Report | Question ID | Question | Discussion | Answer | Year |
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20091127 | MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are to be accessioned for a patient with Neurofibromatosis 2 (NF2) who presents with meningiomas on the left and right side of the brain and multiple meningiomas of the spinal cord? See Discussion. |
We have a patient with NF2 who also has meningiomas diagnosed on the left and right side of the brain as well as multiple meningiomas of the spinal cord. Are the meningiomas all one primary (separate from the NF2): C70.9 and 9530/1? |
For cases diagnosed 2007 or later, this is four primaries. Report NF2 because it occurs with reportable neoplasms. Note: Report NF only once per patient. Per MP/H Benign CNS Rule M4, the meningiomas of the meninges/brain (C70.0) and meninges/CNS (C70.1) are multiple primaries. Code the meningiomas of the spine to the histology to 9530/1 [Multiple meningiomas] (Rule H6) because there are multiple tumors in the spine. Per Rule M5, the meningiomas of the right and left side of the brain are multiple primaries. Code of each to the histology 9530/0 [Meningioma, NOS] per Rule H2 because they are separate primaries (assuming there is one tumor on each side of the brain). |
2009 |
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20091012 | MP/H Rules/Histology--Head & Neck: If the final diagnosis states "see microscopic description," can the micro information be used to code the histology? See Discussion. | In regards to coding histology for 2007 and forward cases, we are instructed to use the final diagnosis, and any addenda or comments associated with the final diagnosis. We are not to use the microscopic description. However, we are seeing pathology reports with a final diagnosis that also includes the notation "see microscopic description" or "see description". Example: "Left Parotid: High grade carcinoma involving deep lobe with marginal extension. See description." The microscopic description goes on to describe the carcinoma in more detail, which includes a statement "consistent with the ductal type of primary parotid carcinoma." Can we use this microscopic description or not? | For cases diagnosed 2007 or later: When the final diagnosis indicates that the microscopic section contains the detailed diagnosis, use the microscopic description to code the histology. Otherwise, code from the final diagnosis only and not from the microscopic description. The final diagnosis is usually the pathologist's conclusion after consideration of the various choices listed in the microscopic description. The histology code should represent the pathologist's final conclusion. |
2009 |
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20091030 | MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. | Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10? | For cases diagnosed 2007 or later: The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.
Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.
For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites. |
2009 |
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20091003 | MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion. | Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules. | For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS]. Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites. In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma. |
2009 |
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20091016 | CS Extension--Pancreas: How do you code this field for a head of pancreas primary with involvement of portal and splenic veins? See Discussion. | The splenic artery/vein is only mentioned in the body and tail scheme; no mention is made of this site in the pancreatic head scheme. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign CS extension code 54 [major blood vessels]. The portal vein is listed under code 54 for head of pancreas. The splenic vein branches from the portal vein. |
2009 |
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20091107 | CS Extension--Lymphoma: Does peripheral blood involvement affect the stage for lymphoma? See Discussion. |
2009 Diagnostic Year Lymph node bx is positive for Mantle Cell lymphoma. Flow cytometry on lymph node tissue shows CD+ pos B cell lymphoproliferative disorder. IHC findings support Mantle Cell lymphoma. Flow cytometry on peripheral blood shows CD+ B cell lymphoproliferative disorder. Because the lymph node is positive for Mantle Cell lymphoma and the flow cytometry findings are the same on the lymph node tissue and peripheral blood, is the peripheral blood involved (Stage IV disease)? |
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.No. Peripheral blood is not the same as bone marrow involvement which is what would be required for stage IV. Lymphomas can arise in lymph nodes which are connected by lymphatic vessels. Both lymphatic vessels and blood vessels travel through lymph nodes and malignant cells can travel between the vessels. Cells in peripheral blood do not prove Stage IV. |
2009 |
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20091096 | MP/H Rules/Multiple primaries--Breast: How many primaries should be reported when an in situ diagnosis is followed by an invasive diagnosis in the same breast 1.5 years later? See Discussion. | Patient had a core biopsy 1/07 that showed DCIS and PE showed no adenopathy. Patient refused resection, and adjuvant treatment. In 6/08, the pt returned for a modified radical mastectomy which showed infiltrating duct carcinoma and positive lymph nodes. A comment in the Correction Record stated "Per MD, patient did not see any urgency and delayed surgery 1.5 years after diagnosis." The patient did not have any treatment in that time period and there is no statement that there was progression. | For cases diagnosed 2007 or later, abstract the 6/08 invasive diagnosis as a separate primary according to rule M8. Rule M8 applies whether or not the later diagnosis in this case is progression of disease. | 2009 |
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20091124 | CS Eval--Lung: How is the CS Reg Nodes Eval field to be coded when the FNA of a paratracheal lymph node is positive for adenocarcinoma and the patient subsequently undergoes neoadjuvant chemoradiation therapy followed by an excision of multiple lymph node fragments that show adenocarcinoma? See Discussion. | The CSv1 scheme for lung shows that code 1 under CS Reg Nodes Eval is a path staging basis. However, the definition for code 1 also states that no regional lymph nodes were removed for examination. Would we use code 1 because the case represents path staging basis? If we select code 5 because regional lymph nodes were dissected, the staging basis would be clinical. If we select code 6, the staging basis would be y. | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Use code "6" for the CS LN evaluation field. As explained on page 113 in the 2007 SEER Manual, when post-operative disease is more extensive despite neoadjuvant therapy, this can be coded in the evaluation field. In this case, only an FNA was done on lymph nodes pre-operatively, but actual lymph nodes were removed and documented in the post-neoadjuvant excision of the lymph nodes which documented that they are histologically positive -- proving that the neoadjuvant therapy did not work. |
2009 |
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20091105 | Multiple Primaries--Hematopoietic: How many primaries and which histologies should be reported for a case presenting with a 2005 diagnosis of CLL/SLL, 2006 clinical diagnosis of MDS and a 2008 diagnosis of AML? See Discussion. |
2005 diagnosis of CLL/SLL (9670) with lymph node involvement, treated with FCR. 2006 clinical diagnosis of MDS secondary to chemo (9987) with CLL/SLL in remission. 2008 biopsy reveals AML (9861). Per Seer Hematopoietic Table, 9987 & 9861 are a single primary. In 6/2008 patient receives bone marrow transplant. 2009 status post BMT, BM biopsy reveals RAEB-1 (9983). Is this still the same disease process or a new primary (since status post BMT)? |
For cases diagnosed prior to 1/1/2010:Two primaries should be abstracted. Using the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, compare 9670 (SLL) in 2005 and 9987 (MDS secondary to chemo) in 2006. This is two primaries. MDS can transform to AML. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9861 (AML) are a single primary. The AML would be documented in follow-up. (While 9670/SLL and 9861/AML are two different primaries, the SLL has already been reported.) RAEB is a form of MDS. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9983 (RAEB) are a single primary. The RAEB would be documented in follow-up. (While 9670/SLL and 9983/RAEB are two different primaries, the SLL has already been reported.) For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ. |
2009 |
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20091125 |
Ambiguous terminology/Reportability--Thyroid: Should a thyroid case be accessioned based only on a cytology that is consistent with papillary carcinoma? See Discussion. |
Instructions in the 2007 SPCSM state that we are not to accession a case based only on a suspicious cytology. Does this rule apply only to the term "suspicious" or does it apply to all ambiguous terms? Example: FNA of thyroid nodule is consistent with papillary carcinoma. |
Do not accession the case if the cytology is the only information in the medical record. The phrase "Do not accession a case based only on suspicious cytology" means that the cytology is the only information in the record. If there is other information that supports the suspicion of cancer (radiology reports, physician statements, surgery), then accession the case. The phrase "suspicious cytology" includes all of the ambiguous terms. | 2009 |