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20110082 | First course treatment/Other therapy--Skin: How is PUVA [psoralen (P) and long-wave ultraviolet radiation (UVA)] coded when used for skin primaries such as melanoma and mycosis fungoides? | Code PUVA as "Other treatment" with Code 1 - Other. We do not have a code specifically for ultraviolet radiation. | 2011 | |
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20110028 | MP/H Rules/Histology--Thyroid: How many primaries and what histology(ies) are coded when the pathology report shows a, 1.9 cm Hurthle cell carcinoma, probable follicular variant of papillary carcinoma, with Hurthle cell features and a 2 mm focus of follicular variant, papillary carcinoma? See Discussion. | Right lobectomy pathology report final diagnosis states: 1.9 cm Hurthle cell carcinoma (see comment). Comment: histologic diagnosis Hurthle cell carcinoma, probable follicular variant of papillary carcinoma with Hurthle cell features. Subsequent left lobectomy one week later showed a 2 mm microscopic focus of follicular variant of papillary carcinoma, encapsulated.
None of the rules seems to fit this scenario. The number of primaries reported for this case depends on the histology coded for each tumor. Does Rule M6 (Follicular and papillary tumors in the thyroid within 60 days of diagnosis are a single primary.) or M17 (Tumors with ICD-O-3 histology codes that are at the first (xxx), second (xxx) or third (xxx) number are multiple primaries.) apply? Does the case represent a single primary because both are papillary/follicular tumors or two primaries because one is Hurthle cell carcinoma, and one is papillary/follicular carcinoma (different histology at second digit)?
To code the histology for the larger tumor in the right lobe, which rule do we apply? Rule H11 (single histology of Hurthle cell carcinoma [8290] per path final diagnosis), H15 (tumor has both follicular and papillary carcinoma [8340], per path comment), or H17 (numerically higher code for 8340 because there is both Hurthle cell and papillary/follicular carcinoma)? |
Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary.
The Hurthle cell carcinoma is a synonym for follicular carcinoma according to the WHO. See page 67 of the 2004 WHO Classification of Tumours of Endocrine Organs. The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules manual. For a thyroid primary, use the Other Sites MP rules under one of the three formats (i.e., flowchart, matrix or text) to determine the number of primaries because the thyroid does not have site specific rules.
Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.
. Follicular and papillary tumors in the thyroid within 60 days of diagnosis are a single primary. The patient has a tumor in each lobe of the thyroid with the same histology. Abstract a single primary for this patient.
Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.
Start with the SINGLE TUMOR: INVASIVE ONLY module, Rule H8. The rules are intended to be reviewed in consecutive order within the module from Rule H8 to Rule H18. You stop at the first rule that applies to the case you are processing.
. Code follicular and papillary carcinoma of the thyroid to papillary carcinoma, follicular variant (8340). Use the comment to code the histology for the right lobectomy. "Probable" is an acceptable ambiguous term to use for coding histology. (See the Ambiguous Terms Used to Code Histology section of the General Instructions in the MP/H manual.) |
2011 |
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20100113 | Reportability--Heme & Lymphoid Neoplasms: Is hemophagocytic lymphohistiocytosis reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
No. This is not a reportable hematologic condition. When you do not find a hematologic or lymphoid condition listed in the Heme DB, it is not reportable. Hemophagocytic lymphohistiocytosis is an uncommon hematologic disorder. The patient usually presents with fever, splenomegaly, and jaundice. Laboratory findings are lymphocytosis and histiocytosis. Pathology findings are hemophagocytosis.
Appendix F lists this term as non-reportable.
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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20100079 | Reportability--Heme & Lymphoid Neoplasms: Does the fact that the Hematopoietic Database states the ICD-O-3 code 9970/1 [Lymphoproliferative disorder/disease, NOS] mean that the ICD-O-3 books should be updated to indicate that as of 2010 the code 9970/1 [Lymphoproliferative disorder/disease, NOS] is no longer applicable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Lymphoproliferative disorder/disease, NOS [9970/1] is not a reportable neoplasm. There are also new codes that define lymphoproliferative disorder/disease more specifically. If you do a "smart search" and enter only the word "lymphoproliferative" into the Heme DB, you will get a listing of all of the reportable and non-reportable terms. That enables you to look at your record and compare the words in the Heme DB to those in the record you are reviewing.
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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20100075 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when a 1/27/10 bone marrow biopsy, FISH and cytogenetics reveals chronic myelogenous leukemia (CML), BCR/ABL positive, t(9;22)(q34;q11) and a 4/15/10 bone marrow biopsy reveals B-acute lymphoblastic leukemia (Blast phase of CML)? | 1/27/10 BM biopsy: CML BCR/ABL+ FISH positive for BCR/ABL and cytogenetics showing the t(9;22)q34q11.2 translocation. Treated with Imatinib. 4/15/10 BM biopsy: B-acute lymphoblastic leukemia (Blast phase of CML). Would the term "blast phase of CML" indicate the 4/15/10 bone marrow biopsy showed CML or would a new primary be abstracted with histology coded 9811/3 [B lymphoblastic leukemia/lymphoma, NOS]?
Applying rule M10, this is a new primary, but note 2 states transformations are defined in the Heme DB. The Abstractor Notes section indicates CML has three phases: chronic, accelerated, and the blastic phase or blast crisis. The accelerated phase can last weeks to months. In the chronic phase the involvement is usually limited to blood, bone marrow and spleen although the liver may be infiltrated. During the blastic phase, lymph nodes and tissue may be involved. The blastic phase is a disease progression from the chronic phase. The disease, however, remains the same histology, chronic myelogenous leukemia. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case represents a multiple primary per Rule M15 which states you are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14.
The histology for the first primary is coded to 9875/3 [chronic myelogenous leukemia, BCR-ABL1 positive].
The histology for the second primary is 9811/3 [B lymphoblastic leukemia/lymphoma, NOS] in the absence of further documentation that the B-ALL was also positive for the t(9;22) translocation.
The histology code 9806/3 [Mixed phenotype acute leukemia with t(9;22)(q34;q11.2); BCR-ABL1] cannot be used for the second primary because there is no documentation that the B-ALL diagnosed on 04/15/2010 also had the t(9;22) translocation and this histology cannot be used in patients ." Per the Definition section in the Heme DB, in order to use histology code 9806/3 "This leukemia meets the criteria for mixed phenotype acute leukemia (MPAL) in which the blasts also have t(9;22) translocation of BCR-ABL1 rearrangement. Some patients with chronic myeloid leukemia may develop or even present with a mixed blast phase that would meet criteria for MPAL; however, this diagnosis should not be made in patients known to have had CML."
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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20100063 | Primary Site-Lung: Can you use a lung subsite code for a histologically confirmed lung primary when a CT scan indicates a sized mass located in one lobe of the lung as well as "too numerous to count nodules" through one or both lungs? See Discussion. | For example, chest CT shows "1.6 cm RUL suspicious mass and too numerous to count nodules throughout both lungs." Core biopsy of mass in the RUL compatible with adenocarcinoma. | For lung primaries with one large mass and numerous nodules, code the primary site to the subsite where the large mass is located. For your example, code the primary site to C341 [upper lobe of lung]. Note: This answer does NOT mean that the other nodules are primary or metastatic cancer. | 2010 |
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20100044 | Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C499 [Blood vessels, NOS] for a case of intravascular large B cell lymphoma, Asian variant [9712/3] found in the bone marrow and liver? See Discussion. | Patient has biopsy proven intravascular large B cell lymphoma, Asian variant, (9712/3) in bone marrow and liver. The Hematopoietic Database does not give a primary site code. Should the primary site be coded C49.9 because, by definition, this lymphoma arises in the blood vessels? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code primary site to C499 [blood vessels]. The definition in the Heme DB does specify that this type of extranodal large B-cell lymphoma is characterized by lymphoma cells within the lumina of blood vessels with the exception of larger arteries and veins. The reason no primary site is specified is that Western variant can originate in the skin or CNS.
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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20100052 | Reportability/Primary Site: What is the reportability status and primary site for a papillary carcinoma of thyroid tissue arising in an otherwise benign mature monodermal cystic teratoma (struma ovarii)? See Discussion. | Final diagnosis on the pathology report states, "One ovary showing mature monodermal cystic teratoma composed of thyroid tissue (struma ovarii)." The pathology COMMENT section states, "There is a 0.1 cm focus of thyroid tissue within the struma ovarii showing cytologic features of papillary carcinoma. This finding is likely of no clinical consequence." | A papillary carcinoma of thyroid tissue in benign struma ovarii (mature cystic teratoma) is reportable.
These ovarian tumors contain a diversity of tissues including hair, teeth, bone, thyroid, etc. This reportable malignancy arose in thyroid tissue within the ovarian tumor. Code the primary site to ovary. Code to the actual organ in which the cancer arose. This will keep the case in the appropriate category for surgery coding, regional nodes, staging, etc. |
2010 |
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20100105 | Surgery of Primary Site--Brain and CNS: Is "debulking" of a primary brain tumor coded to 21 [subtotal resection of tumor] or 30 [gross resection of tumor]? | Assign code 21 [subtotal resection of tumor, lesion, or mass]. Debulking removes as much of the tumor volume as possible in cases where it is not possible to remove the entire tumor. Debulking should improve the effectiveness of subsequent radiation therapy and/or chemotherapy. | 2010 | |
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20100103 | Reportability--Corpus uteri: Is gestational trophoblastic neoplasia reportable if there is no mention of metastasis but the patient has been treated with chemotherapy? See Discussion. | Per SINQ 20021106, for tumors diagnosed prior to 2007, a clinical diagnosis of metastatic gestational trophoblastic disease was to be coded to histology 9100/3 [Choriocarcinoma]. "Gestational trophoblastic neoplasia includes the diagnosis of choriocarcinoma." |
Do not report gestational trophoblastic neoplasia unless stated to be malignant. | 2010 |
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