Report | Question ID | Question | Discussion | Answer | Year |
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20130137 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for follicular lymphoma, low grade? See Discussion. | Pathologists seem to be moving away from identifying follicular B-cell lymphomas as grade 1, grade 2, etc. Instead, the term follicular lymphoma, low grade is being used. Should the histology be coded as follicular lymphoma, NOS even though the Heme DB indicates this code is usually used for death certificate cases? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9690/3 [follicular lymphoma, NOS].
Low grade for follicular lymphoma are not listed in the Heme DB or Manual. Because low grade can mean grade 1 or grade 2, default to follicular lymphoma, NOS [9690/3].
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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20130043 | Reportability--Heme & Lymphoid Neoplasms: Is reactive plasmacytosis a reportable diagnosis that is equivalent to plasmacytoma? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Reactive plasmacytosis is not reportable unless there is another indication of a reportable neoplastic disease. Reactive plasmacytosis is "a well known pathological process described as occurring in a variety of situations including infections, autoimmune disease, diabetes mellitus, sideropenia, liver cirrhosis and neoplastic conditions including leukemia. This process, by definition, is assumed to be a reaction of the immune system to an unknown or poorly defined stimulus." Based on this definition, reactive plasmacytosis is not the same as a plasmacytoma, although it may indicate the presence of a neoplastic process, such as 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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20130188 | Reportability--Heme & Lymphoid Neoplasms: Is plasma cell neoplasm reportable? See Discussion. | A previously submitted question in 2012 stated this was reportable, but recent answers seem to indicate this is not reportable. Please clarify whether this is reportable or not. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Plasma cell neoplasm is not reportable.
We apologize for the confusion that this has caused. The term "plasma cell neoplasm" was not included in the 2010 Heme DB and Manual. It was added to the 2012 Heme DB and Manual after repeated questions were received regarding this diagnosis. After further investigation, this term is being removed from the Manual and DB.
According to WHO, 'Plasma cell neoplasm' is an 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. Physicians may use the term 'plasma cell neoplasm' when they are not sure what the specific disease is. Plasma cell neoplasm is not reportable; however, follow up on these types of patients is recommended because continued evaluation is likely to determine a more specific disease. A reportable neoplasm may be diagnosed at a later date.
Cases of plasma cell neoplasm diagnosed 2010 or later are not reportable. This change should not have taken place as a result of the update in the 2012 Manual. At this time SEER is not requiring registries to go back and review plasmacytoma or multiple myeloma cases that were collected based on this terminology.
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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20130023 | Reportability--Brain and CNS: Why has reportability changed for "intradural extramedullary schwannomas"? Are all "spinal" schwannomas reportable or only those stated to be "intradural"? See Discussion. |
If intradural schwannomas are to be collected for cases diagnosed 2011 and later, why were they not included in the 2012 SEER Manual? Should collection of spinal schwannomas be postponed until the next revision of the MP/H Rules? |
The reportability of schwannomas was not initially agreed upon by the standard setters. After the issue was discussed by the CoC, NPCR and SEER Technical Workgroup and an agreement was reached. See #2 under Reportability in the Data Collection Answers from the CoC, NPCR, SEER Technical Workgroup http://www.seer.cancer.gov/registrars/data-collection.html#reportability.
The most accurate and most current instruction is to report these spinal tumors when they arise within the spinal dura or spinal nerve roots, or when they are stated to be "intradural" or "of the nerve root." Do not report these tumors when they arise in the peripheral nerves. The peripheral nerves are the portion of nerve extending beyond the spinal dura.
Spinal cord intradural schwannomas originate in spinal nerve roots. Spinal nerve root is best classified as spinal cord, C720. |
2013 |
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20130215 | Reportability--Heme & Lymphoid Neoplasms: Is hemophagocytic lymphohistiocytosis synonymous with an EBV-associated lymphoproliferative disorder in children reportable? See Discussion. |
Pathology report states: Prominent T-cell infiltrate with frequent immunoblast-like cells. COMMENT: Findings consistent with an acute EBV-associated hemophagocytic process. In addition, there is a prominent CD8 + T-cell infiltrate with many large, activated forms. This T-cell process may represent an EBV-associated lymphoproliferative disorder in children. EBV-associated lymphoproliferative disorder in children is listed in the Heme database. However, throughout multiple admissions, the oncologist states the diagnosis as "hemophagocytic lymphohistiocytosis". Are the two the same condition? The patient is being treated with Etoposide. |
Per Appendix F, do not report this case based on the information provided. The oncologist likely used the pathology report and clinical factors to determine the diagnosis of hemophagocytic lymphohistiocytosis, which is not reportable. Hemophagocytic lymphohistiocytosis is caused by an over stimulated immune system (infection, etc.). This clinical syndrome is associated with a variety of underlying conditions. To be reportable, it must state "fulminant hemophagocytic syndrome" (in a child) to be reportable (9724/3). The pathology report for this case is not definitive. It states that the process "may" represent the EBV-associated lymphoproliferative disorder in children. Follow back on this case to confirm reportability if possible. |
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. |
2013 | |
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20120087 | MP/H Rules/Histology--Kidney: How is the histology coded and what rule(s) apply for "cyst associated renal cell carcinoma," "cystic renal cell carcinoma," and "cystic renal cell carcinoma, clear cell type"? See Discussion.
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Per SINQ 20031008, these histologies were all coded as 8316/3 [cyst associated renal cell carcinoma]. What are the correct codes for these histologies using the 2007 MP/H Rules?
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For cases diagnosed 2007 or later, the correct histology code for both cyst associated renal cell carcinoma and cystic renal cell carcinoma is 8316/3. The histology code for cystic renal cell carcinoma, clear cell type is 8255/3.
The steps used to arrive at these decisions 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 Kidney Histology rules because site specific rules have been developed for this primary.
Step 2: For the first histology, cyst associated renal cell carcinoma, start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H5. According to this rule you are to use Table 1 if you have a renal cell carcinoma and mention of a more specific renal cell type. To locate Table 1, go to Kidney under the Terms & Definitions section. Per Table 1, titled Renal Cell Carcinomas and Specific Renal Cell Types, "cyst associated" is a specific type of renal cell carcinoma. Code the histology to 8316/3 [cyst associated renal cell carcinoma].
Step 3: For the second histology, cystic renal cell carcinoma start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H5. As in the previous example you are to use Table 1 if you have a renal cell carcinoma and mention of a more specific renal cell type. Per Table 1 "cystic" is a specific type of renal cell carcinoma. Code the histology to 8316/3 [cystic renal cell carcinoma].
Step 4: For the third histology, cystic renal cell carcinoma, clear cell type, start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H6 which states you are to code histology to 8255 (adenocarcinoma with mixed subtypes) when there are two or more specific renal cell carcinoma types. To determine whether "clear cell" and "cystic" are types of renal cell carcinoma use Table 1 again. According to Table 1, both cystic and clear cell are specific types of renal cell carcinoma. Code the histology as 8255/3 [adenocarcinoma with mixed subtypes].
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2012 |
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20120072 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of multifocal Langerhans cell histiocytosis with involvement of the bone, liver, spleen and retroperitoneum? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Per Rule PH30, use the Heme DB to determine the primary site and histology when rules PH1-PH29 do not apply. Code the primary site to C419 [bone, NOS], assuming there are multiple bones involved in this case. If only one bone is involved, code the primary site to the specified bone. In the Abstractor Notes section in the Heme DB, it indicates the primary site may differ for LCH in the solitary disease and multisystem disease. This patient has multisystem disease with involvement of the bone, liver, spleen and retroperitoneum. The most common sites for multisystem involvement include three of the four above sites (bone, liver, and spleen). Determine the primary site based on the knowledge of the usual sites of involvement for this disease, the actual sites of involvement for the case presented, and identifying which sites of involvement are likely metastatic and which are the potential primary sites. There are two potential primary sites of involvement: the bone and the retroperitoneum. Bone is a common site of involvement for LCH while the retroperitoneum is not. Code the primary site to C419 [bone, NOS] because multiple bones are involved for this patient and bone is the most common site for LCH based on the documentation in the Abstractor Notes. The spleen and liver are typically not primary sites for this disease process. They become involved when there is multisystem involvement because they filter the blood. They are typically sites of metastatic involvement. This information will be added to the ABSTRACTOR NOTE section. 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. |
2012 | |
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20120063 | Reportability--Pancreas: Are neuroendocrine "tumors" reportable and are they synonymous with neuroendocrine "carcinoma"? See Discussion. | Example: Pancreatic mass that probably represents a neuroendocrine tumor is staged as cT2N0M0. | According to the World Health Organization (WHO) pancreatic neuroendocrine tumors (NET) are malignant. They are reportable.
For pancreas primaries, code NET, G1 (well differentiated) to 8240/3; NET G2 (moderately differentiated) to 8249/3; and nonfunctional NET, GI or G2 to 8150/3. The histology code for neuroendocrine carcinoma (NEC) is 8246/3, large cell NEC is 8013/3 and small cell NEC is 8041/3. |
2012 |
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20120001 | Multiple primaries/Recurrence--Heme & Lymphoid Neoplasms: How many primaries are abstracted if a patient was diagnosed with diffuse large B-cell lymphoma in 2001 and was diagnosed with diffuse large B-cell lymphoma involving the larynx in 2011? See Discussion. | Does the medical oncologist's statement that this is a second malignancy, rather than a recurrence, given the length of the disease-free interval, affect the number of primaries abstracted? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Abstract a single primary per Rule M2; a single histology is a single primary diagnosed. The histology code for both the 2001 and 2011 diagnoses is 9680/3[diffuse large B-cell lymphoma]. Case is coded as diagnosed in 2001.
The hematopoietic physician experts say that the issue with lymphomas is that the patient may be disease-free then recur years later. Even though years have passed, this is still a recurrence or relapse. Currently, there are no molecular markers that are able to distinguish "new primaries" from recurrences. There are also no established criteria for timing rules that could be used to determine a new primary from a recurrence.
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. |
2012 |