Solid Tumor Rules (2018)/Histology--Lung: If the pathology states non-small cell carcinoma of the lung (NSCLC), consistent with squamous cell carcinoma, is the code non-small cell carcinoma according to the Solid Tumor Rules? The Medical Oncologist states that the tumor is a squamous cell carcinoma. In these instances would you code the squamous cell carcinoma since you have a definite physician statement?
Code the histology to SCC 8070/3.
Based on registrar feedback on the NSCLC rule, we added a rule that specifically addresses when ambiguous terminology can be used to code histology other than NSCLC. The lung rules were update 10/12/2018 so please make sure you are using the currently posted rules. The new rule is: Rule H3-Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma (such as adenocarcinoma, squamous cell carcinoma, etc.) when:
* Clinically confirmed by a physician (attending, pathologist, oncologist, pulmonologist, etc.)
* Patient is treated for the histology described by an ambiguous term
* The case is accessioned (added to your database) based on ambiguous terminology and no other histology information is available/documented
Example 1: The pathology diagnosis is NSCLC consistent with adenocarcinoma. The oncology consult says the patient has adenocarcinoma of the right lung. This is clinical confirmation of the diagnosis, code adenocarcinoma.
Surgery of Primary Site--Breast: How is this field coded for cryosurgery of the breast?
For cases diagnosed 2003 and later: For cryosurgery alone, without a pathology specimen, assign site-specific surgery code 19 [Local tumor destruction, NOS]. Cryosurgery, cryotherapy or cryoablation uses extreme cold to destroy the tumor cells.
If a specimen is sent to pathology use code 20 [Partial mastectomy, NOS] rather than code 19.
If cryosurgery is followed by further surgery, do not use code 19.
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.
Multiple Primaries--Brain and CNS: How many primaries should be recorded in a patient with von Hippel Lindau disease that has a hemangioblastoma of the cerebellum in 2003 and a hemangioblastoma of the brainstem in 2007?
A tumor of the cerebellum (C716) and a tumor of the brainstem (C717) are multiple primaries because the topography codes are different at the fourth character of site.
EOD-Extension--Kidney: If a "tumor thrombus" in a renal vein is discontinuous from the primary tumor in the kidney, is it still coded to 60 [Tumor thrombus in a renal vein, NOS], rather than 85 [Metastasis]?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 60 [Tumor thrombus in a renal vein, NOS]. A thrombus can be a bolus of tumor cells within a large vein that may or may not still be connected/contiguous with the primary tumor. However, both a discontinuous and contiguous thrombus are coded to 60.
Reportability/Recurrence (Pre-2007)--Bladder: If a patient has had recurrent invasive bladder cancers since 1971, should the latest recurrence in 2003 be SEER reportable because the case has yet to be reported to SEER?
For tumors diagnosed prior to 2007:
Because this 2003 recurrent bladder cancer was initially diagnosed prior to 1973, it is not reportable to SEER.
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.
Multiple primaries--Lymphoma: Is a splenectomy done for non-Hodgkin lymphoma diffuse large B-cell of the spleen a composite histology and a single primary if a perihilar lymph node with Hodgkin lymphoma classic type is found at the time of this surgery?
For cases diagnosed prior to 1/1/2010:This is two primaries -- Non-Hodgkin lymphoma (NHL) in the spleen and Hodgkin lymphoma (HD) in a lymph node.
Composite lymphoma is NHL and HD both in a single lymph node.
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.
Multiple primaries--Heme & Lymphoid Neoplasms: Is a new bone marrow diagnosis of acute myelogenous leukemia that follows a 2007 treated diagnosis of a JAK-2 positive polycythemia vera a new primary?
Per Rule M10, abstract two primaries. Per the Heme DB, polycythemia vera [9950/3] transforms to an acute myelogenous leukemia [9861/3]. According to Rule M10, one is to abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (e.g., polycythemia vera) AND there is a second diagnosis of an acute neoplasm (e.g., acute myelogenous leukemia) 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.
Multiplicity Counter--Ill-defined sites: How is this field coded for Ill-Defined sites (C760-C768)?
Code the number of tumors present if known. If the number of tumors present is not known, code 99 [unknown number of tumors, unknown if multiple tumors].
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