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| Report | Question ID | Question | Discussion | Answer | Year |
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20091010 | MP/H Rules/Histology--Breast: What histology is coded when a final diagnosis on a lumpectomy specimen states "adenocarcinoma" but the regional lymph nodes show "poorly differentiated adenocarcinoma with signet ring differentiation"? See Discussion. | 3/23 left breast mass bx: infiltrating lobular carcinoma. 6/22 left breast lumpectomy: infiltrating adenocarcinoma; sentinel lymph nodes with metastatic poorly differentiated adenocarcinoma with signet ring differentiation. Axillary resection with poorly differentiated metastasis in 8/9 nodes. The path micro states: tissue consists of sections of breast tissue having an infiltrating ca which in some areas infiltrates as small duct-like structures, and in other areas as small gland-like structures. In addition, there are foci in which the cells infiltrate in a single file fashion. In a few areas, cells having a signet ring appearance similar to those seen in the lymph nodes are encountered. In other areas, the signet ring appearance is not prominent. Areas of ductal or lobular ca in situ are not identified (the lymph node resection specimen shows 'signet ring appearance in some areas but no ductlike or tubular structures observed')
The comment on the lumpectomy path states: 'This is an unusual tumor in that it has histologic characteristics in varying areas, which would be consistent with infiltrating ductal carcinoma, infiltrating lobular carcinoma, tubular carcinoma or signet ring cell carcinoma. The metastatic material (8/9 total axillary lymph nodes) is most consistent with the poorly differentiated signet ring type portion of the tumor undergoing metastasis.' |
For cases diagnosed 2007 or later: Code the histology 8140 [Adenocarcinoma, NOS] using Breast rule H14. Code the histology from the final diagnosis on the pathology report of the most representative specimen (the lumpectomy in this case). Do not code histology from the microscopic description. Code the histology from the primary site whenever available, not the metastatic site.
Comments on pathology reports can be used to code histology. However, in this case the final diagnosis is more definitive than the comments. The comment provides several choices and none of these appear in the final diagnosis; an indication that the pathologist was not able to clearly identify a more specific type in this case. |
2009 |
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20130059 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded if a patient with a history of chemotherapy treated "groin" lymphoma, subsequently has bone biopsies that demonstrate diffuse large B-cell lymphoma? See Discussion. |
3/2012: Patient states he has a past history of lymphoma of the "groin." A bone biopsy of the right tibia done at this facility showed diffuse large B-cell lymphoma. There was no palpable lymphadenopathy on 03/2012. There is no other information available regarding the initial diagnosis except that the patient was treated with only chemotherapy. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Code the primary site to C774 [inguinal lymph nodes] per Rule PH18. Code the primary site to inguinal lymph nodes [C774] when the site of lymphoma is described only as an inguinal mass. Groin lymph nodes are inguinal lymph nodes. The diffuse large B-cell lymphoma diagnosed by right tibia biopsy is not a new primary per rule M7 because the histology of the history only case would be coded as 9590/3 [lymphoma, NOS]. No more specific histology is known for the initial diagnosis. Accession a single primary when a more specific histology [DLBCL] is diagnosed after the NOS ONLY histology when the Heme DB Multiple Primaries Calculator confirms the NOS and the more specific histology are the same primary. The right tibial involvement is not used to code the primary site because the patient had chemotherapy for this groin lymphoma prior to diagnosis of DLBCL. 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.. |
2013 |
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20051132 | Primary Site/CS Extension/CS Lymph Nodes--Lung: How are these fields coded for untreated lung primaries when only limited information is available from scans, bronchoscopies and biopsies? See Discussion. | 3/13/04 CT scan Chest: extensive mediastinal, subcarinal, rt hilar lymphadenopathy; separate tumor mass in medial rt lung 3/16/04 Bronchoscopy: RLL/RML completely obstructed with extrinsic compression. Impression: CA of lung with hilar adenopathy. Bronchial wash: PD non small cell CA Bx RLL: up to 0.2 cm PD Adenocarcinoma c/w primary lung CA. Treatment not recommended. Expired 5/03/04. |
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. The primary is in the right lung according to the available information. Assign CS extension code 10 [Tumor confined to one lung]. The only information on extension is that there is a tumor in one lung. Assign CS Lymph Nodes code 20 [Mediastinal and subcarinal lymph node involvement]. The CT scan confirms mediastinal and subcarinal lymphadenopathy. Code tumor Size as 999 [Unknown]. "Completely obstructed" is not a size. Do not code the size of the biopsy specimen. |
2005 |
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20091046 | CS Lymph Nodes/CS Site Specific Factor--Melanoma: When CS Lymph Nodes is coded 13, 14 or 15 (codes used when satellite nodule(s) or in-transit metastases are present), why must CS SSF 3 be coded 000 (No lymph node metastasis)? See Discussion. | 3/11/05 Consult - PE: huge exophytic lesion right lower leg (mushroom-type lesion), 6cm. Below that lesion is another ulcerative lesion 2cm. Right upper arm lesion w/ satellite nodule. Note from physician states malignant melanoma on right lower leg metastatic to the left arm/shoulder. No scans done so there is no assessment of the lymph nodes. We coded CS LNS to 13, which captures the satellite nodule, CS SSF3 = 999 and CS Reg Nodes Eval = 0. SEER Edit 216 requires the SSF3 to be 000. SSF 3 is coded 999 as there is no information about the clinical status of 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.When CS lymph nodes is coded 13-15, SSF 3 must be coded 000. Follow the instruction in the SSF 3 Note: Use code 000, No lymph node metastases, if ... there are satellite nodules or in-transit metastases, but no regional lymph node metastases, i.e., CS Lymph Nodes is coded 13-15.
For this case, assign CS lymph node code 15 [Satellite nodule(s) or in-transit metastases greater than 2cm from primary tumor WITHOUT regional lymph node involvement or involvement of regional nodes not stated]. The arm lesion is more than 2cm from the leg lesion. |
2009 |
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20041075 | CS Tumor Size: Can we take the size of a "polypoid" mass? See Discussion. | 3/04 Colonoscopy: 4 cm semi-circumferential friable mass in sigmoid colon. Path: Tubulovillous adenoma indeterminate for malignancy. 4/04 Sigmoid Colectomy: 5 x 4 polypoid mass: WD Adenocarcinoma arising in a tubulovillous adenoma. Define "Polypoid". Size of "polypoid" mass. Would the size be coded to 050 or 999? |
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.If the pathology report confirms that the entire polyp is malignant, code the size of the polyp/polypoid mass. If the pathology report does not confirm that the entire polyp is malignant, code 999. Code tumor size as 999 [Unknown] for the example above. Do not code the size of the polypoid mass in this example. The size given above is the size of the polypoid mass, not the size of the malignancy. Polypoid means "Like a polyp. |
2004 |
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20041086 | Histology (Pre-2007)/CS Tumor Size/CS Extension--Colon: How are these fields coded if a 3 cm sessile polyp is snared and removed piecemeal during a colonoscopy and the path microscopic description indicates a polypoid lesion with foci of malignant transformation found associated with bundles of smooth muscles followed by a LAR with no residual invasive tumor but the final path diagnosis is stated to be a M.D. adenocarcinoma? See Discussion. | 3/04 colonoscopy 3cm sessile polyp snared & removed piecemeal. Path Micro: Polypoid lesion consists of branching & complex neoplastic glands lined by tall columnar epithelial...These foci of malignant transformation are assoicated with large polygonal epithelial...associated with desmoplastic stromal reaction & neoplastic glands can be found associated with bundles of smooth muscle. 4/04 LAR: focus of residual HG dysplasia: no residual invasive tumor. Final path dx: MD adenocarcinoma. Physician staged: T2 N0 M0. Histology: 8140 vs 8210 Tumor Size: 030 vs 999 vs 990 Extension: 12 vs 20 |
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. For tumors diagnosed prior to 2007:
Based only on information provided: Histology: 8210 [Adenocarcinoma in a polyp] Tumor Size: 999 [Unknown] CS Extension: 20 [Muscularis propria invaded]
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. |
2004 |
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20061144 | 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. |
2006 |
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20220027 | Reportability/Heme & Lymphoid Neoplasms--CNS: Is ALK-positive histiocytosis, primary site Central Nervous System (CNS), reportable, and is the correct histology code 9750/3? See Discussion. |
2022 case: Surgical Pathology Report-spinal cord tumor, biopsies: ALK-positive neoplasm most consistent with ALK-positive histiocytosis. |
Report this 2022 case of ALK-positive histiocytosis using histology code 9751/3, Langerhans cell histiocytosis, disseminated. Use text fields to document that this is a case of ALK-positive histiocytosis. This term may be assigned a new code once the 5th edition of the Hematopoietic WHO Blue Book is released. |
2022 |
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20230015 | Solid Tumor Rules/Multiple Primaries: Should two 2021 diagnoses be abstracted as two primaries? The patient has a history of thyroid cancer in 2008 with no evidence of recurrence/progression. In 2021, two abstracts were submitted with a diagnosis of C809, poorly differentiated malignant neoplasm and a C421, myeloproliferative disorder. See Discussion. |
2021-Right pleural fluid: Negative for carcinoma. 5/18/2021: Right iliac crest bone marrow core biopsy, aspirate smear, clot section and peripheral blood smear: Hypercellular bone marrow, morphological findings are suspicious for a myeloproliferative neoplasm. Flow Cytometry: Slight immunophenotypic abnormalities of the myeloid cells. No abnormal B cell, T cell, or NK cell populations identified. Normal female karyotype. KARYOTYPE: 46,XX[20]. Negative for deletion of 13q14.3 (D13S319) by FISH. Negative for deletion of 13q34 (LAMP1) by FISH. Negative for hyperdiploidy involving chromosome 9 by FISH. Negative for t(9;22)(q34;q11.2) by FISH. Negative for deletion of the EGR1 gene on 5q31 by FISH. Negative for monosomy 5 by FISH. Negative for deletion of 7q31 by FISH. Negative for monosomy 7 by FISH. Negative for deletion of 20q12 by FISH. Negative for trisomy of chromosome 8 by FISH. 6/4/21-Left adrenal; biopsy: poorly-differentiated malignant neoplasm with extensive necrosis. Immunohistochemical stains show the neoplastic cells to be negative for CK7, TTF-1 and p63. Negative CK7 and TTF-1 would argue against a lung primary. Correlation with clinical and radiological findings is advised. We are unable to contact the provider. |
Based on the diagnosis date for the unknown primary, use the 2007 MPH Other sites rules. Since the site codes differ for each primary, rule M11 applies, abstract two primaries. |
2023 |
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20210053 | Reportability/Heme & Lymphoid Neoplasms: Is ALK positive (ALK+) histiocytosis involving the bone marrow and kidney reportable? See Discussion. |
2021 Bone marrow biopsy showed erythroid hyperplasia, increased histiocytes with hemophagocytosis and Factor XIIIa positive histocytic cells. Moderate cytoplasmic staining for ALK 1, consistent with bone marrow involvement of ALK-positive histiocytosis. A subsequent kidney lesion biopsy was also found to have ALK-positive histiocytosis. The patient was then treated with clofarabine. Patient is 3 years old. 07/2020-Chart indicates patient presented in June with fevers and refusing to walk with pancytopenia, bone marrow biopsy showed no leukemia buthistiocytes. Impression: ALK positive histiocytosis involving BM and kidney. 10/2020 Bone marrow final diagnosis states right and left bone marrow aspirates and biopsies: No morphologic or immunohistochemical evidence of involvement by the patient's previously diagnosed ALK+ histiocytosis (see Comments) - Multiple histiocytic collections with prominent hemosiderin; favor reactive - background normocellular bone marrow with maturing trilineage hematopoiesis. The patient's prior bone marrow samples are reviewed (9/2020 and 7/2020). Similar to the September bone marrow sample, the current marrow shows numerous histiocyte collections with abundant associated hemosiderin deposition. These histiocytes have a stellate/dendritic appearance and lack the atypical features noted in the patient's marrow at diagnosis, favoring a reactive process. This impression is further supported by the lack of immunoreactivity for either Factor XIIIa or ALK1 among these cells. There is no convincing morphologic or immunohistochemical evidence of marrow involvement by the patient's previously diagnosed ALK+ histiocytosis within the sampled material. Of note, the marrow otherwise appears normocellular for the patient's age, indicative of ongoing marrow recovery post therapy. It is not clear whether this would be equivalent to Langerhans cell histiocytosis, disseminated (9751/3) as there is not a statement of Langerhans cell or whether this is just histiocytosis, NOS and not reportable. |
Do not report this case of histiocytosis. Based on the information provided, this case is not reportable. |
2021 |
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