Report | Question ID | Question | Discussion | Answer | Year |
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20130102 | Histology--Heme & Lymph Neoplasms: Is follicular lymphoma, high grade synonymous with grade 3 lymphoma [9698/3] or is the "high grade" ignored and the histology coded to follicular lymphoma, NOS [9690]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Code histology to 9698/3 [follicular lymphoma, grade 3]. Follicular lymphoma, high grade is listed under the Alternate Names section of the Heme DB for Follicular lymphoma, grade 3. 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. |
2013 | |
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20130122 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when an excisional biopsy of a chest wall nodule shows diffuse large B-cell lymphoma (40%) and follicular lymphoma, grade 3A (60%)? See Discussion. | The patient presented with a right chest wall nodule. The PET scan showed widespread disease: subcutaneous nodule/mass in the left scalp and right chest wall; large right paraspinal mass; soft tissue density likely a second early paraspinal mass at the right costovertebral junction; right paravertebral mass; and abnormal bony foci in the right humeral head, right iliac crest, right acetabulum and right femur. The physical exam showed 2 cm left supraclavicular lymphadenopathy and a firm 3 cm mass in the right chest wall. Lungs were clear. Abdomen showed no masses or ascites, and no palpable hepatosplenomegaly.
Chest wall nodule excisional biopsy pathology: Lymph node and adjacent soft tissue: Malignant lymphoma with components: 1. Diffuse large B-cell lymphoma (40%). 2. Follicular lymphoma, grade 3A (60%). Pathology report note states the diffuse large cell lymphoma is probably arising from the follicular center cell lymphoma.
Should this be a single primary? There is no mention of cutaneous lymphoma. |
Accession a single primary per Rule M4. Code histology to 9680/3 [diffuse large B-cell lymphoma] per Rule PH11.
Per Rule M4, accession a single primary when two or more non-Hodgkin lymphomas are present in the same lymph node or organ.
Per Rule PH11 code the histology to diffuse large B-cell lymphoma (DLBCL) (9680/3) when DLBCL and any other non-Hodgkin lymphoma are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow.
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. |
2013 |
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20130205 | MP/H Rules/Multiple primaries--Breast: How many primaries are reported and what is the histology for each in a case of infiltrating duct and lobular carcinoma of the breast (8522) with Paget disease of the same breast? | Abstract as two primaries according to rule M12. We interpret this as one tumor with infiltrating duct and lobular carcinoma (8522) and a second tumor with Paget disease (8540). | 2013 | |
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20130088 | Grade--Heme & Lymphoid Neoplasms: Should Grade be coded to 5 [T-cell] or 9 [cell type not determined, not stated, not applicable] for anaplastic large cell lymphoma, NOS [9714/3]? See Discussion. | Under the Grade section in the Heme DB for anaplastic large cell lymphoma, NOS it indicates the following:
"Grade - Code grade specified by pathologist. If no grade specified, code 9."
There is no reference in the Grade section that we should look at the Abstractor Notes or a specific Module in the Heme DB for additional information. However, in the Abstractor Notes section it states, "Grade is T-cell (5) unless pathologist specifically designates as a B-cell (see G2 rule)." These two statements are conflicting. Which is the correct grade? |
Assign code 5 [T-cell] for anaplastic large cell lymphoma [9714/3] unless the pathologist specifies that the histology is a B-cell disease process. See Grade rule G2, Note 2.
In the Heme DB, there is a default value in the Grade field for histologies that do not have a grade specified. However, this particular histology does not default to code 9. There was an error in the Grade section of the 2010 and 2012 versions of Heme DB that has now been corrected in the latest release. |
2013 |
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20130060 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a diagnosis of bilateral extranodal orbital lymphoma when the same histology is present in both orbits? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as a single primary lymphoma of bilateral orbits per Rule M2. Abstract a single primary when there is a single histology. Both orbits showed the same histology. Note 1 for Rule M2 states bilateral involvement of lymph nodes and/or organs is a single primary.
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. |
2013 | |
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20130019 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when a patient has a lymph node biopsy and peripheral blood that are positive for B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma but refuses a bone marrow biopsy? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C421 [bone marrow] per Rule PH5. Note 1 for Rule PH5 states CLL always has peripheral blood involvement. If the peripheral blood is positive for CLL/SLL and no bone marrow biopsy is done, code the primary site to C421 [bone marrow].
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. |
2013 | |
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20130171 | Reportability--Heme & Lymphoid Neoplasms: Is "plasma cell neoplasm" a synonym for multiple myeloma and is it reportable? See Discussion. | Path report in the comment section states "plasma cell neoplasm such as monoclonal gammopathy of undetermined significance (MGUS)." | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, plasma cell neoplasm is not a synonym for multiple myeloma. Plasma cell neoplasm is a disorder that has an abnormal number of plasma cells. MGUS is such a disorder, but it is not reportable.
According to WHO, 'Plasma cell neoplasms' is the umbrella term that includes MGUS, plasma cell myeloma, solitary plasmacytoma of bone, immunoglobulin deposition diseases, extraosseous plasmacytoma, and osteosclerotic myeloma. Of these, only plasma cell myeloma, solitary plasmacytoma of bone, and extraosseous plasmacytoma are reportable.
Note: This terminology was added to the 2012 Hematopoietic Manual and Database for 1/1/2012. This should not have been added. If the only diagnosis is "plasma cell neoplasm," this is not reportable. If the diagnosis is "plasma cell neoplasm c/w multiple myeloma (or another reportable disease)," then it would be a reportable disease.
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. |
2013 |
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20130116 | Histology/Primary site--Heme & Lymphoid Neoplasms: How are the histology and primary site coded if a pleurocentesis is compatible with plasmablastic plasmacytoma/lymphoma when no further information is available? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9735/3 [plasmablastic lymphoma] and the primary site to C809 [unknown] per Rule PH27.
Code the histology specified when the only histology for the case is preceded by ambiguous terminology. For this case, code the histology to plasmablastic lymphoma because it is the only histology mentioned in the diagnosis.
Per the Heme DB Abstractor Notes section for plasmablastic lymphoma, most patients present with Stage III-IV disease. The positive pleural fluid is likely due to advanced disease. In the absence of any other information for this case, Rule PH27 applies, "Code primary site to unknown primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR multiple organ involvement without any nodal involvement."
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. |
2013 | |
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20130170 | MP/H Rules/Histology--Breast: What is the histology code for "invasive carcinoma of the breast, no special type" as the final diagnosis on a pathology report? See Discussion. |
Recently pathology reports for breast primaries are no longer listing invasive ductal carcinoma as the histology on many cases if the treating physician calls the cancer an invasive ductal carcinoma. The pathology report (final diagnosis and synopsis) state this is invasive carcinoma, no special type.
Upon inquiry to the pathology department, the response received stated, In 2012, the WHO got rid of ductal carcinoma as a specific type. So what would have been called Invasive ductal carcinoma, Not Otherwise Specified (NOS), is now being called Invasive carcinoma, No Special Type (NST). In the new WHO classification, lobular, tubular, cribriform, mucinous, etc. are the special types. But ductal is gone.
Is this a change in terminology? Should these cases be coded as 8500/3 [ductal carcinoma, NOS] or 8010/3 [carcinoma, NOS]? |
Code the histology to ductal carcinoma, NOS [8500/3] for a pathology report with a final diagnosis of "invasive carcinoma, no special type." Do not code the histology to carcinoma, NOS [8010/3].
The 4th Edition of the WHO Classification of Tumors of the Breast refers to invasive ductal carcinoma as invasive carcinoma, no special type. The ICD-O-3 code remains the same as invasive duct carcinoma [8500/3]. The next revision to the MP/H Solid Tumor Rules will clarify this issue. |
2013 |
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20130206 | Primary site--Heme & Lymphoid Neoplasms: What rule applies to code a primary site for a peripheral blood diagnosis of marginal zone lymphoma that has a positive flow cytometry/FISH analysis when no biopsies are performed, scans show no evidence of disease, exam indicates no lymph nodes are palpable and the physician's clinical diagnosis "marginal zone lymphoma, unspecified site, stage 1"? See Discussion. | PE: No palpable lymph nodes.
PET scan: No spleen or lymph node uptake; no uptake anywhere in the body.
Peripheral blood and flow cytometry/FISH analysis diagnosis: Marginal zone lymphoma.
No bone marrow or biopsy of any lymph nodes done. Doctor states "marginal zone lymphoma, unspecified site, stage 1." |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule PH27, code the primary site to C809 [unknown primary]. According to Rule PH27 one is to code the primary site to unknown primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR multiple organ involvement without any nodal involvement.
If further workup is done and a primary site is determined, update the primary site for this case.
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. |
2013 |