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| Report | Question ID | Question | Discussion | Answer | Year |
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20000493 | EOD-Clinical Extension--Prostate: For prostate cancer, can an elevated PSA be used to code metastasis? See discussion. | 5/31/98 PE: 30 gm prostate with nodularity, suspicious for CA. Final diagnosis: Stage D Ca of prostate with mets, NOS PTA IVP: Normal collecting system 5/11/98 CXR: NED PSA 86.3 Suggestive of prostate Ca per MD 5/13/98 TURP and bilat. orchiectomy: Plan was to perform orchiectomy as treatment of choice if biopsy was positive. Appears MD feels that the patient has mets, NOS based on the elevated PSA. 5/13/98 TURP Adenocarcinoma, PD |
For cases diagnosed 1998-2003, do not code the EOD-Clinical Extension field based on elevated PSA alone. If a recognized practitioner states that there is metastasis, then metastasis should be coded.
In this case, code the EOD-Clinical Extension field to 85 [Metastasis] because it is Stage D. But if you had D1 or D2 staging based on the involvement of lymph nodes, then that involvement would be coded under EOD lymph nodes and not under the clinical extension field. |
2000 |
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20081105 | Primary site/Surgery of Primary Site--Lymphoma: What is the primary site for lymphoma involving lymph nodes and tonsil? Is a tonsillectomy coded as surgery for lymphoma? See Discussion. | 6/1/2008 cervical lymph node biopsy showed lymphoma. A 6/3/2008 CT Chest/abdomen showed mediastinal and mesenteric lymphadenopathy. A 6/15/2008 tonsillectomy is performed for markedly enlarged right tonsil. Tonsil pathology reveals extensive lymphoma involvement. Nothing in the chart specifies the primary site. Should this be a C778 primary because of 3 lymph node areas plus tonsil (a lymphatic organ)? Or should it be coded to C099 Tonsil? Is this tonsillectomy coded as surgical therapy? If so, is it surgery of primary site or surgery of other site? |
For cases diagnosed prior to 1/1/2010:Code the primary site to tonsil (C099). This advanced stage lymphoma involves an extranodal site (tonsil) and that site's regional lymph nodes (cervical). The lymphoma has also spread to non-regional lymph nodes (mediastinal and mesenteric). Code the tonsillectomy as surgery of primary site. 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. |
2008 |
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20110010 | Multiple primaries--Heme & Lymphoid Neoplasms: Is a recently diagnosed granulocytic sarcoma followed by a diagnosis of AMLÂ two primaries? See Discussion. |
6/10/10 Axillary lymph node biopsy was compatible with AML. The physician noted that the patient was diagnosed with granulocytic sarcoma [9930/3] in the axillary node. 6/15/10 Bone marrow biopsy compatible with AML FAB M1 [9873/3]. After induction, a second bone marrow biopsy on 6/30/10 shows persistent/refractory AML. The physician noted that the second biopsy is compatible with AML FAB M7 [9910/3]. Is the granulocytic sarcoma a chronic form of the disease? If so, do we have one primary diagnosed 6/10/10 with primary site coded to C42.1 and histology coded to 9873/3? Does the second biopsy on 6/30/10 represent the same primary even though the persistent disease is now FAB M7? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Granulocytic sarcoma does not transform into AML. Per the Abstractor Notes section in the Heme DB under the term "granulocytic sarcoma," it indicates that "Myeloid sarcoma (also known as granulocytic sarcoma) may occur de novo; it may precede or coincide with AML, or represent an acute blastic transformation of myelodysplastic syndromes." This means that when granulocytic/myeloid sarcoma is seen with AML, it represents a solid manifestation of the systemically involved AML. In other words, it is all the same disease process (coded to AML) if it occurs simultaneously (i.e., at the same time or within 21 days of on another). Apply Rule M3 to this case which states to abstract a single primary when a sarcoma is diagnosed simultaneously or after a leukemia of the same lineage. Code the primary site to C421 [bone marrow] with histology coded to 9873/3 [acute myeloid leukemia, M1]. The FAB category is an older classification that is seldom used. Changes from FAB 1 to FAB 7 do not constitute a new 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. |
2011 |
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20130050 | Multiple Primaries/Primary site/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what is the primary site and histology for each if a 6/12/12 left shoulder mass specimen suspicious for large B-cell lymphoma is followed on 7/10/12 with three skin nodules excised from the back with a diagnosis of "composite lymphoma? See Discussion. | 6/12/12 Excisional biopsy left shoulder soft tissue mass: Suspicious for large B-cell lymphoma.
7/10/12 Excisional biopsy three skin nodules of back: "Composite lymphoma" - primary cutaneous anaplastic large cell lymphoma (CD3 pos, CD4 pos, CD30 pos, ALK neg with partial loss of CD5) and CONCURRENT cutaneous follicular center lymphoma (CD20 pos, PAX5 pos, BCL-6 pos, partially CD10 pos) and flow cytometry revealed results compatible with involvement by a lymphoproliferative disorder of T-cell lineage.
Per imaging performed, there was no involvement of lymph nodes or other organs.
Is the primary site C449 Skin, NOS and histology 9718/3 [Lymphoma, primary cutaneous anaplastic large cell] be correct? |
Code primary site to C445 [skin, back] and histology to 9718/3 [cutaneous anaplastic large cell lymphoma] .
Per Rule M6, abstract a single primary when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location. For this case, there is cutaneous follicular (follicle) center lymphoma (9597/3) and cutaneous anaplastic large cell lymphoma (9718/3).
Per Rule PH22, code the primary site to the site or origin (skin, back) and the histology to the NHL with the numerically highest ICD-O-3 code. In this case, that would be 9718/3. |
2013 |
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20021183 | Primary Site--Head & Neck: What site code is used to represent the following head and neck primary where there is not a clear statement of primary site? See discussion. | 6/29/02: PE: 2-3 cm mass in the posterior pharynx that seems to arise from the right side of back of tongue. 6/29/02 CT soft tissue of neck: 3 cm right sided oropharyngeal mass, possibly arising from right tongue mass. There is near occlusion of airway at this level. 7/3/02 Excision of oropharyngeal tumor: Palpated mass could clearly be felt coming off the right lateral tongue in approximately the mid portion of the tongue near the tonsillar base. |
Code the Primary Site field to C02.9 [tongue, NOS], based on the information provided. | 2002 |
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20240016 | Histology/Behavior--Head and Neck: What is the histology code for sinonasal glomangiopericytoma in 2023? See Discussion. |
6/8/2023 A. Left nasal mass: Sinonasal glomangiopericytoma B. Additional left nasal mass: Sinonasal glomangiopericytoma Is this a borderline tumor? I am unable to find in this in the ICD-O-3 purple book or the Head and Neck Solid Tumor Rules. |
Assign histology code 8815/3 per ICD-O-3.2. Sinonasal glomangiopericytoma is also referred to as a sinonasal hemangiopericytoma. Prior to 2021, it was coded as 9150/3. |
2024 |
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20081029 | Multiple Primaries--Brain and CNS: Multiple cavernous hemangiomas diagnosed in 1995 are treated with radiation and steroids in 1996. A 1999 MRI states there is no interval change with the lesions in selected location since 1995. How many new primaries should be reported if a 2006 MRI states there are additional cavernous hemangiomas in other parts of the brain? See Discussion. | 7-03-97 PE: Past history significant for cavernous hemangiomas. Has had radiation and was on high-dose steroids in early 1996. Patient reports subsequent MRI done and neurologist gave "clean bill of health." 1-26-99 MRI BRAIN. Clinical information: history of intracranial cavernous hemangiomas. Comparison with prior brain MRI in 12/15/95. IMP: Upper medullary, right parieto-occipital, left frontal cavernous hemangiomas without interval change in size as compared to 12/15/95.
1-25-06 MRI BRAIN. Clinical info: history of prior radiation for cavernous angiomas. Comparison made with prior exam on 1/26/99. Impression: Multiple, variable sized cavernous angiomas within medulla, pontomedullary junction, midbrain, & cerebral hemispheres. Dominant lesion centered within posterior pontomedullary junction. FINDINGS: 8mm lesion in posterior pontomedullary junction. 2mm lesion within right paracentral portion of medulla. Several less than 5mm lesions noted within brain stem bilateral. Two, less than 1-2mm, areas within right inferior aspect of right and left cerebellar hemispheres. 1cm lesion centered within white matter within right posterior parietal/occipital region. Several small, less than 1-2mm, lesion within surrounding white matter. 3rd dominant lesion within left frontal lobe equal 6mm. Several 1-2mm foci of susceptibility artifact within subcortical white matter of high right and left cerebral hemispheres consistent with small cavernous angiomas. |
Benign and borderline brain and CNS tumors diagnosed January 1, 2004 and later are reportable. Multiple tumors in different brain and CNS sites are separate primaries. Different sites are those with ICD-O-3 topography codes that differ at the first, second, third or fourth character. There are four reportable primaries in the scenario described above. |
2008 |
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20130166 | Reportability--Heme & Lymphoid Neoplasms: Is "indolent multiple myeloma" reportable and synonymous with "indolent/smoldering myeloma"? See Discussion. |
7/10/12 Diagnosed with monoclonal gammopathy of undetermined significance (MGUS) 7/27/12 Diagnosed with MGUS/smoldering myeloma. There was no intervention at this time. In about October/November 2012 the diagnosis was reported as smoldering myeloma,. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Indolent myeloma [9732/3] and smoldering myeloma [9732/2] are reportable terms synonymous with plasma cell myeloma. Monoclonal gammopathy of undetermined significance (MGUS) [9765/1] is not reportable. 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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20120092 | MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence? See Discussion. | 7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.
3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and "there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence."
Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a "recurrence" of the 7/12/2007 diagnosis after reviewing the slides? |
For cases diagnosed 2007 or later, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007.
The steps used to arrive at this decision are:
Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.
General Information Rule 7 states "Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary."
Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary. |
2012 |
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20190006 | MP/H Rules/Multiple primaries--Breast: Please confirm Multiple Primaries/Histology Breast Rule M8 applies in this 2017 case. The surgical resection is >60 days past the biopsy date but is it possible treatment plans for breast could span >60 days and this is one primary? See Discussion. |
7/25/17 Part A: Left breast at 8:00, 5 CFN: Specimen type: Stereotactic biopsy. Tumor type: Ductal carcinoma in situ (DCIS), cribriform type. Tumor size: The largest focus of DCIS measures 1 mm in greatest dimension as measured on the slide. Nuclear grade: 2 (Intermediate grade). Microcalcifications: Present. Other findings: Stromal fibrosis, microcalcification and fat necrosis. 11/1/17 A. Sentinel lymph node, left: One lymph node, negative for metastatic tumor on three levels of routine H\T\E and pan cytokeratin immunohistochemical stains. B. Left breast: Procedure: Total mastectomy with skin and nipple. Specimen Laterality: Left. Lymph Node Sampling: Yes, portion A. Specimen Integrity: Intact. Histologic Type: Extensive ductal carcinoma in situ and one focus of Invasive ductal carcinoma with mucinous features. Histologic Grade (Nottingham Histologic Score): Glandular Differentiation: Score 3 Nuclear Grade: Score 2. Mitotic Count: Score 1. Total Nottingham score 6 (grade 2, moderately differentiated). Tumor Size: 3.3 x 2 mm (0.33 x 0.2 cm) measured on slide (B3). Tumor Site: Lower inner quadrant of left breast. Tumor Focality: Unifocal. Ductal Carcinoma In Situ (DCIS): Present, cribriform, solid and micropapillary types with focal necrosis and calcifications. Size of DCIS: Number of blocks examined: Thirty (30). Number of blocks with DCIS: Thirteen (13). Lobular Carcinoma In Situ (LCIS): Not identified, Lymphovascular Invasion: Present. Perineural Invasion: Not identified. Other Findings: Changes consistent with previous biopsy site. Cysts, foci of atypical ductal hyperplasia, focal ductal hyperplasia, adenosis, stromal fibrosis and microcalcifications. Skin (epidermis): Uninvolved. Nipple: Uninvolved. Margins: 1 mm from DCIS to the closest deep margin (slide B12). At least 10 mm (1 cm) from invasive carcinoma to deep margin. Estrogen receptor (ER, clone 1D5) by immunohistochemistry performed on this material: Positive (invasive and in situ carcinoma), high intensity, in greater than 95% of carcinoma cells. Progesterone receptor (PR, clone 16) by immunohistochemistry performed on this material: Positive (invasive and in situ carcinoma), moderate intensity in about 80% of the carcinoma cells. Her 2 by FISH performed on this material: Pending, an addendum to follow. Pathologic staging: pT1aN0(sn)MX (AJCC 7th edition). Dictated by: (Pathologist), MD Intradepartmental review. |
Abstract a single breast primary. Apply MP/H Rule M3 as this is a single tumor identified in the biopsy at 8 o'clock and at the same location in the mastectomy specimen. Code the behavior as invasive according to rule H9. The first course of therapy ends when the documented treatment plan is completed, no matter how long, unless there is progression, recurrence, or treatment failure. |
2019 |
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