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20130172 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what is the histology for each if a bone marrow diagnosis reveals co-existent systemic mastocytosis and a lymphoplasmacytic neoplasm? See Discussion. | 11/7/12 Peripheral blood flow cytometry: small population of clonal CD5- CD10- B-cells consistent with a B-cell lymphoproliferative process.
1/16/13 Bone marrow final diagnosis: co-existent systemic mastocytosis and lymphoplasmacytic neoplasm.
B-cell component of lymphoplasmacytic neoplasm constitutes 20% of bone marrow cellularity and the plasma cell component approximately 20%. The differential diagnosis includes marginal zone lymphoma with plasmacytic differentiation and lymphoplasmacytic lymphoma.
Flow cytometry: kappa monotypic B-cells and plasma cells.
Comment: Co-existence of systemic mastocytosis and mature B-cell lymphoma meets the criteria for Systemic mastocytosis with Associated Clonal Hematological Non-Mast Cell Lineage Disease (SM-AHNMD).
From our physician's progress note: KIT-D816V-positive, CD117+/CD25+ /SM-AHNMD(40% of the nucleated cells as spindled mast cells) but also seemingly two distinct lymphoid neoplasms, a CD5-negative/CD10-negative B-cell lymphoproliferative neoplasm consistent with occupying another 20% of the nucleated marrow space, together with an IgG-kappa-restricted (non-reportable diagnosis) occupying another 20% of the nucleated marrow space (and an accompanying 2.0 g/dl M-spike without hypercalcemia or anemia). |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Under the Alternate Names section of the Heme DB, systemic mastocytosis with Associated Clonal Hematological Non-Mast Cell Lineage Disease (SM-AHNMD) is a synonym for systemic mastocytosis. Per Rule M2, this is one primary. Abstract a single primary when there is a single histology. Code the histology to 9741/3 [systemic mastocytosis].
Per the pathology report, the two diagnoses of systemic mastocytosis and mantle cell lymphoma meet the criteria for SM-AHNMD. The B-cell lymphoma is a symptom/marker of the AHNMD. In systemic mastocytosis with AHNMD, a myeloid or lymphatic malignancy is diagnosed with the SM. The prognosis is usually dominated by the non-mast cell malignancy.
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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20130083 | Ambiguous terminology/Histology--Heme & Lymphoid Neoplasms: How is the histology coded if an FNA reveals high grade B-cell lymphoma, compatible with diffuse large B-cell lymphoma, and the treating physician states this is diffuse large B-cell lymphoma? See Discussion. | The FNA showed high grade B-cell lymphoma, morphologically compatible with diffuse large B cell lymphoma. Special studies state: Tumor cells are positive for Vimentin, CD45, and CD20, focally weakly positive for CD43; negative for Myeloperoxidase, CD99, AE1/AE3, CK7, CK20, S100, CD3, cyclin D1, CD34, CD5 and TTF1. The cellular findings and immunophenotype are compatible with large B-cell lymphoma.
The treating physician refers to this disease process and is treating the patient for diffuse large B-cell lymphoma. Should the histology be coded as B-cell lymphoma, NOS (9591/3) because both the FNA and the immunophenotyping use ambiguous terminology? Does the physician reference to the disease process as diffuse large B-cell lymphoma, Stage II-AE impact the histology used? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to diffuse large B-cell lymphoma [9680/3] because the physician states this is a DLBCL and is treating the patient accordingly. Although the pathology report was only compatible with DLBCL, there was a subsequent clinical diagnosis that confirmed a diagnosis of DLBCL. In addition, the patient was treated for DLBCL.
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. |
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20130007 | MP/H Rules/Histology--Colon: What rule applies and how is histology coded if a colon tumor is composed of moderately differentiated adenocarcinoma and neuroendocrine tumor, grade 1 (G1)? See Discussion. |
Intestine, large -- moderately differentiated adenocarcinoma
Pathological stage: IIIA (T2 N1a Mx) -- Neuroendocrine tumor, G1
Addendum comment: The results of the immunochemical study are compatible with a neuroendocrine tumor, G1. |
For cases diagnosed 2007 or later, the correct histology code is 8244/3 [composite carcinoid]. The steps used to arrive at this decision are:
Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Colon Histology rules because site specific rules have been developed for this primary.
Step 2: Start at the SINGLE TUMOR module, rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H9. Code the histology as 8244/3 [composite carcinoid] when the diagnosis is adenocarcinoma and carcinoid tumor.
Neuroendocrine tumor, grade 1 (G1) is synonymous with carcinoid tumor [8240/3] for the purpose of rule H9. |
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20130120 | Primary site--Heme & Lymphoid Neoplasms: What is the primary site for a Langerhans cell Sarcoma of the lower extremity? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
If the bone is involved, code the primary site to bone. Langerhans more commonly starts in the bone and extends to the soft tissue.
If bone is not involved, code primary site to C492, Connective, subcutaneous and other soft tissues of lower limb and hip.
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. |
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20130101 | Reportability--Heme & Lymphoid Neoplasms: Is plasma cell dyscrasia, favor MGUS vs. smoldering myeloma reportable? See Discussion. | The pathology report states, "plasma cell dyscrasia, favor MGUS vs. smoldering myeloma." The patient then died of a heart attack and no further information is available. If this is reportable, what histology code applies? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case is not reportable. Neither plasma cell dyscrasia nor MGUS are reportable. Smoldering myeloma was given as a possible diagnosis, but never confirmed.
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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20130209 | Multiple primaries--Heme & Lymphoid Neoplasms: Is a new bone marrow diagnosis of acute myelogenous leukemia that follows a 2007 treated diagnosis of a JAK-2 positive polycythemia vera a new primary? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Per Rule M10, abstract two primaries. Per the Heme DB, polycythemia vera [9950/3] transforms to an acute myelogenous leukemia [9861/3]. According to Rule M10, one is to abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (e.g., polycythemia vera) AND there is a second diagnosis of an acute neoplasm (e.g., acute myelogenous leukemia) 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. |
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20130185 | Reportability/Behavior: Is HGSIL (high grade squamous intraepithelial lesion) of the vulva or vagina reportable and is it a synonym for histology code 8077/2 [squamous intraepithelial neoplasia, grade III]? |
For cases diagnosed 2018 and later HGSIL of the vulva or vagina is reportable. HGSIL is a synonym for squamous intraepithelial neoplasia, grade III. |
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20130173 | Histology/Primary site--Heme & Lymphoid Neoplasms: How is the primary site and histology coded when a bladder biopsy reveals myeloid sarcoma and a simultaneously performed bone marrow biopsy demonstrates acute myeloid leukemia? See Discussion. | 12/22/11 Bladder biopsy: myeloid sarcoma,
12/22/11 Bone marrow biopsy: acute myeloid leukemia.
Presenting symptoms were urological with three month history of painful hematuria and hydronephrosis with solid mass of bladder.
Prior to biopsy hem/onc states bladder mass of unknown pathology. CBC revealed peripheral blasts and Auer rods -- presumed diagnosis of acute myeloid leukemia (AML). No statement from physician as to where disease originated. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M3, abstract a single primary when a sarcoma (myeloid sarcoma) is diagnosed either simultaneously or after a leukemia of the same lineage (acute myeloid leukemia). Per the notes for Rule M3, the sarcoma is a solid manifestation of the associate leukemia.
Per PH10, code the histology to 9861/3 [acute myeloid leukemia] and the primary site to C421 [bone marrow]. PH10 states one is to code the primary site bone marrow (C421) and code the histology acute myeloid leukemia, NOS (9861/3) or any of the specific AML histologies (9840/3, 9865/3-9867/3, 9869/3-9874/3, 9891/3, 9895/3-9898/3, 9910/3, 9911/3 and 9931/3) when the diagnosis is myeloid sarcoma (9930/3) AND there is a simultaneous or previous diagnosis of acute myeloid leukemia.
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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20130118 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of Langerhans cell histiocytosis with extensive bony metastatic disease and lymphadenopathy? See Discussion. | Patient was diagnosed with LCH on a biopsy of the right femur. Imaging showed extensive bony metastatic disease, extensive infiltrative perinephritis, encasement of both kidneys, renal hilar, retroperitoneal and periaortic lymphadenopathy. The right femur biopsy pathology report did not state this was metastatic. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C419 [bone, NOS] per Rule PH30.
This patient has widely metastatic disease. Per Rule PH30, one needs to reference the Heme DB to determine the primary site and histology for this case. Per the Abstractor Notes section, Langerhans cell histiocytosis arises in the bone and many times can involve multiple bones, along with other organs and lymph nodes. Although the right femur was biopsied, this does not prove that the primary site is the femur [C402] because the patient has what was described as extensive bony metastatic 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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20130220 | Reportability--Thyroid: Is a hyalinizing trabecular neoplasm of the thyroid reportable? See Discussion. | The pathology comment states: Hyalinizing trabecular neoplasm is considered by some to represent a variant of papillary thyroid carcinoma because of the similar nuclear cytology, immunoprofile and RET-oncogene rearrangements. | Hyalinizing trabecular neoplasm is not reportable.
Hyalinizing trabecular neoplasm, or hyalinizing trabecular tumor, is a synonym for hyalinizing trabecular adenoma [8336/0] in the ICD-O-3. The 2004 WHO classification states that "fine needle aspiration biopsy is often interpreted as papillary carcinoma because of the nuclear features in the tumor." |
2013 |
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