Report | Question ID | Question | Discussion | Answer | Year |
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20021158 | Multiple Primaries/Histology--Lymphoma: What is the primary site(s) for a patient who had a lymph node biopsy with the histology of "large B cell lymphoma arising in the setting of low grade B cell lymphoma c/w marginal zone B cell lymphoma with plasmacytic features"? See discussion. | This patient also had a bone marrow biopsy that demonstrated "low grade B cell lymphoma." Per the clinician, "Pt with discordant lymphoma. We will be approaching his lymphoma as two different diseases. The large B cell had cleared after chemotherapy and radiation therapy. The low grade lymphoma is incurable." | For cases diagnosed prior to 1/1/2010: Code as two primaries with each arising in lymph nodes [C77._]. The histology for the first primary is 9699/3 [marginal zone B cell lymphoma]. The histology for the second primary is 9680/3 [large B cell lymphoma]. 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. |
2002 |
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20031031 | Reportability/Histology--Hematopoietic, NOS: What histology code is used for a patient diagnosed with "myelodysplasia" prior to 2001, if a bone marrow biopsy in 2002 is consistent with myelodysplastic syndrome with refractory anemia with bilineage dysplasia with excess blasts and the final impression is "myelodysplastic syndrome slowly evolving toward acute leukemia?" |
Patient was admitted in July 15, 2002. Per the H&P, patient was diagnosed 5 years ago with myelodysplasia. Patient had bone marrow biopsy about 5 years ago and then again on 6-10-02. Patient has become transfusion dependent since mid-March. Bone marrow on 6-10-02 was consistent with myelodysplastic syndrome with refractory anemia with bilineage dysplasia with excessive blasts. Impression: Myelodysplastic syndrome slowly evolving toward acute leukemia. Plan: start chemo. 7-16-02 bone marrow biopsy showed acute myeloid leukemia. Can we assume that the myelodysplasia diagnosed 5 years ago was refractory anemia and therefore, patient's first reportable diagnosis would be the AML? Or is the 6-10-02 bone marrow biopsy showing refractory anemia to be the first reportable diagnosis because the term "myelodysplasia" is non-specific? |
For cases diagnosed prior to 1/1/2010: Based on the information provided, the diagnosis date is June 2002. The diagnosis is 9895/3, acute myeloid leukemia with multilineage dysplasia (AML with prior myelodysplastic syndrome). According to the SEER table of hematopoietic diseases, refractory anemia and myelodysplastic syndrome followed by AML is one primary. Prior to 2001, a diagnosis of myelodysplasia was not reportable. 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. |
2003 |
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20031201 | Reportability/Terminology, NOS--Hematopoietic, NOS: Are the diagnoses "myelodysplastic syndrome," "myelodysplastic syndrome, thrombocytopenia" and "myelodysplastic syndrome, anemia" all reportable to SEER for diagnosis 2001 and later? | For cases diagnosed prior to 1/1/2010:"Myelodysplastic syndrome" (NOS) is reportable to SEER--ICD-O-3 code 9989/3. "Myelodysplastic syndrome, thrombocytopenia" is not reportable to SEER because "thrombocytopenia" is not reportable. "Myelodysplastic syndrome, anemia" is not reportable to SEER because "anemia" is not reportable. 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. |
2003 | |
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20061075 | Multiple Primaries--Lymphoma: Is a diagnosis of mycosis fungoides followed a year later with a biopsy proven diagnosis of anaplastic large T-cell lymphoma stated to represent a transformation of the previous mycosis fungoides reportable as one or two primaries? | For cases diagnosed prior to 1/1/2010: This is one primary. Code the histology according to the original diagnosis, mycosis fungoides. The physician states that this one disease process started as mycosis fungoides and progressed into lymphoma. A physician's statement has priority over other sources in determining the number of hematopoietic primaries. In October 2006, a committee will begin working on multple primaries among hematopoietic diseases. The committee will provide further guidance on dealing with disease transformation and other issues. 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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20061037 | Multiple Primaries/Histology--Lymphoma: If a gastric biopsy demonstrates large B cell lymphoma arising in a low grade MALT lymphoma, how many tumors should be abstracted and how should the histology field(s) be coded? See Discussion. | Final path for gastric biopsy on 12/2005 is "consistent with malignant lymphoma" and Micro says "morphologic findings consistent with MALT lymphoma and an increased proportion of large atypical cells is concerning for large cell transformation. However, since the large cells are present only focally, a definitive diagnosis of large cell lymphoma cannot be rendered" A second gastric biopsy a week later said: Final Path: Diffuse large B cell lymphoma arising in low grade MALT lymphoma. Micro says: "Compared to patient's previous biopsy...the current specimen contains a higher percentage of large atypical cells which stain positively for CD79a, a B cell marker. The morphologic and immunohistochemical findings are consistent with a large B cell lymphoma arising in a low grade MALT lymphoma." These are different primaries according to the table of single versus subsequent primaries of lymphatic and hematopoietic diseases. |
For cases diagnosed prior to 1/1/2010: This is one primary. Code as 9699 [Marginal zone B-cell lymphoma, NOS]. The first biopsy was not conclusive. The biopsy one week later was more definitive. The reports are describing a difference between specimens, not a difference in disease. According to the WHO classification, extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is an extranodal lymphoma with B-cells, cells resembling monocytoid cells, small lymphocytes and scattered immunoblast and centroblast-like cells. 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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20071131 | Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"? | For cases diagnosed prior to 1/1/2010: The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source. See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas. For cases diagnosed 1/1/10 and later, 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. |
2007 | |
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20061126 | Histology--Leukemia: How is a "plasmacytoid dendritic cell leukemia/lymphoma" coded when it is discovered on a bone marrow biopsy for a patient who presented with multiple enlarged lymph nodes and the discharge diagnosis was Type 2 plasmacytoid dendritic cell leukemia? | For cases diagnosed prior to 1/1/2010: The best code currently available for this entity is 9727/3 [precursor cell lymphoblastic leukemia]. The WHO classification refers to this as "Blastic NK-cell lymphoma." The 2005 WHO-EORTC classification for cutaneous lymphomas states that blastic NK-cell lymphoma may be derived from a plasmacytoid dendritic cell precursor. They suggest more appropriate terms for this condition may be "CD4+/CD56+ hematodermic neoplasm," and "early plasmacytoid dendritic cell leukemia/lymphoma." According to WHO, this is a rare form of lymphoma.
Willemze, et al. WHO-EORTC classification for cutaneous lymphomas. Blood, 15 May 2005. Volume 105, Number 10. 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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20061135 | Reportability--Hematopoietic, NOS: Is a "refractory cytopenia with excess blasts" discovered on a bone marrow biopsy reportable? | For cases diagnosed prior to 1/1/2010: Refractory cytopenia with excess blasts (RCEB) is reportable. RCEB is the same disease process as refractory anemia with excess blasts, except there is more than one type of blood cell that is low (red, white, platelets). 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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20010042 | Grade, Differentiation--Bone Marrow: Can we use the AJCC Cancer Staging Manual, which lists myeloma as a B cell neoplasm under non-Hodgkin lymphomas, to code Grade, Differentiation field for myeloma to B-cell (code 6)? | For cases diagnosed prior to 1/1/2010: No. Myeloma is a malignancy of plasma cells. Plasma cells are the daughters of B cells. So technically it would be correct to call them B cell, but that is not common usage.
Cell marker (phenotype) should be coded in the Grade, Differentiation field for only leukemias and lymphomas, as classified in the ICD-O-3. In the ICD-O-3, myeloma is listed under Plasma Cell Tumors, not Lymphomas. When a cell marker is coded for a leukemia/lymphoma it should be coded only from pathology and/or cytology reports.
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. |
2001 | |
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20061079 | Histology--Lymphoma: Is histology for "large B-cell lymphoma evolving from extranodal marginal zone B-cell lymphoma" coded to 9680/3 [Malignant lymphoma, large B-cell, diffuse, NOS] or 9699/3 [Marginal zone B-cell lymphoma]? | For cases diagnosed prior to 1/1/2010: Code the histology as 9699 [marginal zone B-cell lymphoma]. Code the histology from the original diagnosis. 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 |