Report | Question ID | Question | Discussion | Answer | Year |
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20110023 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported in a patient with a November 2009 diagnosis of refractory anemia and a 10/25/2010 biopsy diagnosis of refractory anemia with excess blasts type 2 with ringed sideroblasts that the clinician indicates actually demonstrates progression to AML? See Discussion. | Refractory anemia, NOS diagnosed in November 2009. The diagnosis on a bone marrow biopsy performed on 10/25/10 is myelodysplastic syndrome - refractory anemia with excess blasts type 2 with ringed sideroblasts. Per the medical oncologist, in the 12/16/10 clinic note it states, "Pt underwent bone marrow biopsy on 10/25/10 and ultimately this marrow demonstrates progression to AML.
When applying the Hematopoietic Rules, the refractory anemia, NOS and the myelodysplastic syndrome - refractory anemia with excess blasts type 2 with ringed sideroblasts is the same primary. However, the refractory anemia NOS and the AML are multiple primaries. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
First, note that myelodysplastic syndrome (MDS) is a term that includes a number of diseases. Refractory anemia, NOS and refractory anemia with ringed sideroblasts are types of MDS. These two diseases are an NOS and a more specific disease, which is accessioned as one primary per Rule M7.
Next, assess the change from refractory anemia to AML. In checking the Heme DB, AML is listed under transformations for refractory anemia with ringed sideroblasts. This patient has a chronic disease (refractory anemia with ringed sideroblasts) and an acute disease (AML). Per Rule M10, abstract as multiple primaries when a neoplasm is originally diagnosed in a chronic (less aggressive) phase AND second diagnosis of a blast or acute phase more than 21 days after the chronic diagnosis.
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. |
2011 |
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20100072 | Histology/Reportability--Heme & Lymphoid Neoplasms: Is a diagnosis of follicular lymphoma in situ of the gallbladder reportable for 2010? See Discussion. | Coding the histology to 9690 [Follicular lymphoma] with a behavior of 2 [in situ] causes many edits including SEER and CS edits to fail. According to the chief of pathology, this is a recently identified pathologic entity. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Currently, lymphoma in situ is not reportable. It is true that this is a recently identified pathologic entity. Our experts say that there is still some controversy to be ironed out regarding the criteria for identifying an in situ lymphoma. Their recommendation was to wait until clear guidelines had been established for the pathologists before we start collection of in situ lymphomas. We anticipate collecting these entities in the future.
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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20130160 | Histology--Heme & Lymphoid Neoplasms: Should the histology be coded to a therapy-related myeloid neoplasm when the physician states the diagnosis of acute myeloid leukemia is secondary to treatment with Imuran? See Discussion. | Patient has a diagnosis of AML for which the physician recommends a bone marrow transplant. The physician indicated the diagnosis is actually a secondary AML due to treatment with Imuran for polymyalgia rheumatica. The physician also stated this is a high risk type of AML. Imuran is not a chemotherapy agent per SEER*Rx. Can the histology be coded as 9920/3 (e.g., Therapy-related acute myeloid leukemia, NOS) when the patient has not been treated with chemotherapy for a reportable disease? The physician is a bone marrow transplant expert who states the AML is therapy-related disease. Bone marrow disease is a listed as a risk for treatment with Imuran. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code this histology to 9920/3 [therapy-related myeloid neoplasm] when the physician states the acute myeloid leukemia is therapy-related.
Therapy-related AML can result from any systemic therapy for benign or malignant diseases. In this case, AML resulted from immune system-suppressing therapy with Imuran for a benign disease, polymyalgia rheumatica. The drugs that induced the AML do not have to be listed in the SEER*Rx database.
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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20130037 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a "cutaneous diffuse large B-cell lymphoma, leg type" that has been verified as a valid diagnosis with prognostic factors including age and number of lesions on the legs? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code this histology to 9680/3 [diffuse large B-cell lymphoma]. Primary cutaneous DLBCL, leg type, is listed as an Alternate Name for DLBCL per the Heme DB.
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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20130096 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a mantle cell lymphoma found in the sigmoid colon on colonoscopy with biopsy? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to the sigmoid colon [C187] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ. Based on the information provided, the lymphoma is present only in the sigmoid colon.
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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20130104 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of intrasinusoidal diffuse large B-cell lymphoma involving lymph nodes, the liver and the bone marrow? See Discussion. | Intrasinusoidal DLBCL was diagnosed by liver biopsy. The bone marrow was involved based on abnormal cytogenetic findings. Per a physician's note, a PTA CT Abd/Pelvis showed hepatosplenomegaly and mild periportal/peripancreatic lymphadenopathy. A GI physician stated the lymphoma involves the veins of the liver.
Should the primary site be coded to the liver [C220] and the histology to 9680/3 [DLBCL]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to the intra-abdominal lymph nodes [C772] per Rule PH20.
Code the primary site to the specific lymph node region when multiple lymph node chains within the same region as defined by the ICD-O-3 are involved. Periportal and peripancreatic nodes are both intra-abdominal region nodes.
Based on the information provided, there is involvement of lymph nodes, the liver, spleen and bone marrow, but no other documentation of the primary site. Given that a primary lymphoma of the liver is very rare; it is unlikely that this lymphoma arose from the liver. Involvement of the liver and spleen is very common for patients with lymphoma. The involvement of the liver, spleen and bone marrow is coded in the CS fields as Stage IV involvement.
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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20130112 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of post-transplant lymphoproliferative disorder (PTLD) diagnosed on an inguinal lymph node biopsy with CT scan evidence of lymphadenopathy in the chest, abdomen and pelvis if the bone marrow is also involved? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to multiple lymph node regions, NOS [C778] per Rule PH21 when multiple lymph node regions, as defined by the ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated
In the Abstractor Notes section in the Heme DB for PTLD it states PTLD commonly involves lymph nodes, GI tract, lungs and the liver. This patient has extensive lymph node involvement. Rule PH26 states to code the primary site to the bone marrow when ONLY the bone marrow is involved; however, that does not apply in this case.
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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20130147 | Primary site--Heme & Lymphoid Neoplasms: What the primary site for a diagnosis of Langerhans cell histiocytosis with multifocal multisystem involvement of the skin, chest, CNS and thyroid, but no evidence of involvement on a bone scan? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C809 [unknown].
Langerhans Cell Histiocytosis (LCH) includes three major groups:
When the disease is both multifocal and multisystem, code the primary site to unknown [C809] because there is no way to identify the origin of the neoplasm in this situation.
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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20130080 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are the primary site and histology coded when a right neck mass and spinal mass both show B-cell lymphoma, favor Burkitt lymphoma? See Discussion. | 2/5/11 Right neck swelling. Biopsy of mass B-cell lymphoma, favor Burkitt lymphoma.
7/5/11 Hemi-laminectomy, L2-L5 spinal mass: Malignant lymphoma, B-cell phenotype, favor Burkitt lymphoma.
Should the primary site be C779? Is the correct histology Burkitt lymphoma [9687/3] or malignant lymphoma, diffuse large B-cell [9680/3]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C779 [lymph nodes] per Rule PH22 and the histology to 9591/3 [B-cell lymphoma, NOS].
Code the primary site to C779 [lymph nodes, NOS] when lymphoma is present in an organ and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. The patient has involvement of a lumbar spine mass and cervical lymph nodes. Cervical lymph nodes are not regional to the lumbar area of the spine.
Do not use ambiguous terminology to code histology for hematopoietic neoplasms. "Favor" is ambiguous terminology. Therefore, the histology must be coded to B-cell lymphoma and not to diagnosis which is "favored" (Burkitt lymphoma). Remember that ambiguous terminology is only used to determine case reportability, not to code histology for hematopoietic neoplasms.
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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20110037 | Primary site--Heme & Lymphoid Neoplasms: What primary site is coded for the 2010 cervical lymph node excision diagnosis of composite lymphoma that followed a 2002 history of follicular lymphoma involving lymph nodes and organs on both sides of the diaphragm? See Discussion. | The patient was diagnosed with a composite lymphoma of a cervical lymph node 8 years after diagnosis of follicular lymphoma that involved lymph nodes and organs on both sides of the diaphragm. The patient's follicular lymphoma was diagnosed in 2002.
In 2010 an excisional biopsy of a left neck lymph node showed classical Hodgkin lymphoma, nodular sclerosis type, grade 2 (predominant component) associated with (minor component) low grade follicular lymphoma (composite lymphoma).
Should the primary site for the 2010 primary be coded to C770 [lymph nodes of head, face & neck] or C778 [multiple lymph node regions]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C770 [lymph nodes of the head and neck]. Per Rule PH19, code the primary site to the specific lymph node region when only one lymph node or one lymph node region is involved. No involvement other than the cervical lymph nodes is mentioned for the disease in 2010.
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. |
2011 |