Reportability/Behavior:
Our registry collects some borderline (behavior /1) cases that are not
reportable to SEER or any other standard setters. Can we assign a behavior code
of /2 to these cases?
Do not assign a behavior code of /2 to these cases unless you
have a way to flag them so that they are not reported to the standard setters
as in situ cases. Work with your state central registry to ensure that these cases are not unintentionally included in state case submission.
MP/H Rules/Histology--Lung: How is histology coded for a diagnosis of squamous carcinoma and large cell undifferentiated neuroendocrine carcinoma?
For cases diagnosed 2007 or later, apply rule H7 and code the numerically higher ICD-O-3 code, 8070/3 [Squamous cell carcinoma]. See Chart 1, the histology tree in lung equivalent terms. Large cell neuroendocrine carcinoma is histology code 8013/3. The other histology is squamous carcinoma, 8070/3. 8070/3 is higher numerically than 8013/3.
Histology (Pre-2007)--Melanoma: How is histology coded if the final diagnosis is "melanoma" and only in the comment section of the pathology report is there an indication of "Type: Lentigo Maligna. Cell Type: Small Cell"?
For tumors diagnosed prior to 2007:
Code the histology as 8742 [lentigo maligna melanoma]. Code the specific histologic type, even if stated only in the comment section.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Multiple primaries--Heme & Lymphoid Neoplasms: Is this 2 primaries? In 2011, a patient had a spinal mass biopsied positive for DLBCL and follicular lymphoma. The heme rules make this one primary coded as DLBCL. Patient had 2 rounds of chemo, but in 2014, he had a recurrent tumor in the same location. The 2014 biopsy was follicular lymphoma. Is this a new primary -- conversion of acute to chronic after treatment? Or is it the same, since FL was diagnosed in the original specimen?
Rule M13 applies, abstract as two primaries. Since both DLBCL and FL were present in 2011, rule M2 does not fit -- not a single histology. Rule M13 reflects the situation in this case much better: an acute neoplasm which was treated and a chronic neoplasm diagnosed later.
Code the histology to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable]. Per the Definition section in the Heme DB, this neoplasm has the, "Clinical laboratory and morphological features of myeloproliferative neoplasm but fails to meet the criteria for a specific myeloproliferative neoplasm; or presents with features that overlap two or more MPN neoplasms."
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.
Histology--Hematopoietic: How is histology coded for a "chronic lymphocytic leukemia with plasmacytic differentiation"?
For cases diagnosed prior to 1/1/2010:Assign histology code 9823/3 [Chronic lymphocytic leukemia]. Plasmacytic differentiation does not indicate a plasma cell or plasmacytic leukemia.
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.
Grade, Differentiation--Lymphoma: What code is used to represent this field when the only grade/differentiation given is "low grade", "intermediate grade" or "high grade"?
Code the Grade, Differentiation field to 9 [cell type not determined, not stated or not applicable]. For lymphomas, do not code the descriptions "high grade," "low grade," and "intermediate grade" in the Grade, Differentiation field. These terms refer to categories in the Working Formulation and not to histologic grade for lymphoma histologies.
Generally, for histologies other than Non-Hodgkin lymphoma, the Grade, Differentiation field is coded to 2 [low grade], 3 [intermediate grade] and 4 [high grade] for most cancers.
Reportability--Breast: Is a final path diagnosis of "phyllodes tumor, borderline (malignant, low grade)" reportable if the comment states "Features favor the diagnosis of a borderline phyllodes tumor (or also called malignant phyllodes tumor of low grade)"?
No, borderline phyllodes tumors (PT) are not reportable. The ICD-O-3 code is 9020/1. According to the WHO Classification of Tumours of the Breast and Female Genital Organs, borderline PT's are also called low grade malignant PT's.