Neoadjuvant Treatment/Date Therapy Initiated--Breast: If Tamoxifen has been used since 2000 for the treatment of hyperplasia, should it be coded as neoadjuvant treatment for a 2004 diagnosis of breast cancer?
Do not code tamoxifen given for hyperplasia as treatment for breast cancer. In this case, tamoxifen started four years before the breast cancer diagnosis -- not treatment for breast cancer.
Multiple Primaries (Pre-2007)--Brain and CNS: Is neurofibromatosis a separate and distinct primary in the presence of a longstanding glioma? Does the following show one or two primaries? See Discussion.
MRI of Brain: 1. Findings compatible with left optic nerve glioma. 2. Stable enhancing focus in left temporal white matter. Lack of interval change since Dec 2000 suggests a white matter finding typical of neurofibromatosis and makes more aggressive processes such as astrocytoma less likely. Small aneurysm can not be excluded.
For tumors diagnosed prior to 2007:
Neurofibromatosis and glioma would be separate brain/CNS primaries.
However, there is only one primary in the case example above: Glioma, left opic nerve. "...suggests a white matter finding typical of neurofibromatosis" is not reportable. "Suggests" is not a reportable term. Therefore, in this example neurofibromatosis is not reportable unless there is a more definitive statement in the record.
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.
Reportability: Is a "pleomorphic hyalinizing angiectatic tumor of soft parts (PHAT)" reportable if the case has a TNM stage assigned and is stated by the pathologist to be a rare intermediate grade sarcoma?
Pleomorphic hyalinizing angiectatic tumors of the soft parts are not reportable.
According to our pathologist consultant, PHAT is a borderline malignancy (/1). While the true nature of these tumors is under debate (reactive vs. neoplastic), so far none have metastasized.
Histology (Pre-2007)--Bladder: How is a "carcinoma with squamous, mucinous, and signet ring cell features" coded?
For tumors diagnosed prior to 2007:
Code histology to 8490 [Signet ring cell carcinoma]. Rule 7 on page 87 of the 2004 SEER Manual applies to this case.
Rule 7: Code the numerically higher ICD-O-3 code. This is the rule with the lowest priority and should be used infrequently.
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.
Histology--Hematopoietic, NOS: How is an "advanced MDS (RAEB-T)/emerging AML" coded when discovered on a bone marrow biopsy?
For cases diagnosed prior to 1/1/2010:Code histology to 9984/3 [RAEB-T]. This particular MDS is refractory anemia with excess blasts in transformation. It has not yet progressed to acute myeloid leukemia.
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.
Reportability--Colon: Is a pathologically confirmed "tubulovillous adenoma with high grade dysplasia" reportable if clinical diagnosis at the time of the subsequent re-biopsy states "follow-up for colon polyps with ca in situ"? See Discussion.
SINQ 20000245 states that high grade dysplasia is not synonymous with behavior code 2 (in situ). However, the 2004 SEER manual states that "cases clinically diagnosed are reportable. If the physician treats a patient for cancer in spite of the negative biopsy, accession the case."
A pathologic diagnosis has priority over a clinical diagnosis. According to the pathologist, this case is not reportable. A re-biopsy is not treatment.
Histology (Pre-2007)--Melanoma: Is the code 8740/3 [malignant melanoma in a junctional nevus] to be used when the pathologic diagnosis is "malignant melanoma arising in a compound nevus"?
For tumors diagnosed prior to 2007:
Assign code 8720/3 [malignant melanoma, NOS] for malignant melanoma arising in a compound nevus. A compound nevus is not the same as a junctional nevus.
ICD-O-3 does not have a specific code for melanoma in a compound nevus. Assign the code for the type of melanoma specified; for example, NOS, superficial spreading, etc.
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 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.
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