Report | Question ID | Question | Discussion | Answer | Year |
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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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20130161 | Primary Site--Heme & Lymphoid Neoplasms: Is the primary site coded to C779 or C421 for a bone marrow that is positive for B-cell acute lymphoblastic leukemia, the peripheral blood demonstrates leukemic involvement and the PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones? See Discussion. | 1/11/13 Bone marrow bx: B-cell acute lymphoblastic leukemia. Flow cytometry of peripheral blood shows leukemia involvement.
PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones. The patient has an elevated WBC, anemia and thrombocytopenia.
The answer to SINQ 20120047 (which is no longer visible in the system) said to code B lymphoblastic leukemia/lymphoma to bone marrow for primary site if there is bone marrow involvement. The Heme/Lymph Manual Rule PH7 says to code bone marrow as the primary site if bone marrow is the only site involved.
Following the manual, the primary site would be C779. However, according to the answer to SINQ 20120047, the primary site would be C421. Which is correct? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per the Heme DB, the histology B-cell acute lymphoblastic leukemia is synonymous with B lymphoblastic leukemia/lymphoma, NOS. Per Rule PH8, for a neoplasm that can manifest as either leukemia lymphoma or leukemia lymphoma, one is to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. The Note 4 instruction states it is necessary to go to Module 7 (Rules PH18-PH27) to code the more specific primary site. In this case, use Rule PH22 to code primary site to C779 [lymph nodes, NOS] for the case you describe.
In this case, there is involvement of abdominal lymph nodes, spleen, bone marrow and bone. There is no indication of the primary site. Per the Heme DB, the most frequent sites of involvement for the lymphoma are bone and lymph nodes. This is a Stage IV lymphoma.
The now inactivated SINQ 20120047, stated that based on the sites of involvement, this histology could be coded as either leukemia or lymphoma. If the only involvement is the bone marrow, the site is coded to C421 [bone marrow]. The involvement of peripheral blood does not change the primary site because such involvement is part of the leukemic process.
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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20130195 | Laterality--Heme & Lymphoid Neoplasms: Is laterality coded to 0 [not paired] for all lymphoma cases including paired sites (e.g., breast, lung)? | Laterality coding for lymphomas is based on the primary site not histology. Laterality describes the side of a paired organ or side of the body on which the reportable tumor originated. Determine whether laterality should be coded for each primary.
Laterality coding instructions are located in the SEER Program Coding and Staging Manual. See pages 68-70 in the 2013 manual, http://www.seer.cancer.gov/manuals/2013/SPCSM_2013_maindoc.pdf. |
2013 | |
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20120038 | Reportability/Histology--Heme & Lymphoid Neoplasms: Is Monoclonal B-lymphocytosis of uncertain significance (MLUS) reportable? If so, what is the correct histology code? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, monoclonal B-lymphocytosis of uncertain significance (MLUS) is not reportable.
Some papers point out that a lymphocyte count less than five thousand is equivalent to monoclonal B-lymphocytosis of uncertain significance (MLUS) or monoclonal B-cell lymphocytosis (MBL). A lymphocyte count of five to thirty thousand could be smoldering chronic lymphocytic leukemia (CLL). The diagnosis of MLUS is a benign process that does not meet the criteria for CLL.
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 | |
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20120050 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what histology codes apply if a patient has a 1998 diagnosis of essential thrombocythemia and a recent clinical diagnosis of secondary myelofibrosis? See Discussion. | The patient has a history of essential thrombocythemia (ET) since 1998. This has been treated daily with aspirin. A recent bone marrow biopsy was consistent with myeloproliferative disorder with excess blasts, marked extensive reticulin marrow fibrosis with osteosclerosis, excess blasts (11%) in the marrow aspirate and peripheral blood. JAK2 mutation was present in a small minority of cells. The physician stated patient was, "considered to have secondary myelofibrosis and was started on Jakafi." | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, a secondary myelofibrosis is not a reportable case.
Secondary myelofibrosis is not listed as a synonym for primary myelofibrosis in the Heme DB. The term "secondary myelofibrosis" means that the myelofibrosis was caused by, in this case, the essential thrombocythemia.
The diagnosis "consistent with myeloproliferative disorder" is also not a new reportable diagnosis. "Myeloproliferative disorder" refers to a group of diseases (an NOS category) that includes essential thrombocythemia, which was originally diagnosed in 1998, prior to reportability for this disease type.
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 |
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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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20120051 | MP/H Rules/Histology--Breast: What histology code for a diagnosis of pleomorphic lobular carcinoma in situ? | For cases diagnosed 2007 or later, code the histology as lobular carcinoma, in situ [8520/2].
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 Histo rules because site specific rules exist for this primary.
Start at the SINGLE TUMOR: IN SITU CARCINOMA ONLY module, Rule H1. The rules are intended to be reviewed in consecutive order. Stop at the first rule that applies to the case you are processing. Code the histology to lobular carcinoma in situ [8520/2] because this is the only histologic type identified.
Pleomorphic lobular carcinoma is a variant of lobular carcinoma which does not have an ICD-O-3 code. It is still a lobular carcinoma. The identification of the variants of lobular carcinoma was a relatively recent discovery and the information was not available when the 2007 MP/H Rules were written. All of the lobular variants will be included in the next revision of the MP/H Rules. |
2012 | |
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20120092 | MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence? See Discussion. | 7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.
3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and "there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence."
Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a "recurrence" of the 7/12/2007 diagnosis after reviewing the slides? |
For cases diagnosed 2007 or later, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007.
The steps used to arrive at this decision are:
Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.
General Information Rule 7 states "Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary."
Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary. |
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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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 |