Report | Question ID | Question | Discussion | Answer | Year |
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20120030 | MP/H Rules/Histology- -Melanoma: What is the correct histology code if the final diagnosis for an excisional biopsy specimen is reported as "malignant melanoma, superficial spreading type" but the under the "cell type" section in the CAP protocol layout of the pathology report it lists "cell type: epithelioid"? See Discussion. |
The MP/H rules do not address the concept of "cell type" for melanomas when the pathologist uses the CAP protocol to report findings and the cell type listed in that section of the report differs from the specific cell type mentioned in the final diagnosis. Does a case have two specific cell types when the final diagnosis and the "cell type" sections of a single pathology report indicate two more specific melanoma histologies? Pre-2007 SINQ entries indicate the cell type should be coded. However, if it differs from the specific cell type listed in the final diagnosis does it matter? Do the MP/H rules still take the cell type into account? |
Code the histology to malignant melanoma, superficial spreading type [8743/3] based on the final diagnosis. For cases diagnosed 2007 or later, the steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules manual. For a melanoma primary, use the Melanoma Histology rules to determine the histology code because there are site specific rules for cutaneous melanomas. Start at Rule H1. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H10. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the more specific histologic term when the diagnosis is melanoma, NOS [8720] with a single specific type (i.e., superficial spreading) mentioned in the final diagnosis. The final diagnosis takes precedence over the CAP protocol. The CAP protocol may be used when it provides additional or noncontradictory information, but that does not apply in this case. |
2012 |
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20120055 | Surgery of Primary Site--Kidney, renal pelvis: How do you code a laparoscopic renal mass core biopsy followed by cryoablation of the tumor? See Discussion. | The note under the local tumor destruction codes states "No specimen sent to pathology from this surgical event 10-15." The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted? | Code for Surgery of Primary Site to 13 [Cryosurgery]. While the core biopsy provided a pathology specimen, it is not coded as surgery of the primary site. | 2012 |
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20120059 | Primary site/Reportability--Breast: Is a "right nipple skin" biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See Discussion. | In the 2011 SEER Manual Reportability Examples, example 3, it states a "biopsy-proven squamous cell carcinoma of the nipple" is reportable when the subsequent resection shows "no evidence of residual malignancy in the nipple epidermis." However, this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500. | Because the site is specifically stated to "skin" of nipple [C44.5], this case is not reportable.
If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain a full-thickness of skin and subcutaneous breast (nipple) tissue. If that is the case, this tumor would likely be a reportable squamous cell carcinoma of nipple [C50.0]. If, however, this was a punch biopsy it is more likely a non-reportable squamous cell carcinoma of the skin [C44.5]. |
2012 |
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20120027 | MP/H Rules/Histology--Colon: How is histology coded if a patient has two frank invasive adenocarcinomas in one segment of the colon and multiple tubular adenomas and hyperplastic polyps throughout the entire colon without a diagnosis of familial polyposis [FAP]? See Discussion. | Does Rule H19 apply which indicates the histology is coded to 8221 [adenocarcinoma in multiple adenomatous polyps] because there are multiple polyps (number not specified) throughout the colon? Does tumor have to arise in at least one of the adenomas in order to apply Rule H19? Or, does Rule H22 apply which indicates the histology is coded to 8140 [adenocarcinoma, NOS] because the adenocarcinomas are both frank invasive adenocarcinomas and not adenocarcinoma arising in an adenoma? |
Code the histology as adenocarcinoma, NOS [8140/3].
For cases diagnosed 2007 or later, the steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Colon Histology rules to determine the histology code for this case. The Module you use depends on the behavior and number of tumors identified in the primary site.
Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module Rule H15. The rules are intended to be reviewed in consecutive order from Rule H15 to Rule H24. Stop at the first rule that applies to the case you are processing. Code the histology when only one histologic type is identified. In this case, the only histology present was adenocarcinoma, NOS [8140/3].
Rules H17 through H21 do not apply in this case because there is no malignancy arising in any of the adenomas or polyps scattered throughout the colon. |
2012 |
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20120017 | Reportability: Is a low-grade neuroendocrine neoplasm with gastrin expression found in a periportal lymph node reportable if the clinical impression is compatible with a gastrinoma? See Discussion. |
SINQ 20110095 states that "low-grade neuroendocrine neoplasm/carcinoid tumor with expression of gastrin" is reportable. However, in this case "carcinoid tumor" is not mentioned. Is this case reportable if the expression "carcinoid tumor" is missing in the diagnosis of the pathology report? Also, does the fact that the gastrinoma was found in a lymph node affect reportability? |
This is a reportable case. Code the histology as malignant gastrinoma [8153/3]. Gastrinomas are usually malignant. This one is apparently present in a metastatic site (periportal lymph node) which confirms the malignancy. |
2012 |
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20120090 | First course treatment/Chemotherapy: Can a drug be coded as treatment for primary sites or histologies not listed for that drug in the SEER*Rx Database? See Discussion. | The patient was diagnosed with chronic myelogenous leukemia in 2008 followed by a diagnosis of chronic lymphocytic leukemia in 2011. Per the physician statement, the patient started nilotinib in 10/2011 for CML.
The SEER*Rx Database lists CML and GIST as the only primary site/histology combinations treated using nilotinib. Can nilotinib also be coded as treatment for the CLL primary? |
SEER*Rx lists the approved sites/histologies for each drug. However, if you have a physician statement that indicates the drug was given for another site/histology, code the agent as treatment for that site/histology. | 2012 |
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20120095 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a patient is diagnosed with inflammatory carcinoma of the left breast, (ductal with apocrine features type on biopsy), and an incidental lobular carcinoma in the right breast? See Discussion. | A 1.2 cm lobular carcinoma was incidentally discovered during the work-up of the patient's left breast that was inflammatory carcinoma. The lobular carcinoma on the right was localized without any skin involvement. Rule M6 indicates inflammatory breast carcinoma in either breast is a single primary. Does rule M6 apply when the patient has inflammatory carcinoma in one breast and a separate lobular carcinoma in the other? | For cases diagnosed 2007 or later, accession two primaries, ductal with apocrine features in the left breast and lobular carcinoma in the right breast.
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Breast MP rules because site specific rules exist for this primary.
Start at the MULTIPLE TUMORS module, rule M4. The rules are intended to be reviewed in consecutive order within a module. The patient has tumors in both the right and left breasts.
Rule M6 does not apply because inflammatory carcinoma involves only the left breast and the patient has a different histology in the right breast and there is no mention of inflammatory carcinoma in that breast. In this situation continue to the next applicable rule. |
2012 |
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20120081 | Reportability: Is VIN II-III reportable? |
For cases diagnosed 2021 and later VIN II-III is reportable based on ICD-O-3.2 which lists squamous intraepithelial neoplasia, grade II as 8077/2 making it reportable. Also see SINQ 20120094. |
2012 | |
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20120034 | Primary site--Brain and CNS: How is the primary site to be coded if a clinician used an MRI to diagnose a left cerebellar venous angioma? See Discussion. |
According to the WHO Classification of Brain/CNS Tumors, code 9122/0 (venous angioma) does not appear under tumors of the cerebellum (C716). |
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous angioma arising in the cerebellum is C490. The combination of 9122/0 and C490 is not reportable. Venous angioma is a venous abnormality, currently referred to as a developmental venous anomaly (DVA). |
2012 |
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20120058 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when the patient is diagnosed with an acute neoplasm (diffuse large B-cell lymphoma) per a pathology report and is subsequently diagnosed clinically with a chronic neoplasm (chronic lymphocytic leukemia/small lymphocytic lymphoma) less than 21 days later? See Discussion. | The patient was diagnosed with an extranodal DLBCL on a biopsy of the stomach. A bone marrow biopsy performed 16 days later showed no DLBCL, but demonstrated an abnormal CD5-positive B-cell population that was subsequently referred to as CLL/SLL by the physician. The peripheral blood was negative and showed only moderate thrombocytopenia.
Does rule M10 apply in this case? Abstract the acute neoplasm as a single primary (DLBCL) as there was only one pathology specimen (stomach biopsy) proving DLBCL and the bone marrow did not definitively identify CLL/SLL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as two primaries per Rule M11. Code the histology of one primary to 9680/3 [diffuse large B-cell lymphoma], the acute neoplasm. Code the histology for the second primary to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma], the chronic neoplasm.
Per Rule M11, abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach biopsy).
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. |
2012 |