Histology (Pre-2007)--Colon: What code is used to represent the histology "adenocarcinoma arising in a papillary adenomatous polyp"? See discussion.
Is "adenocarcinoma arising in a papillary adenomatous polyp" equivalent to adenocarcinoma in a villous adenoma [8261/3] or adenocarcinoma in an adenomatous polyp [8210/3]?
For tumors diagnosed prior to 2007:
Code the Histology field to 8261/3 [adenocarcinoma in a villous adenoma]. In describing colon polyps, papillary and villous are equivalent terms.
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.
Heme and Lymphoid Neoplasms/Multiple Primaries--Myeloproliferative Neoplasms: Are essential thrombocytosis (ET) in 1998 and primary myelofibrosis in 2022 the same primary or is the 2022 diagnosis a new primary? See Discussion.
Patient was diagnosed with essential thrombocytosis 9962/1 or 3 in 1998 (depending if ET was reportable in 1998), treated with Hydrea.
11-17-2022 Blood smear: CALR + myeloproliferative neoplasm, Most Consistent with Primary Myelofibrosis 9961/3 (Noted CALR and ASXL1 mutations).
The following abstractor note from 9661/3 is confusing: A diagnosis of "post essential thrombocythemia myelofibrosis" is a progression of essential thrombocythemia and would be the same primary.
Abstract two separate primaries, ET (9962/3) and primary myelofibrosis (9961/3) using the current Hematopoietic and Lymphoid Neoplasms (Heme) Manual and Database (DB), Rule M15, use the Heme DB Multiple Primaries Calculator. Also refer to the example in Rule M15. In 1998, though the ET was not reportable (9962/1), the patient was treated with chemotherapy as a malignant neoplasm (9962/3). The Calculator instructs us to code separate primaries for these two histologies.
ET may evolve into a secondary myelofibrosis, also known as post-essential thrombocythemia-myelofibrosis (post-ET MF). The diagnosis must be stated as post-ET MF; this would be a single primary.
Heme & Lymphoid Neoplasms: Is a clinical remission sufficient to change the tumor status to "disease free" for a patient on long-term chemotherapy for a diagnosis of either a chronic hematologic disease, such as CML, or a myeloproliferative disorder, such as essential thrombocythemia? See Discussion.
For some patients with chronic hematologic diseases, the disease/recurrence status could change frequently as chemotherapy is started and stopped over an extended period of time. Should the tumor status for these cases always be "not disease free"? When the physician documents the patient is in clinical remission, does their status change to "NED or disease free?" There seems to be a lot of variation across the US in how registrars are coding this field. Clarification would be appreciated.
The term "disease free" is not used in a standard fashion for hematopoietic and lymphoid neoplasms.
Code the cancer status to free of disease when the physician indicates NED. For hematopoietic and lymphoid neoplasms, a physician's statement of NED, disease-free, clinical remission or no evidence of disease at this time, should be recorded with cancer status to disease free. The term "disease free" or NED means that there is no clinical evidence of disease.
Heme & Lymphoid Neoplasms/Histology--Myelodysplastic Neoplasm: What is the histology code for myelodysplastic neoplasm with low blasts and SF3B1 mutation with primary site bone marrow (C421) diagnosed in 2023?
Assign histology as 9982/3 (myelodysplastic neoplasm with low blasts and SF3B1 mutation). This is a new term for 9982/3. WHO Classification of Hematolymphoid Tumors, 5th edition, defines myelodysplastic neoplasm (MDS) with low blasts and SF3B1 mutation (MDS-SF3B1) as a myeloid neoplasm with cytopenia and dysplasia characterized by SF3B1 mutation and often ring sideroblasts.
Hematologic Transplant and Endocrine Procedures--Breast: Is a bone marrow transplant first course of cancer-directed therapy for breast cancer? If yes, are time guidelines relating to the first "remission" the same as for those used in leukemia primaries?
For cases diagnosed 1/1/2003 and after: A bone marrow transplant can be first course of therapy for cases in which there has been no progression of disease between the initial therapy (e.g., surgery, radiation, chemotherapy) and the bone marrow transplant. Code Hematologic Transplant and Endocrine Procedures field to 10-12 or 40 (depending on the type of bone marrow transplant performed).
Do not use leukemia treatment time guidelines when coding breast cancer treatment.
Grade: If the biopsy site is a higher grade, is the grade of the biopsy used over the grade of the surgical resection? See Discussion.
When coding tumor grade, our pathologists have told us to code grade based on the specimen from the most definitive surgery or with the most amount of tissue, and that coding grade from the biopsy would not be appropriate even if it is a higher grade than from the surgical resection. Coding of solid tumors Instruction 5 states: If there is more than one grade, code the highest grade within the applicable system. Code the highest grade even if it is only a focus. Code grade in the following priority order using the first applicable system.
For cases diagnosed prior to 2018: Use the Grade Coding Instructions to code grade. The instructions are intended to standardize coding of grade across the U.S. and to eliminate differences in opinion between pathologists. Standardized coding ensures that data can be combined and used for statistical analysis.
You may code grade based on the biopsy when following the grade coding instructions.
Grade: Can the FIGO grade be used to code the morphologic grade? See discussion.
FIGO Grade is coded in CS SSF 7 in the Corpus Uteri schema. The SEER Manual does not address using FIGO grade for coding grade in morphology.
Do not use FIGO grade to code the grade field. See the sentence below the table in Instruction #6 in the Grade Coding Instructions for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/
Grade/Sarcoma--Breast: Is the correct grade for high grade angiosarcoma of the breast a code 3 or 4? The breast usually uses a three grade system but sarcoma is not a typical histologic type of the breast.
Assign grade code 4 using the sarcoma table. Nottingham or Bloom-Richardson (BR) Score/Grade does not apply to angiosarcomas. This is a good question and points out needed clarification of the grade rules.
Grade/Neuroblastoma: What grade is to be used when pathology states only differentiating retroperitoneal neuroblastoma?
For cases diagnosed prior to 2018
Assign grade code 2 for "differentiating" retroperitoneal neuroblastoma. The rationale of our expert pathologist advisor is that "it leaves the grade 1 category open (since a "well differentiated neuroblastoma" is actually called ganglioneuroblastoma), and it also avoids putting "differentiating" into what is usually a well differentiated category."
Additionally, assign grade code 3 to a poorly differentiated retroperitoneal neuroblastoma and grade code 4 to an undifferentiated retroperitoneal neuroblastoma.
For cases diagnosed 2018 and later
Follow the instructions for coding grade in SEER*RSA
Grade/Histology--Rectum: How should histology and grade be coded for high grade neuroendocrine tumor (NET) (WHO Grade 3) of the rectum? See Discussion.
Rectal mass biopsy final diagnosis: High grade neuroendocrine tumor (WHO Grade 3). Neither SINQ 20170033 nor 20160023 address coding histology or grade for neuroendocrine tumors that are designated as high grade and/or WHO grade 3.
Assign histology code 8246/3. Assign grade code 4 based on the description "high grade." A high-grade neuroendocrine "tumor" is actually a neuroendocrine "carcinoma" (NEC) according to WHO Classification of Tumors of the Digestive System. If possible, verify this interpretation with the diagnosing pathologist. Use text fields to document the details of this case.
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