First Course Treatment/Surgical Margins of the Primary Site--Melanoma: Is margin status positive or negative when the lesion “approximates” margins? This was noted in the pathology report comment on a malignant melanoma in-situ shave biopsy. Follow-up with physicians is not possible in this situation.
Assign margin status as “positive” when stated as approximates margins as recommended by our expert pathologists. Approximating means coming right up to inked margin without the margin transecting the tumor.
Histology (Pre-2007)--Breast: Is histology coded from the more representative specimen or should the combination code 8522/3 [Infiltrating duct and lobular carcinoma] be used for a case in which a right breast mass needle core biopsy revealed infiltrating ductal ca, grade III and the subsequent right mastectomy revealed a 2.3 cm lobular carcinoma?
For tumors diagnosed prior to 2007:
Code the histology using the final diagnosis on the pathology report of the procedure that resected the majority of the primary tumor. In this case, the mastectomy removed more of the tumor than the needle biopsy. The final diagnosis from the mastectomy is infiltrating lobular carcinoma. Code histology to 8520/3 [lobular carcinoma].
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.
EOD-Extension--Corpus Uteri: How is this field coded for a stage III A endometrial primary with positive pelvic washings, involvement of the omental serosa, and negative lymph nodes?
For cases diagnosed 1998-2003: Code EOD-extension as 85 [Metastasis]. According to our TNM consultant, Omental metastasis is M1, Stage IVB [EOD 85].
EOD-Extension--Corpus Uteri: How do you code myometrial involvement described as 1) "to the level of the middle one-third" or 2) "superficial"?
For cases diagnosed 1998-2003:
Evaluate each case carefully.
1. Code the EOD-Extension field to 12 [Myometrium-inner half] because the pathology report indicates involvement of the myometrium "to the level of." However, if you feel that you cannot make that determination with certainty and you cannot ask a pathologist for clarification, then code the EOD-Extension field to 14 [Myometrium, NOS].
2. Code the EOD-Extension field to 12 [Myometrium-inner half] for cases with "superficial" myometrial invasion.
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a patient is simultaneously diagnosed with multiple myeloma/plasma cell myeloma, plasmacytoma and plasma cell leukemia?
This is accessioned as one primary and the histology is coded to 9732/3 [multiple myeloma].
To arrive at this answer, it is important to first try to determine how many different unique neoplasms there are to correctly identify the number of primaries to report. Per the Heme DB, plasma cell leukemia is an obsolete term. The current term and histology code for this diagnosis is 9732/3 [plasma cell myeloma]. Plasma cell myeloma and multiple myeloma are synonyms per the Heme DB. Therefore, per Rule M2 a single primary exists when there is a single histology. That takes care of the multiple myeloma/plasma cell myeloma and plasma cell leukemia, but not the plasmacytoma.
In checking the Heme DB, the terms plasma cell myeloma and multiple myeloma are not synonyms for plasmacytoma. Therefore, we are left to determine whether the multiple myeloma/plasma cell myeloma vs the plasmacytoma represents one or two primaries.
Under the Transformation section of the Heme DB, it indicates that plasmacytoma (a chronic disease process) transforms to multiple myeloma (an acute disease process). Per Rule M9, abstract a single primary and code the acute histology when both a chronic and an acute neoplasm are diagnosed simultaneously. The histology is coded to the acute neoplasm when there is no information on the biopsy regarding which is the "later" histology. This update will be added to the Heme Manual.
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.
MP/H Rules/Histology--Lung: What would the histology code be for a wedge bx of the left lung, lower lobe, that was read out as well differentiated adenocarcinoma with micropapillary features?
Code papillary adenocarcinoma 8260/3. The ICD-O-3 codes for micropapillary have specific associations such as ductal, serous or transitional. None of those associations fit lung primaries.
EOD-Extension--Urinary Tract: Can the rules used to code bladder extension involving the term "no involvement of muscularis/and no mention of subepithelium/submuscosa" be used to code extension for other urinary tract primaries, such as ureter?
For cases diagnosed 1998-2003:
No. The inferred descriptions of noninvasion apply to bladder cases only.
MP/H/Histology--Breast: What MP/H Rule, histology, and behavior code for a breast primary apply to the following?
2 foci DCIS, solid, high grade (Grade 3) w/microca++
Apply the Multiple Primaries/Histology, Breast Rule H3: DCIS and a more specific in situ are coded to the more specific histology term which in this case is solid. Code the histology to ductal carcinoma in situ, solid type (8230/2). Based on the information provided, there is no invasive component. The term "microca ++" means micro-calcifications are present, not micro carcinoma.
Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when a patient has a lymph node biopsy and peripheral blood that are positive for B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma but refuses a bone marrow biopsy?
Code the primary site to C421 [bone marrow] per Rule PH5. Note 1 for Rule PH5 states CLL always has peripheral blood involvement. If the peripheral blood is positive for CLL/SLL and no bone marrow biopsy is done, code the primary site to C421 [bone marrow].
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.
Grade--Heme & Lymphoid Neoplasms: How is grade coded for a malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant?
Code grade to 6 [B-cell] for the histology malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant [9680/3]. Under the Definition section for histology code 9680/3 it states there are morphologic variants of the disease: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.
Rule G3 in the Heme Manual confirms the grade listed in the Heme DB under its Grade section for the histology 9680/3. While the patient presented with a variant of DLBCL that is T-cell/histiocyte rich, it is still a B-cell phenotype. The grade is coded accordingly.
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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