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| Report | Question ID | Question | Discussion | Answer | Year |
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20100042 | Reportability--Heme & Lymphoid Neoplasms: Given that there appears to be many differences in the reportability of these case types pre- and post-2010 (e.g., [refractory] thrombocytopenia), is there a list available that gives the reportability dates for these diseases? See Discussion. |
For cases diagnosed prior to 2010 "thrombocytopenia" was not reportable. According to the Heme Database, the term "refractory thrombocytopenia" is now reportable for cases diagnosed 1/1/10 and later. It would be helpful to have a list of diagnosis date requirements for the different hematopoietic diseases. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Thrombocytopenia (NOS) is not reportable per Appendix F. However, the term "refractory thrombocytopenia" [9992/3] is reportable for cases diagnosed 2010 or later.
There has been no change in the reportability for thrombocytopenia. The hematopoietic "help" system lists all of the synonyms, variants, and abbreviations for diseases.
See the Hematopoietic & Lymphoid Neoplasm Coding Manual for changes in reportability associated with these cases.
Terms and codes in Appendix D are effective 01/01/10 and later. Refractory thrombocytopenia is included in D1a and D1b. The notes for D1a and D1b provide explanation and reiterate the dates these terms are effective.
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. |
2010 |
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20100061 | MP/H Rules/Histology: The 2010 SEER Manual has omitted some useful information in the Histologic Type ICD-O-3 section, specifically the statement of "Do not revise or update the histology code based on subsequent recurrence(s)". Will this statement be added to the revisions of the MPH rules? See Discussion. | Example: A 2005 diagnosis of left breast lobular carcinoma [8520/3], followed by a 2009 diagnosis of left breast ductal carcinoma [8500/3]. Rule M10 states this is a single primary, but there is no information in the Histology rules (Multiple Tumors Abstracted as a Single Primary) that the original histology should be retained, thus a person could potentially use these rules to change the original histology to 8522/3 [duct and lobular carcinoma] per rule H28. | We will reinstate the instruction not to change the histology code based on recurrence in future versions of the histology coding instructions. However, this instruction may not be applicable to all anatomic sites. It will be reinstated on a site-by-site basis. You may also refer to the instructions on Page 7 of the 2010 SEER Manual under the heading "Changing Information on the Abstract." | 2010 |
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20100091 | Reportability/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and how is histology coded when a patient has a history of chronic myelogenous leukemia diagnosed in 1997 and a "blast crisis with myeloid markers" of this disease in 2010? See Discussion. | The patient was initially diagnosed with CML in 1997. In February 2010 the disease went into a "blast crisis with myeloid markers." The patient received induction chemotherapy and the disease went back into a chronic phase. To capture the 2010 diagnosis of a blast crisis, is the histology code 9875/3 [chronic myelogenous leukemia, BCR/ABL1 positive] or 9861/3 [acute myeloid leukemia, NOS] used? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M2, there is a single primary. Code histology to 9863/3 [CML, BCR-ABL1 status unknown, Blastic phase (BP)]. The blast phase is not recorded as a new primary because this disease does NOT change histologies.
Code 9875 [Chronic myelogenous leukemia, BCR-ABL1 positive] does not apply to the 2010 diagnosis because BCR/ABL status unknown. Code 9861/3 [Acute myeloid leukemia, NOS] also does not apply because the diagnosis was not acute.
It is not clear which chronic myelogenous leukemia (CML) this patient has. Each CML is unique in that it has a blast phase without the histology itself changing. See the Abstractor Notes section in the Heme DB under any of the chronic myelogenous leukemias for a further explanation of this disease 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. |
2010 |
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20100009 | MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion. | A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.
Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma? |
For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. | 2010 |
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20100010 | MP/H Rules/Multiple primaries--Ovary: How many primaries are to be abstracted when a patient is diagnosed with serous cystadenocarcinoma [8441] of the right ovary and clear cell adenocarcinoma [8310] of the left ovary? See Discussion. |
Patient had bilateral ovarian tumors. The right ovary had serous cystadenocarcinoma and left ovary had clear cell adenocarcinoma. The pathology COMMENT section stated, "Based on the histologic differences of the tumors within each ovary, feel these represent two distinct separate primaries. Lymph node metastases are clearly serous ca." The physician staged the right ovary as T2a N1 M0 and left ovary as T1c N0 M0. Do we accession one primary per rule M7 [Bilateral epithelial tumors (8000-8799) of the ovary within 60 days are a single primary]? What is intention of Rule M7? If the histology in each ovary is different but within the range (8000-8799), is that supposed to be accessioned as one primary? Or is the intention of Rule M7 that tumors in both ovaries must have the SAME histology within that histology range to be a single primary? |
For cases diagnosed 2007 or later, apply rule M8 and abstract this case as multiple primaries. Rule M7 does not apply when each ovary has a distinctly different histology, even when both histologies are with the specified code range. This clarification will be added to the next version of the rules. |
2010 |
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20100038 | Surgery of Primary Site--Prostate: Is a prostate saturation biopsy coded under diagnostic biopsy or surgery? | A prostate saturation biopsy is a transperineal template-guided stereotactic saturation prostate biopsy that typically produces 30 to 80 core biopsies. This is an alternative biopsy technique used for some high-risk patients including men with persistently elevated PSA, those who have atypia on prior prostate biopsies, or men with biopsies showing high-grade prostate intraepithelial neoplasia (PIN). Although this is a different procedure, it is still a diagnostic biopsy. Do not code prostate saturation biopsy under Surgery of Primary Site. | 2010 | |
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20100017 | MP/H Rules/Multiple primaries--Prostate: Does adenosquamous carcinoma found in the prostate represent a second primary in a patient previously diagnosed with adenocarcinoma of the prostate? See Discussion. | Patient was diagnosed many years ago with adenocarcinoma of the prostate and treated with hormonal and radiation therapy. The patient recently underwent a TURP and is found to have adenosquamous carcinoma of the prostate. The pathology report comment states squamous carcinoma of the prostate is rare and is often associated with a history of hormonal or radiation therapy. There is no information indicating a history of a squamous carcinoma in the urinary system that could have involved the prostatic urethra.
Would the MP/H rules make this a second primary with the histology of 8560/3 [adenosquamous carcinoma]? |
For cases diagnosed 2007 or later, based on the limited information available for this unusual case, abstract a second prostate primary and code the histology as adenosquamous carcinoma. Rule M3 does not apply in this case. Apply rule M10. | 2010 |
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20100066 | MP/H Rules/Multiple Primaries--Breast: How many primaries should be accessioned if two tumors are present in the same breast, a 1.7 cm colloid carcinoma and a 1.5 cm colloid carcinoma with infiltrating ductal carcinoma? See Discussion. | If a patient has two masses in the same breast with different histology codes and different sizes, should this be accessioned as two primaries? Or should this be a single primary based on the largest tumor size or numerically higher histology code?
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For cases diagnosed 2007 or later, abstract this case as two primaries. Mucinous/colloid carcinoma of the breast is rare. The first tumor describes (1.7 cm) fits this criteria because the pathologist simply says mucinous carcinoma. The diagnostic criteria for mucinous carcinoma is that pools of extracellular mucin make up at least 1/3 of the volume throughout the tumor mass. If focal areas are not at least 33% mucinous, the designation is a mixed mucinous/ductal. That fits the second tumor (1.5 cm).
For this case, you must get the histology codes for both tumors in order to use the Multiple Primary rules. Per H14 the first tumor is coded mucinous carcinoma [8480/3]. Per H17 the second tumor is coded duct carcinoma mixed with any other carcinoma [8523/3]. Now go to the MP rules. Per M12 abstract this case as multiple primaries because the ICD-O-3 histology codes are different at the second and third digit. |
2010 |
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20100047 | Reportability--Heme & Lymphoid Neoplasms: Is "myelodysplasia" a reportable disease? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
The diagnosis of "myelodysplasia" is not reportable.
Myelodysplasia covers a group of disorders that result in the inability to produce enough healthy mature blood cells. Those disorders include: anemia, leukopenia, thrombocytopenia, MDS, refractory anemia, refractory anemia with excess blasts in transformation, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, chronic myelomonocytic leukemia, acute myeloid leukemia. Follow-back to the physician is necessary to determine whether or not a particular case represents a malignancy.
"Myelodysplasia" is also listed in 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. |
2010 | |
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20100049 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a lymph node biopsy reveals "malignant lymphoma, peripheral T-cell type, with some features of angioimmunoblastic T-cell lymphoma and follicular T-cell lymphoma," the bone marrow biopsy was negative for involvement, and the oncologist states this patient has "peripheral T-cell lymphoma"? See Discussion. |
CT scan showed retroperitoneal and inguinal adenopathy. Right inguinal lymph node biopsy revealed "malignant lymphoma, peripheral T-cell type, with some features of angioimmunoblastic t-cell lymphoma and follicular t-cell lymphoma." Flow cytometry studies showed no evidence of B-cell lymphoma and atypical CD3+/CD10+/CD7-/CD4+/CD56+ T cells are detected (19%). The bone marrow biopsy was negative for involvement. Patient was staged as Stage II Peripheral T-Cell lymphoma by the oncologist and started chemotherapy. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the oncologist's clinical diagnosis of peripheral T-cell lymphoma.
The definition for this neoplasm is "A large group of lymphomas which we collectively refer to as peripheral T-cell lymphomas with the optional addition of "unspecified" to emphasize that these cases do not belong to any better defined entities. Attempts to distinguish between them on morphological basis have met with poor reproducibility."
Per the Abstractor Notes in the Heme DB: Patients present with peripheral LN involvement. The diagnosis of PTCL, NOS is made ONLY when other specific entities have been explored.
This fits your case; attempts to find a more specific disease (flow cytometry; BM biopsy) were negative and gave no further information that could be used to assign a more specific classification.
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. |
2010 |
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