis fungoides? See Discussion. |
Per the Heme DB and Manual, this is a single primary; however, per the MP/H Rules, this would be multiple primaries. Which rules apply to this case? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. When there is a question of whether the SEER MP/H Rules or Hematopoietic and Lymphoid Neoplasm Rules apply, check the histology and refer to the Case Reportability Instructions in the Hematopoietic and Lymphoid Neoplasm Manual. All ICD-O-3 morphology codes in the range 9590 - 9992 are included in the Hematopoietic Rules. Mycosis Fungoides [9700/3] is included in this range. Therefore, the SEER MP/H Rules do not apply to mycosis fungoides. This case should be accessioned as a single primary: mycosis fungoides [9700/3] of the skin, NOS [C449]. Per Rule M2 abstract a single primary when there is a single histology. Note that in the Primary Site(s) section of the Heme DB, it states the primary site must always be coded to skin (C440 - C449) for mycosis fungoides. Because the primary site is stated in this section of the Heme DB, it is not necessary to use the Primary Site Rules to determine the primary site. Code the primary site to C449 [skin, NOS] because the patient has multiple sites of skin involvement and there is no documentation indicating which subsite of skin was the origin of the mycosis fungoides. 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. |
2011 |
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20110094 | Surgery of Primary Site--Breast: Is a "nipple sparing mastectomy" coded to 30 [subcutaneous mastectomy] or 40 [total (simple) mastectomy] if the nipple/areolar complex was not removed but the pathology specimen indicates some breast skin was removed? See Discussion. |
In the past, the SEER Manual indicated that code 30 [subcutaneous mastectomies], which captured nipple-sparing mastectomies, would rarely be used because it was not typically performed as treatment for a malignancy. This note was removed from the 2010 SEER Manual, Appendix C. Code 30 which now states, "A subcutaneous mastectomy is the removal of breast tissue without the nipple and areolar complex or overlying skin." More "nipple-sparing mastectomies" are now being performed at certain facilities.
Should the Surgery of Primary Site field be coded to 30 when a nipple-sparing mastectomy with reconstruction is performed, even if there is skin removal? Or, does the skin removal indicate that this is not a subcutaneous mastectomy, and therefore code 43 [Total (simple) mastectomy with reconstruction, NOS] applies? |
Code Surgery of Primary Site to 30 [Subcutaneous mastectomy] for this case.
Assign code 30 when the nipple and areolar complex are NOT removed. Assign code 40 (or higher) when the nipple and areolar complex ARE removed. |
2011 |
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20110080 | Grade--Kidney, renal pelvis: How is this field coded for a non-invasive high grade papillary urothelial carcinoma of the renal pelvis? See Discussion. | Per instructions in the 2010 SEER Manual, Appendix C, Coding Guidelines for Bladder, "Code grade 9 (unknown) for non-invasive urothelial (transitional) tumors." The Coding Guidelines listed under Renal Pelvis, Ureter are only for Kidney [C649]. Do the grade instructions under bladder apply to ALL non-invasive urothelial tumors, or are we to use the kidney grading instructions to code grade for renal pelvis and ureter malignancies? | Code grade to 4 [high grade]. Follow the instructions in the main part of the 2010 SEER Manual under the data item Grade (pages 73 - 76). There are no specific instructions for coding grade for renal pelvis. Apply the general instructions in the absence of site-specific instructions. | 2011 |
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