Report | Question ID | Question | Discussion | Answer | Year |
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20120057 | Reportability--Appendix: Is a low grade mucinous neoplasm of uncertain malignant potential with an in situ mucinous cystadenoma component reportable? See Discussion. | The patient was diagnosed with pseudomyxoma peritonei and the pathology report final diagnosis stated, "Low grade mucinous neoplasm, of uncertain malignant potential, involving a dilated appendix (5cm) with the following features: In situ mucinous cystadenoma component is identified, with low-grade cytology of neoplastic epithelium." Does the presence of an in situ component make this mucinous cystadenoma of the appendix reportable based on the ICD-O-3 matrix rule? | This diagnosis is not reportable. Cystadenoma is not reportable. The "in situ" description in this case does not make cystadenoma reportable.
According to our expert pathologist consultant, this is a "non-invasive, low grade, epithelial proliferation in an often cystic appendiceal tumor, 8480/1. If this has leaked or ruptured it can seed the peritoneal cavity causing pseudomyxoma peritonei." |
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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20120068 | Histology--Heme & Lymphoid Neoplasms: What is the correct histology code for a diagnosis of mature B cell leukemia/lymphoma diagnosed only on a peripheral blood smear? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9591/3 [B-cell lymphoma, NOS].
After searching the Heme DB for the term , no B-cell leukemia/lymphoma NOS code is found. However, the diagnosis of B-cell lymphoblastic leukemia/lymphoma is found. This case scenario does not specify that this is a lymphoblastic leukemia/lymphoma; therefore, the histology code 9811/3 [B-cell lymphoblastic leukemia/lymphoma, NOS] cannot be applied.
A subsequent search of the Heme DB for the term returns "Non-Hodgkin lymphoma, NOS" [9591/3]. Under the Alternative Names section of the Heme DB, B-cell lymphoma, NOS, is a synonym for Non-Hodgkin lymphoma, NOS. Therefore, the B-cell lymphoma NOS code [9591/3] is the most appropriate histology code to use for this case.
This will be added to the next revision of the Heme DB and Manual.
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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20120075 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for chronic lymphocytic leukemia/small lymphocytic lymphoma when a lymph node biopsy was positive for CLL/SLL but no bone marrow biopsy was performed? See Discussion. | A right neck lymph node biopsy and flow cytometry proved CLL/SLL. The PET scan showed multiple involved lymph nodes in the right cervical, mediastinal and para-aortic areas. No bone marrow biopsy was done. Per the Hematopoietic DB, Module 3, the histology should be coded 9823/3 [CLL/SLL], but how is primary site coded? The manual states to code the primary site to the involved lymph node region when there is no bone marrow involvement, but it does not specifically address how to code the primary site when no bone marrow biopsy or peripheral blood smear was done. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C77.8 [multiple lymph node regions, NOS].
Per Rule PH6, code the primary site to the involved lymph node region(s) when there is no bone marrow involvement or when it is unknown whether the bone marrow is involved. To determine the more specific lymph node subsite to code, use Rule PH21. It indicates one is to code the primary site to C778 [multiple lymph node regions, NOS] when multiple lymph node regions, as defined by the ICD-O-3 (see Table C1: Lymph Node/Lymph Node Chain Reference Table in Appendix C), are involved and it is not possible to identify the lymph node region where the lymphoma originated.
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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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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20120087 | MP/H Rules/Histology--Kidney: How is the histology coded and what rule(s) apply for "cyst associated renal cell carcinoma," "cystic renal cell carcinoma," and "cystic renal cell carcinoma, clear cell type"? See Discussion.
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Per SINQ 20031008, these histologies were all coded as 8316/3 [cyst associated renal cell carcinoma]. What are the correct codes for these histologies using the 2007 MP/H Rules?
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For cases diagnosed 2007 or later, the correct histology code for both cyst associated renal cell carcinoma and cystic renal cell carcinoma is 8316/3. The histology code for cystic renal cell carcinoma, clear cell type is 8255/3.
The steps used to arrive at these decisions are:
Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Kidney Histology rules because site specific rules have been developed for this primary.
Step 2: For the first histology, cyst associated renal cell carcinoma, start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H5. According to this rule you are to use Table 1 if you have a renal cell carcinoma and mention of a more specific renal cell type. To locate Table 1, go to Kidney under the Terms & Definitions section. Per Table 1, titled Renal Cell Carcinomas and Specific Renal Cell Types, "cyst associated" is a specific type of renal cell carcinoma. Code the histology to 8316/3 [cyst associated renal cell carcinoma].
Step 3: For the second histology, cystic renal cell carcinoma start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H5. As in the previous example you are to use Table 1 if you have a renal cell carcinoma and mention of a more specific renal cell type. Per Table 1 "cystic" is a specific type of renal cell carcinoma. Code the histology to 8316/3 [cystic renal cell carcinoma].
Step 4: For the third histology, cystic renal cell carcinoma, clear cell type, start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H6 which states you are to code histology to 8255 (adenocarcinoma with mixed subtypes) when there are two or more specific renal cell carcinoma types. To determine whether "clear cell" and "cystic" are types of renal cell carcinoma use Table 1 again. According to Table 1, both cystic and clear cell are specific types of renal cell carcinoma. Code the histology as 8255/3 [adenocarcinoma with mixed subtypes].
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2012 |
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20120048 | MP/H Rules/Primary site: Can you clarify how you interpreted the term "synchronous" to appropriately code the primary site to C68.9 [urinary tract] for SINQ 20110119 and did not use that code for SINQ 20100025 when both cases used MP/H Rule M8 to determine the number of primaries? See Discussion. | In SINQ 20100025 a patient was diagnosed with multiple urinary system tumors over a year apart. Rule M8 applies (single primary) and the primary site was left coded to the original primary site, C65.9 [renal pelvis]. In SINQ 20110119 a patient is diagnosed with multiple urinary system tumors within a month of each other, again rule M8 applies (single primary) and the primary site was coded to C68.9 [urinary system, NOS].
In both cases, rule M8 applies. However, the tumors were not diagnosed synchronously (e.g., one month apart in one case and greater than one year apart in the other). When the SINQ answer states, "same time" or "synchronous" does this mean during the same event? If not, what is the time range for "same time" or "synchronous"?
Please clarify when it is appropriate to code the primary site to C68.9 [urinary system, NOS] for Rule M8 and when it is not. |
For the purpose of applying the MP/H rules, the term "synchronous" means that the two diagnoses occurred at the same time or less than or equal to 60 days apart.
The case in SINQ 20100025 was not synchronous. The first lesion in the renal pelvis [C65.9] occurred in 1/08 and the subsequent tumors were diagnosed in 5/09, more than one year apart. In this case, you do not go back to change the primary site code on the original abstract.
The case in SINQ 20110119 was diagnosed synchronously, the first lesion in the bladder [C67.9] was diagnosed in 11/09 and the second lesion in the renal pelvis [C65.9] was diagnosed in 12/09, less than 60 days apart. Because the lesions were synchronous, the primary site is coded urinary system, NOS [C68.9]. |
2012 |
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20120045 | Primary site--Heme & Lymphoid Neoplasms: What is the primary site of a diffuse large B-cell lymphoma described on a PET and an abdominal CT scan as a large pelvic mass displacing bladder and uterus, inseparable from anus, right pelvic sidewall, cervix and bilateral ovaries and per the clinician as stage IIE? See Discussion. | PET: large pelvic mass displacing bladder and uterus, inseparable from anus, right pelvic sidewall, cervix and bilateral ovaries. Diffuse abnormal uptake within this mass as well as the adjacent structures. No regional hypermetabolic adenopathy is noted and no imaging evidence of distant metastatic disease. The PET also demonstrated diffuse abnormal uptake within the pelvic mass as well as the adjacent structures.
CT abdomen: large pelvic mass invading vagina and inseparable from the anus, right pelvic sidewall, cervix and bilateral ovaries.
MD states: "stage IIE with invasion of vagina." |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule 18, code the primary site to C775 [pelvic lymph nodes]. Per Rule PH18, code the primary site to the specified lymph node region when the site of lymphoma is described only as a mass. This rule also indicates that the Code pelvic lymph nodes [C775] when the lymph nodes are described as a pelvic mass.
This rule has been effect for SEER for over 20 years. It is based on the fact that a number of lymphomas that originate in nodes are not diagnosed until those nodes become matted or fixed. The presentation is then one of a "mass" in those nodal regions.
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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20120086 | Primary site: What is the single primary site used for a patient with multiple tumors in the duodenum and jejunum? See discussion. | The patient has a tumor in the jejunum and another tumor in the duodenum. Both tumors have the same histology. This disease process is a single primary per Other Sites Rule M18. Is the primary site coded to the more invasive tumor? If the tumors are equally invasive, is the primary site coded to C179? | Code the primary site to C179 [small intestine, NOS] for multiple invasive tumors of the small intestine accessioned as a single primary.
The steps used to arrive at this decision are:
Step 1: Go to the Primary Site subsection located in Section IV of the 2012 SEER Manual titled "Description of This Neoplasm."
Step 2: Apply instruction 5. "Code the last digit of the primary site code to '9' for single primaries, when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined." Code the primary site to C179 [small intestine, NOS].
When multiple tumors arising in different subsites are accessioned as a single primary, the primary site is coded to the NOS code, in this case small intestine, NOS [C179]. The level of invasion does not determine the primary site, unless one or more of the tumors is in situ and another is invasive. |
2012 |
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20120036 | Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C779 or C809 when a patient is diagnosed at another facility with mantle cell lymphoma and the staging bone marrow biopsy performed at this facility is negative? There is no available information concerning where the lymphoma originated. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per PH Rule22, code the primary site to C779 [lymph nodes, NOS].
Rule PH22 is a default rule for lymphomas that is used when there is no other information regarding the primary site and the Heme DB does not indicate a primary site under its Primary Site(s) section. Rule PH27, code the primary site to unknown [C809], does not apply. Only use C809 [unknown] as the primary site when there is no evidence of lymphoma in lymph nodes AND the physician documents that the lymphoma originates in an organ(s).
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 |