Report | Question ID | Question | Discussion | Answer | Year |
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20100088 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient has 2005 diagnosis of multiple myeloma diagnosed returns in 2010 with extramedullary plasmacytoma and a bone marrow biopsy showing plasma cell dyscrasia that is clinically stated to "consistent with a relapse of myeloma"? See Discussion. | Patient was diagnosed in 2005 with multiple myeloma and following stem cell transplant 2005 was in complete remission.
On 2/1/10 an excisional biopsy of a soft tissue right flank mass showed plasmacytoma. On 3/2/10 the bone marrow biopsy was stated to be consistent with plasma cell dyscrasia. An outside attending physician stated the bone marrow biopsy was consistent with a relapse of myeloma. There was no radiologic evidence of disease elsewhere as of Feb 2010, only the soft tissue right flank mass. Patient initially presented for post-op radiation to the right flank and was treated 3/29/10. On 8/6/10 a biopsy of a right perinephric mass was positive for plasmacytoma. Subsequent xray on 8/16/10 of the right tibia and fibula showed lytic lesion consistent with progression of myeloma.
Using the Hematopoietic Database, the plasmacytoma in 2/1/10 is a second primary. How do the rules apply to the perinephric soft tissue disease and right tibia lesion? Are they separate new primaries? Or is all of this simply a recurrence of the original 2005 diagnosis as the attending physician states? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession a single primary with the histology coded to 9732/2 [multiple myeloma]. The disease discovered in 2010 represents further advancement of former disease. Per the Abstractor Notes section in the Heme DB, it states that bone marrow involvement, lytic bone lesions, and bone tumor masses of plasma cells are common. Under the Recurrence and Metastases section in the Heme DB it further states that extramedullary (in tissue other than the bone) involvement is a generally a manifestation of advanced disease. This case is an example of such a situation.
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. |
2010 |
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20100050 | Reportability--Colon: Would a carcinoid tumor, NOS, of the appendix with perineural or angiolymphatic invasion be reportable if there is no mention of malignancy in the pathology report? |
Carcinoid, NOS, of the appendix diagnosed in 2015 or later is reportable.
For cases diagnosed prior to 2015
Carcinoids of the appendix are reportable when they meet any of the following conditions.
Note that the implants/involvement must be designated as malignant. Many benign tumors will spawn implants that are also benign. If implants are benign, this is not a reportable tumor. |
2010 | |
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20100041 | Reportability--Heme & Lymphoid Neoplasms: Are "anemia of chronic disorders" or "hemolytic anemia" reportable given that a search of the Hematopoietic Database returns many different reportable conditions but no exact terminology match for either diagnosis? See Discussion. |
Searching the Heme Database for the term ANEMIA OF CHRONIC DISORDERS yields 71 results. However, none of the results match the terminology entered, yet all 71 "matched terms" are reportable. Is this diagnosis reportable?
Another example is HEMOLYTIC ANEMIA. The search results showed 28 "matched terms" which are all reportable, but none are exact matches.
Please clarify how we should interpret the results of these searches when using the Heme Database. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Neither diagnosis is reportable. Anemia of chronic disorder or disease is seen when a patient has a chronic immune disorder or a malignancy; the anemia itself is not a malignancy. Hemolytic anemia can be caused by many conditions, but is not malignant.
The problem you are having using the Heme DB is that you are searching for the entire term such as "anemia of chronic disorder." The DB search engine is not the same as those used in Google or other widely used internet search engines. The words lymphoma, leukemia, etc. are so common in the DB that the traditional search is not effective.
In order to make your search easier, search on a unique word. For example, for "anemia of chronic disorder" search on the words (use the quotes) "anemia of" and for the term hemolytic anemia, search on "hemolytic" By using the unique word search you will cut down on the number of terms displayed. If you do get several terms, click on "Name" in the header and all of the results will be alphabetized for quick identification. You may also use the "diseases matching any term" or the "disease match all terms" options to narrow down the results when searching the whole term phrase.
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. |
2010 |
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20100043 | Primary site--Heme & Lymphoid Neoplasms: When only pathology reports are available, how should the primary site be coded when a both a bone marrow biopsy and colon biopsy demonstrate "mantle cell lymphoma"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
For this case, code primary site to C189 [colon, NOS] per Rule PH24.
Mantle cell lymphoma usually begins with lymph node involvement and spreads to other tissue. However, it can begin in a lymphocyte such as those in the GI tract. Per the Abstractor Notes section in the Heme DB, patients usually present with advanced disease. About half will have some combination of B symptoms. Swelling of lymph nodes and spleen are usually present. Bone marrow, liver and GI tract involvement occurs in a very high percentage
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. |
2010 | |
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20100054 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a pathology specimen reveals an infiltrating mammary carcinoma with mixed tubular and lobular features, 2.3 cm, low grade cribriform in situ ductal carcinoma, and Paget disease of the overlying skin with ulceration? See Discussion. | According to SINQ 20081134 the histology would be 8524 if this is one primary. | For cases diagnosed 2007 or later, this is a single primary.
In order to determine whether this case represents a single or multiple primary, you must first determine the correct histology code for the underlying tumor. Using rule H9, ignore the DCIS.
See Table 3 in the equivalent terms and definitions. Infiltrating lobular, tubular, and Paget are coded to a single histology code (8524/3). Our current multiple primary rules do not say infiltrating lobular and tubular and Paget are a single primary. This was an omission and will be corrected in a future revision. Thank you for bringing this omission to our attention. |
2010 |
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20100095 | MP/H Rules/Multiple primaries--Kidney, renal pelvis: In a patient who was never disease free because of multiple recurrences of invasive transitional cell carcinoma of the bladder originally diagnosed in 2004, is an invasive high grade urothelial carcinoma of the renal pelvis diagnosed in 2010 a new primary? See Discussion. |
Patient has invasive TCC of the bladder diagnosed in 2004, and has never been disease free. In 2/18/10 a left renal pelvis wash showed urothelial carcinoma, high grade. On 4/7/10 a nephroureterectomy revealed high grade urothelial carcinoma with sarcomatous and squamous differentiation invading through pelvic wall and perihilar soft tissue. Is this a new renal pelvis primary? |
For cases diagnosed 2007 or later, the renal pelvis is a new primary per rule M7. M7 will be better explained in the revised MP/H rules, but the rationale is that no field effect was present for more than 3 years. Although the bladder CA continued to recur, there were no other organs involved until 2010. M7 is intended to make the renal pelvis a new primary because there was no field effect (no organs other than bladder involved) for more than 3 years. |
2010 |
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20100032 | First course treatment--Prostate: Is Degarelix coded as hormonal treatment for prostate cancer? | Code the administration of Degarelix in the "Hormone Therapy" field. Assign code 01 [Hormone therapy administered as first course therapy]. This drug will be added to the next update of SEER*Rx. | 2010 | |
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20100019 | Histology--Ovary: How is histology coded for an ovarian mucinous neoplasm of low malignant potential (borderline mucinous cystadenoma) that shows extensive intraepithelial carcinoma and focal microinvasion? See Discussion. | At surgery a 25 cm left ovarian mass is found adherent to the anterior abdominal wall. The final diagnosis per the pathology report is, "Mucinous neoplasm (26 cm) of low malignant potential (borderline mucinous cystadenoma) with extensive intraepithelial ca and focal microinvasion. Right ovary, fallopian tubes, uterus, omentum, biopsies of diaphragm, 28 para-aortic and pelvic LNS and peritoneal fluid are all negative for malignancy." | Histology code 8470/3 [mucinous cystadenocarcinoma] is the best choice in this case. There is a mucinous cystadenoma [8470/0] with intraepithelial carcinoma and focal microinvasion. 8470/3 comes as close as possible to the description of the tumor. | 2010 |
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20100039 | Casefinding--Heme & Lymphoid Neoplasms: Is the 2010 casefinding code of 289.6 (Familial Polycythemia) addressed anywhere in the Hematopoietic Database? See Discussion. |
When you enter "familial polycythemia" into the Heme DM, polycythemia vera (PV) appears; however, the term "familial polycythemia" is not listed as one of the synonyms for PV. |
Familial polycythemia by itself is not reportable. This is a benign condition which occurs within families. Familial polycythemia can progress to polycythemia vera (9950/3), which would then be reportable. The code, 289.6, which is the ICD-9-CM code for Familial polycythemia is not included on the reportable list for casefinding. There is only one ICD-9-CM code for Polycythemia vera, 238.4. "Familial polycythemia" is listed in Appendix F: Non-Reportable List for Hematopoietic Diseases. |
2010 |
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20100100 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a Langerhans cell histiocytosis diagnosed on an excisional biopsy of the T8 vertebral bone? See Discussion. | The patient had an excisional biopsy of the T8 vertebral bone, but no other tissue biopsy. The doctor confirms the case is malignant. However, Langerhans cell histiocytosis, NOS is listed as /1 (borderline) in the ICD-O-3. | For cases diagnosed 2010 and forward, do not use the ICD-O-3 book to determine the hematopoietic and lymphoid histology codes. Use the Hematopoietic Database and access it at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9751/3 [Langerhans cell histiocytosis] and the primary site for unifocal disease to C412 [bone, vertebral column]. Per Rule PH 30, use the Heme DB to determine the primary site and histology when PH1-PH29 do not apply. Per the Abstractor Notes section in the Heme DB, lytic bone lesions are the most common primary site.
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. |
2010 |