Reportability--Heme & Lymphoid Neoplasms: Is the diagnosis of large granular lymphocyte syndrome or large granular lymphocyte disorder a reportable synonym for T-cell large granular lymphocytic leukemia? See Discussion.
The physician consult in this case further specifies that the large granular lymphocyte disorder represents an autoimmune disease of autoimmune T-cell mediated mechanism. Is this a reportable diagnosis?
Report large granular lymphocyte disorder (9831/3). Alternate names for T-cell large granular lymphocytic leukemia (9831/3) listed in the Hematopoietic and Lymphoid Neoplasms Database include but are not limited to Chronic large granular lymphocyte lymphoproliferative disorder, large granular lymphocytosis, NOS, and T-cell large granular lymphocytosis.
Reportability/Breast: Is lobular carcinoma in situ (LCIS) reportable? The eighth edition, American Joint Commission on Cancer (AJCC) Cancer Staging Manual does not stage LCIS.
Yes, LCIS is reportable. Staging does not determine reportability. Follow the reportability requirements of your state and national standard setter. SEER reportability requirements are found in the SEER manual starting on page 5, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf
Histology--Heme & Lymphoid Neoplasms: How should histology be coded for final bone marrow diagnosis of myelodysplastic syndrome with excess blasts? See Discussion.
This terminology is not specifically included in either alternate names list for myelodysplastic syndrome, NOS (9989/3) or refractory anemia with excess blasts (9983/3).
Example: Bone Marrow Biopsy, Final Diagnosis: Consistent with involvement by myelodysplastic syndrome with excess blasts-2 (MDS EB-2).
Assign code 9983/3 refractory anemia with excess blasts. Refractory anemia is a type of myelodyplastic syndrome. We will add this to the Heme & Lymphoid database during the next update.
MP/H Rules/Histology--Brain and CNS: Is meningioma with atypical features coded as meningioma (9530/0) or atypical meningioma (9539/1)? See Discussion.
Pathology report microscopic description: The tumor is a meningothelial neoplasm (EMA+; BCL-2 and CD34 negative) with prominent collagen deposition. Necrosis and prominent nucleoli are present; no other atypical features are seen. Mitoses are present, up to 2 per 10 high-powered fields. Final Diagnosis: Dura, bicoronal craniotomy (specimen A): Meningioma with atypical features.
There is no rule in benign brain and CNS section of Multiple Primary/Histology (MP/H) Rules stating to code the most specific histologic term when the diagnosis is (something less specific, i.e., adenocarcinoma). This rule is in other site chapters of MP/H but appears missing in the benign brain and CNS section.
Code as meningioma, NOS (9530/0). This lesion has some of the features of an atypical meningioma (necrosis and prominent nucleoli), but it does not fit the definition of atypical meningioma in WHO Classification of Tumors of the Central Nervous System. Use text fields to document the details.
Reportability/Histology--Testis: Is neoplasm consistent with carcinoid type of monodermal teratoma reportable as a teratoma, NOS, and if yes, what is the histology code?
Carcinoid type of monodermal teratoma or well differentiated neuroendocrine tumor (carcinoid), monodermal teratoma of the testis is reportable. Assign 8240/3 according to the WHO classification for this neoplasm.
Primary Site/Sarcoma--Breast: How should the primary site and stage be coded for osteosarcoma of breast? Is C509 correct or should the code be a different primary site? When assigning C509, the Collaborative Stage (CS) still pertains to breast cancer and AJCC stages it as a breast cancer and not as a sarcoma.
Code primary osteosarcoma of the breast to breast, C500-C509. Not all site and histology combinations can be staged in CS or AJCC. 9180/3 of breast cannot be staged using the CS breast schema. Breast (C500-C509) cannot be staged using the CS soft tissue schema. The same is true for AJCC. You can stage this case using SEER Summary Stage.
Important: Do NOT change the primary site or histology code based on whether or not the case can be CS or AJCC staged. We need to know how many cases are unable to be staged because of their primary site and histology combinations.
Race, ethnicity: How do you code race for someone from New Zealand?
I recently did a presentation on coding the data item Race. In my presentation I discussed understanding geography help code race in some circumstances. One of the slides demonstrates how large Polynesia is and what Pacific islands are found in Polynesia, such as, Tahiti, Samoa, and even Hawaii, all of which have their own codes. Someone in the audience asked "How do you code New Zealand? Upon some research, New Zealand is not listed in Appendix D of the SEER coding manual. We could code them 01-White. But research shows there is a very large indigenous population. Technically, New Zealand is located within the boundaries of Polynesia - Code 25 (Polynesian).
If the only information you have on race is that the person is from New Zealand, code race as white. This is based on the instructions for Australia, the closest neighbor to New Zealand as no other guidance was found.
MP/H Rules/Multiple primaries--Melanoma: Is a melanoma with an unknown laterality a different laterality for the purposes of applying Multiple Primaries/Histology Rule M4? See Discussion.
8/1/2016 Left Abdomen biopsy: Early melanoma in situ (C445-2, 8720/2).
Does rule M4 apply and multiple primaries should be reported or does rule M8 apply and a single primary should be reported?
Abstract multiple primaries following Multiple Primary Rule M4. Unknown laterality is a different laterality for the purposes of applying the MP/H rules for melanoma.
NOTE: This answer applies to cases diagnosed prior to 2018. As of 1/1/2018, early melanoma is not reportable.
Reportability/Histology--Skin: Is 'skin, left temporal scalp, low grade adnexal carcinoma, probable sweat gland origin' reportable as 8400/3, skin of temple?
Assign 8390/3 for adnexal carcinoma of skin. 8390/3 is reportable, including 8390/3 of skin.
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