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20110012 | Reportability--Sarcoma: Is "atypical lipomatous tumor/well-differentiated liposarcoma" reportable? See Discussion. | The final diagnosis for a soft tissue excision is, "atypical lipomatous tumor/well-differentiated liposarcoma". The Comment section states, "Atypical lipomatous tumor/well differentiated liposarcoma has a significant risk for local recurrence, but no metastatic potential."
Per the 2010 SEER Manual, page 3, example 4: The pathologist makes the final decision about the behavior for a particular case. In this case, the pathologist uses both a reportable and a non-reportable term in the final diagnosis and in the comment section of the pathology report. Does the pathologist's comment impact the behavior and reportability of this tumor? |
For cases diagnosed 1/1/2014 and later: Atypical lipomatous tumor (8850/1) is not reportable. If the pathologist uses the term "well-differentiated liposarcoma" (8851/3) report the case. Use of this terminology indicates a less favorable prognosis. | 2011 |
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20110023 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported in a patient with a November 2009 diagnosis of refractory anemia and a 10/25/2010 biopsy diagnosis of refractory anemia with excess blasts type 2 with ringed sideroblasts that the clinician indicates actually demonstrates progression to AML? See Discussion. | Refractory anemia, NOS diagnosed in November 2009. The diagnosis on a bone marrow biopsy performed on 10/25/10 is myelodysplastic syndrome - refractory anemia with excess blasts type 2 with ringed sideroblasts. Per the medical oncologist, in the 12/16/10 clinic note it states, "Pt underwent bone marrow biopsy on 10/25/10 and ultimately this marrow demonstrates progression to AML.
When applying the Hematopoietic Rules, the refractory anemia, NOS and the myelodysplastic syndrome - refractory anemia with excess blasts type 2 with ringed sideroblasts is the same primary. However, the refractory anemia NOS and the AML are multiple primaries. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
First, note that myelodysplastic syndrome (MDS) is a term that includes a number of diseases. Refractory anemia, NOS and refractory anemia with ringed sideroblasts are types of MDS. These two diseases are an NOS and a more specific disease, which is accessioned as one primary per Rule M7.
Next, assess the change from refractory anemia to AML. In checking the Heme DB, AML is listed under transformations for refractory anemia with ringed sideroblasts. This patient has a chronic disease (refractory anemia with ringed sideroblasts) and an acute disease (AML). Per Rule M10, abstract as multiple primaries when a neoplasm is originally diagnosed in a chronic (less aggressive) phase AND second diagnosis of a blast or acute phase more than 21 days after the chronic diagnosis.
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. |
2011 |
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20110126 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned, and what rule applies, when the patient has a history of diffuse large B-cell lymphoma diagnosed in 2003, a follicular lymphoma diagnosed in 2009, and another diagnosis of follicular lymphoma in 2010? Is the application of the multiple primary rules effected if it is unknown whether the patient was ever disease free? See Discussion. | Patient has a history of diffuse large B-cell lymphoma involving multiple lymph node regions (site C778) with bone marrow involvement diagnosed in 2003 and a history of follicular lymphoma confined to the thyroid and neck lymph nodes diagnosed in 2009. In 2010 the patient was diagnosed with follicular lymphoma in the inguinal and abdominal lymph nodes.
The 2003 diagnosis of DLBCL and the 2009 diagnosis of follicular lymphoma are the same primary according to the 2009 rules, the Single Versus Subsequent Primaries Table.
What rule is used to determine whether the 2010 diagnosis of follicular lymphoma represents a new primary? Which histologies are compared using the rules: the 2010 follicular lymphoma diagnosis to the 2009 follicular diagnosis or the 2010 follicular lymphoma diagnosis to the 2003 DLBCL diagnosis? |
This case should be accessioned as one primary.
Reportability is determined by the year of diagnosis. The original DLBCL was diagnosed in 2003 and the follicular lymphoma in 2009. The pre-2010 rules are used for both cases. Per the Single Versus Subsequent Primaries Table, these are the same primary. It is reported with the histology 9680/3 [diffuse large B-cell lymphoma]
Do not compare the DLBCL diagnosed in 2003 and the follicular lymphoma diagnosed in 2010 because the determination of the number of primaries for the two specific histologic types was done (as it should have been) using the rules in effect in 2009 when the follicular lymphoma was first diagnosed. The determination of a single or multiple primaries is made the first time the patient presents with the two different diseases; it is not changed when the same disease process reappears after 2010. |
2011 |
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20110149 | Ambiguous Terminology/Histology--Heme & Lymphoid Neoplasms: How are the histology and diagnostic confirmation to be coded when the pathology report's final diagnosis is "plasma cell dyscrasia consistent with plasma cell myeloma" and the physician subsequently states this diagnosis was plasma cell myeloma? See Discussion. |
Pathologists often use the diagnosis "plasma cell dyscrasia" followed by an ambiguous term such as "consistent with" or "favors" with a more specific histology such as "plasma cell myeloma." Per initial training for Hematopoietic, ambiguous terminology is not used to code the histology for Heme & Lymphoid Neoplasms. Should the histology be coded as plasma cell dyscrasia (which is not found in the Heme DB or Manual) because the pathology report uses ambiguous terminology to describe the plasma cell myeloma? If the physician subsequently states the diagnosis is "plasma cell myeloma" in a note following the pathology, should the histology be coded as plasma cell myeloma based on that diagnosis as there was no ambiguous terminology used? How is the diagnostic confirmation coded for this case? Should this be a positive histology diagnosis (diagnostic confirmation code 1) if the pathology diagnosis uses ambiguous terminology only? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. The histology is coded as Plasma cell myeloma [9732/3]. The diagnostic confirmation is coded to 1 [positive histology]. Under the Definitive Diagnostic Methods section in the Heme DB it indicates that a bone marrow aspiration and bone marrow biopsy are procedures used to diagnose this disease process. This patient's diagnosis was based on the pathology (presumably from a bone marrow biopsy). NOTE: This is a reportable case. Ambiguous terminology is used to accession cases (determine reportability) because it has been used for over 30 years to do so. Any deviation from using ambiguous terminology to determine case reportability would cause the reporting of incidence counts to vary. In this case, there was a reportable, ambiguous terminology diagnosis of plasma cell myeloma on the pathology report; as well as a reportable physician's statement/diagnosis of plasma cell myeloma. Ambiguous terminology, however, is not used to report a more specific diagnosis for the Heme & Lymphoid neoplasms. For example, if the pathology report final diagnosis was "Myeloproliferative neoplasm, probably Polycythemia Vera" the histology would be coded as myeloproliferative neoplasm, unclassifiable [9975/3]. The ambiguous terminology indicates that the genetic testing, immunophenotyping, etc., probably are not complete or are not diagnostic of the more specific disease. Wait to code the histology until there is a definite diagnosis given. 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. |
2011 |
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20110104 | Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C421 [bone marrow] or C770-C779 [lymph nodes] for an adult T-cell leukemia/lymphoma [9827/3] that presented with a positive bone marrow biopsy and involvement of lymph nodes and the lung? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph..
Code the primary site to the involved lymph nodes [C770-C779]. Per Rule PH 8, it indicates you are 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. Note 2 further states that the bone marrow may or may not be involved. If the bone marrow is involved, code this information in the CS Extension field.
Per the Abstractor Notes section in the Heme DB, this is a systemic disease with widespread lymph node involvement as well as involvement of the peripheral blood. In addition, systemic involvement of extranodal sites (including lung) are often involved.
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. |
2011 | |
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20110125 | MP/H Rules/Histology--Lung: What would the histology code be for a wedge bx of the left lung, lower lobe, that was read out as well differentiated adenocarcinoma with micropapillary features? | Code papillary adenocarcinoma 8260/3. The ICD-O-3 codes for micropapillary have specific associations such as ductal, serous or transitional. None of those associations fit lung primaries. | 2011 | |
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20110123 | Reportability--Heme & Lymphoid Neoplasms: Are the terms EBV positive B-cell lymphoproliferative disorder with or without the term "of the elderly" and iatrogenic EBV positive lymphoproliferative disorder reportable? See Discussion. |
The only reportable term listed is "EBV positive B-cell lymphoproliferative disorder of the elderly." Are the following cases reportable?
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For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
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. |
2011 |
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20110108 | Primary site--Heme & Lymphoid Neoplasms: What is the primary site for a bone marrow biopsy positive for systemic mastocytosis that also involves the spleen and lymph nodes with associated leukocytosis, mild anemia and thrombocytopenia? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule PH30, one is to use the to determine the primary site and histology when rules PH1-PH29 do apply. Code the primary site to C421 [bone marrow] because that is the only site listed under the Primary Site section of the Heme DB.
Under the Abstractor Notes section in the Heme DB, it indicates that the bone marrow is always involved, and the white and red pulp of the spleen may be involved with systemic mastocytosis. This is how this patient presented; therefore, the bone marrow is the primary site. The spleen is secondarily involved because the spleen cleanses the blood and the neoplastic cells have infiltrated the red and white pulp of the spleen. The same is true for the lymph nodes. Although the lymph nodes are rarely involved, they may be involved when the patient has systemic mastocytosis.
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. |
2011 | |
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20110077 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be reported if different recurrence scores are found on the Oncotype Dx studies performed for multiple tumors in the same breast if the clinician states the patient has two primaries but the pathologist does not address the issue? See Discussion. | A patient has two separate lesions in the same quadrant with the same histology. According to the MP/H rules this is a single primary. However, Oncotype Dx studies were performed on both tumors and the DX recurrence was different for each tumor. The medical oncologist states the patient has two primaries. The pathologist does not indicate the number of primaries. | This is a single primary. The only rules used to determine the number of primaries are the MP/H rules for cases diagnosed 2007 or later. Do not use other information such as Oncotype Dx to determine the number of primaries for a patient. Oncotype is used to determine whether the cancer is likely to recur AND whether the cancer would benefit from chemotherapy.
The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Breast MP rules under one of the three formats (i.e., flowchart, matrix or text).
Start with the MULTIPLE TUMORS module, Rule M4. The rules are intended to be reviewed in consecutive order within the module from Rule M4 to Rule M13. You stop at the first rule that applies to the case you are processing.
The patient has two tumors in the same breast with the same histology. Abstract a single primary for this patient. |
2011 |
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20110107 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a precursor T lymphoblastic leukemia involving the bone marrow and peripheral blood (per pathology) with a clinically noted large mediastinal mass and cervical lymphadenopathy? See Discussion. | The patient had a large mediastinal mass and cervical lymphadenopathy, however, no biopsy was performed of either area nor was there a specific statement indicating involvement. The bone marrow biopsy showed 100% cellular marrow with involvement by precursor T lymphoblastic leukemia. The peripheral blood also showed precursor T lymphoblastic leukemia. The discharge summary and office notes state the diagnosis as T-cell acute lymphoblastic leukemia. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9837/3 [adult T cell leukemia/lymphoma] and the primary site to C778 [lymph nodes, multiple regions]. Per Rule PH8, code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. A statement of "mediastinal mass" and lymphadenopathy for lymphoma primaries is equivalent to lymph node involvement. To identify the more specific primary site, you need to move to Rule PH21 that indicates you are to code the primary site as multiple lymph node regions, NOS [C778] when multiple lymph node regions, as defined by ICD-O-3, 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. |
2011 |
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