Histology--Heme & Lymphoid Neoplasms: How is histology coded for a diagnosis of composite lymphoma (follicular lymphoma and small lymphocytic lymphoma, BCL-2 positive)?
Code the histology to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)] per Rule PH15. Code the histology to the non-Hodgkin lymphoma (NHL) with the numerically highest ICD-O-3 code when two or more NHLs are present in the same present in the same lymph node(s) or lymph node region(s), tissue(s), organ(s), or bone marrow. Both follicular lymphoma [9690/3] and SLL [9823/3] are types of NHL. Therefore, the histology is coded to 9823/3.
This composite histology represents a single primary per Rule M4. The rule states to abstract a single primary when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location(s), such as the same lymph node or lymph node region(s), the same organ(s), and/or the same tissue(s).
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.
MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later?
For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules.
EOD-Size of Primary Tumor: How is tumor size coded when there is a clinical tumor size, the excisional biopsy pathology report has a tumor size and the resection specimen has residual tumor, but there is no tumor size provided in the pathology report?
For cases diagnosed 1998-2003: Code the EOD-Size of Primary Tumor from the excisional biopsy. If there is some indication that a large amount of tumor was removed at the time of the resection, code the clinical size instead. When both an excisional biopsy and a resection show tumor, code the largest size of tumor reported.
MP/H Rules/Histology--Thyroid: How many primaries are to be reported and what histology is to be coded for an anaplastic/undifferentiated thyroid carcinoma with sarcomatoid transformation likely arising in association with a papillary thyroid carcinoma? Thyroid contains one tumor: 12.5 cm in greatest dimension...almost completely replaces entire thryroid gland.
For cases diagnosed 2007 or later:
This is a single primary using rule M2; a single tumor is always a single primary.
The histology code for this case is 8260/3 [Papillary carcinoma of thyroid]. Begin with Histology Coding rule H8. Stop at rule H17 and code the histology with the numerically higher ICD-O-3 code.
Solid Tumor Rules/Histology--Ovary: How is histology coded for an ovary case with a diagnosis of “high grade papillary serous carcinoma” in 2023? This term is not in the Solid Tumor Rules and ICD-O 3.2 updates. Is “high grade papillary serous carcinoma” equivalent to “high grade serous carcinoma” (8461) or to “papillary serous adenocarcinoma” (8441) with high grade captured only in the Grade fields, or is there another more appropriate code?
Assign code 8461/3 for high-grade papillary serous carcinoma.
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned for a patient with a history of CLL undergoing chemotherapy who is subsequently diagnosed on a liver biopsy with diffuse large B-cell lymphoma (Richter transformation)?
Abstract the diffuse large B-cell lymphoma (Richter transformation) as a second primary per Rule M10. Rule M10 states to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (CLL) AND there is a second diagnosis of an acute neoplasm (the diffuse large B-cell lymphoma (Richter transformation)) more than 21 days after the chronic diagnosis.
"Richter transformation," also known as "Richter syndrome," is a term that indicates CLL has transformed to DLBCL. Richter syndrome is listed under the Alternate Names section in the Heme DB for DLBCL (9680/3).
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.
MP/H Rules/Histology--Colon: What histology would be coded when the right colon demonstrates a combined adenocarcinoma and high grade small cell neuroendocrine carcinoma [forming the dominant component] arising in a villotubular adenoma and the liver biopsy demonstrates metastatic high grade small cell neuroendocrine carcinoma?
For cases diagnosed 2007 or later, start with rule H1 in the Single Tumor module. Stop at rule H4. Assign code 8263 [adenocarcinoma in tubulovillous adenoma].
Stop at the first rule that applies. Code histology based on a specimen from the primary site whenever available.
MP/H Rules/Histology--Colon: Regarding histology rule H21, is there a hierarchy or do you code the higher histology if there is an adenocarcinoma arising in a polyp and an adenocarcinoma in a villous adenoma?
For cases diagnosed 2007 or later:
If you arrive at H21 and have an additional decision to make regarding the use of 8210, 8261 or 8263, you must make another pass through the histology rules. The second pass will determine which of the two or three histology codes to assign. The answer will vary depending of the specifics of the case.
Example:
Transverse colon: Adenocarcinoma in an adenomatous polyp involving muscularis propria and adenocarcinoma in a villous adenoma involving subserosa of transverse colon. Start with rule H15 because there are multiple tumors. Stop at H21 -- code either 8210 or 8261. To decide between 8210 and 8261, make a second pass through the histology rules, starting again with H15. Stop at H20. Code the histology of the most invasive tumor, 8210 [Adenocarcinoma in adenomatous polyp].
First course treatment--Anus: Is the topical application of trichloroacetic acid to an anal condyloma with AIN III first course treatment coded to 10 [Local tumor destruction, NOS] in the Surgery of Primary Site field?
Code the trichloroacetic acid treatment of reportable AIN III in the "Other Therapy" field. Assign code 1 [Other].
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