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20120021 | Multiple primaries--Heme & Lymphoid Neoplasms: How are the terms "chronic" and "acute" used to help determine the number of primaries to be abstracted and what rule applies when a diagnosis of diffuse large B-cell lymphoma is followed two years later by a diagnosis of follicular lymphoma, grade 3A of 3? See Discussion. |
7/31/08 Biopsy of the left supraclavicular lymph node diagnosed Stage IIIB DLBCL [9680/3] 10/14/10 Biopsy of a right supraclavicular lymph node diagnosed follicular lymphoma, grade 3A or 3 [9698/3]. Which multiple primary rule applies to determine the number of primaries to report? Is Rule M4 ignored? Does Rule M13 apply because follicular lymphoma normally transforms to DLBCL? Is this still a transformation because the follicular lymphoma came AFTER the DLBCL (the "acute" reverted to "chronic")? Or does Rule M15 apply, and the Multiple Primaries Calculator should be used to determine the number of primaries to report? Are "transformations" the acute phases of the more chronic disease? The Heme Manual and previous training sessions do not make this apparent. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. This case should be accessioned as two primaries per Rule M13. Code the histology for the 7/31/08 diagnosis to 9680/3 [diffuse large B-cell lymphoma] and the code the histology for the 10/14/2010 diagnosis to 9698/3 [follicular lymphoma, grade 3A of 3]. Rule M13 applies to this case because the neoplasm was originally diagnosed in the blast or acute phase (DLBCL) and reverted to a less aggressive or chronic phase (follicular lymphoma) after treatment. Per the "Transformations to" section in the Heme DB for follicular lymphoma, grade 3 transforms to diffuse large B-cell lymphoma [9680/3]. This means that the follicular lymphoma is the chronic neoplasm and that DLBCL is the acute neoplasm. In this case, the chronic neoplasm was diagnosed after the acute neoplasm was diagnosed and treated (with chemotherapy). Do not Stop at Rule M4 because diffuse large B-cell lymphoma and follicular lymphoma (both NHL's) were not present in the same node(s) AT THE SAME TIME. 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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20200053 | Solid Tumor Rules (2018)/Multiple primaries--Bladder. Would the metastatic diagnosis indicate a new primary? If the metastatic diagnosis indicates a new primary, would the primary site be C688 and date of diagnosis 11/14/18? See Discussion. |
7/8/16 Urinary bladder, biopsy: Non-invasive low grade papillary urothelial carcinoma. Muscularis propria (detrusor muscle) is not identified. 9/2/16 Urinary bladder, bladder tumor, transurethral resection: High grade papillary urothelial carcinoma. No definite invasion identified. Muscularis propria (detrusor muscle) is identified and not involved by tumor. 1/7/17 A\S\Bladder: Noninvasive low grade papillary urothelial carcinoma. Granulomatous cystitis, consistent with BCG (Bacillus Calmette-Guerin) treatment. Lamina propria is not involved with tumor. Detrusor muscle is not identified. 4/4/17 Dome: Papillary urothelial carcinoma, low grade. No evidence of invasion. Muscularis propria is not present. Patient is clearly followed for at least a year but no further information until 19 months later, 11/14/18, when biopsy of lung indicates metastatic disease. 11/14/18 Lung, right lower lobe, mass, biopsy: Metastatic urothelial carcinoma. Immunohistochemical analysis results (CK7 positive, CK20 focally positive, P63 positive, GATA3 positive, TTF1 negative and NAPSIN-A negative) support the diagnosis |
Do not use the solid tumor rules to assess the 2018 diagnosis. See Note 1 on page 20 of the Urinary Sites Solid Tumor Rules, https://seer.cancer.gov/tools/solidtumor/Urinary_STM.pdf The 2018 diagnosis proves that this patient had invasive bladder cancer. Change the behavior on the abstract to /3 and use text fields to record the details. |
2020 |
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20140027 | MP/H Rules/Histology--Bladder: What is the correct histology for the following bladder case and how do you determine? See discussion. |
8/1/10 CYSTOSCOPY -- MULTIPLE BLADDER TUMORS INVOLVING POSTERIOR WALL, DOME & BLADDER NECK AREA. LARGEST WOULD BE MORE THAN 5 CM IN SIZE. 8/17/10 path -- BLADDER TUMORS:PAPILLARY TRANSITIONAL CELL CARCINOMA OF urinary bladder, GRADE III. ONE FRAGMENT OF TISSUE SHOWS NECROTIC CHANGE WITH APPARENT TRANSFORMATION TO A HIGH GRADE SARCOMATOID VARIANT W ITH EXTENSIVE SUBMUCOSAL INVASION & FOCAL AREA SUGGESTIVE OF ANGIOLYMPHATIC INVASION NOTED. MAJORITY OF TUMOR APPEARS CONFINED TO MUCOSAL SURFACE W ITH NO OTHER AREAS OF DEFINITIVE SUBMUCOSAL INVASION FOUND. |
Code 8122/3 (UC/TCC, Sarcomatoid). Rule H5 and Table 1 apply.
This is based on the information provided: Transitional Cell Carcinoma with sarcomatoid variant, and Table 1 in Terms and Definitions for "Ureter/Renal Pelvis/Bladder". |
2014 |
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20160045 | Neoadjuvant treatment/Grade--Prostate: How should the grade/differentiation field be coded when hormone therapy is given prior to radiation for metastatic prostate cancer? Is hormone treatment "neoadjuvant treatment" in this situation? Per NCCN guidelines, neoadjuvant hormone therapy is strongly discouraged outside of a clinical trial for localized disease. However for metastatic disease, hormone is recommended (gold standard). See discussion. |
8/1/15 CT Exam showed enlarged prostate and left seminal vesicle with multiple enlarged pelvic LNs. Findings: suspicious for prostate cancer with invasion of seminal vesicle. Bone scan findings: positive bone mets in multiple sites. PSA 169.0 (elevated). Patient was started on casodex 8/12/15. A prostate biopsy was performed on 9/16/15 to confirm diagnosis, adenocarcinoma Gleason 4+5. Patient's treatment continued with radiation to bone. |
For cases diagnosed prior to 2018 Code the grade/differentiation field from the biopsy for this situation. According to experts consulted, hormone therapy does not alter the grade in this case and grade should be coded based on information after hormone therapy when that is the only grade information available. |
2016 |
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20170027 | MP/H Rules/Multiple primaries--Melanoma: Is a melanoma with an unknown laterality a different laterality for the purposes of applying Multiple Primaries/Histology Rule M4? See Discussion. |
8/1/2016 Left Abdomen biopsy: Early melanoma in situ (C445-2, 8720/2). 9/2/2016 Upper back: Superficially invasive malignant melanoma (C445-9, 8720/3). Does rule M4 apply and multiple primaries should be reported or does rule M8 apply and a single primary should be reported? |
Abstract multiple primaries following Multiple Primary Rule M4. Unknown laterality is a different laterality for the purposes of applying the MP/H rules for melanoma. NOTE: This answer applies to cases diagnosed prior to 2018. As of 1/1/2018, early melanoma is not reportable. |
2017 |
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20031189 | Multiple Primaries (Pre-2007)--Thyroid: Would a papillary carcinoma of the right lobe of the thyroid diagnosed approximately 2 1/2 years after a papillary carcinoma of the left lobe be coded as a second primary? See Description. | 8/31/1999: papillary carcinoma, left lobe thyroid, treated with lobectomy. 1/17/2002: papillary carcinoma, right lobe, treated with lobectomy, completion thyroidectomy. |
For tumors diagnosed prior to 2007:
Yes, this is a second primary. The second papillary carcinoma was more than 2 months after the first and not specified as recurrent or metastatic.
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. |
2003 |
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20000529 | EOD-Extension--Lung: If LUL mass "crosses the pleural surface" into the LLL, do we assume this represents extension to the pleura? See discussion. | 9/22/93 Left upper lobe lobectomy: 3 x 3 cm mass in the periphery of the LUL near the LLL. Multiple enlarged nodes around the aortic arch and within the pulmonary fissure.
9/22/93 Pathology: Moderately differentiated Adenoca. The neoplasm does cross the pleural surface into the segment of the lower lobe. Lower margin of resection is free of neoplasm. Six lymph nodes negative for metastatic carcinoma. Tumor staged as T2N0M0 Stage Ib by physician.
Is tumor extension coded 10 [confined to one lung] or 40 [extension to pleura]? |
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to pleura]. The tumor has penetrated (extended to) the pleura. |
2000 |
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20130203 | MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are accessioned for a diagnosis of cerebral cavernous malformation disorder (CCM1) and MRI evidence of dozens of cavernous angiomas/malformations throughout the supra and infratentorium? See Discussion. | 9/9/11 IMP: Presymptomatic cerebral cavernous malformation disorder (CCM1).
9/9/11 Brain MRI: FINDINGS: Total of 14 foci. 2 largest in rt frontal lobe. In rt frontal lobe, total of 4 foci. Of remaining 10 small foci, 4 are in cerebellum, 1 in rightward pons, 1 in lt temporal lobe, 1 in lt occipital lobe, 1 in rt occipital lobe, 1 in posterior rt temporal lobe, & 1 in lt frontal lobe. Lesions in bilateral occipital lobes & lt temporal lobe are associated w/weighted signal suggestive of hemosiderin & are most c/w additional cavernous malformations. IMPRESSION: Just over a dozen scattered foci of gradient susceptibility throughout supra & infratentorium.
9/13/13 Brain MRI. Clinical diagnosis: Cerebral cavernous angiomas. FINDINGS: Approximately a dozen scattered foci. 2 largest in rt frontal lobe. Remaining small foci identified w/in cerebellum, rightward pons, rt occipital lobe, rt temporal lobe, & lt frontal lobe. Many are less conspicuous than in 2011 & a few that were present on prior study are not evident on current exam. This is likely due to differences in technique. IMPRESSION: Redemonstration of numerous scattered foci c/w cavernous malformations. |
This case is not reportable as is. The clinical diagnosis on the 9/13/13 MRI was "cerebral cavernous angiomas," but the final impression on the MRI was a re-demonstration of the numerous scattered foci consistent with cavernous malformations seen on the previous 9/9/11 MRI. There was no reportable statement of cavernous angioma. Cavernous malformation is not a reportable neoplasm; it has no valid ICD-O-3 code.
Vascular tumors of the CNS are reportable when they arise in the dura or parenchyma of the CNS. When they arise in blood vessels or bone, they are not reportable. Do not report vascular tumors when there is not enough information to determine whether they arise in the dura or parenchyma or elsewhere. |
2013 |
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20250008 | Diagnostic Confirmation--Heme & Lymphoid Neoplasms: How is Diagnostic Confirmation coded for hematopoietic and lymphoid neoplasms (heme) when immunophenotyping, genetics, etc. confirm the diagnosis. |
Assign Code 3 (Positive histology PLUS positive immunophenotyping or genetic testing) for 1. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis), ANDÂ
2. A not otherwise specified (NOS) histology diagnosed and not a provisional diagnosis, AND genetic/immunophenotyping was performed and positive Refer to the current version of the Heme Manual for specific notes and examples when coding Diagnostic Confirmation. |
2025 | |
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20130165 | MP/H Rules/Multiple primaries--Thyroid: How many primaries are reported and what is histology for the papillary carcinomas if a Classical cytomorphology with a follicular architecture is on the right and a Columnar cell cytomorphology with a follicular and papillary architecture is on the left? See Discussion. |
The answer seems to hinge on whether or not the two tumors differ at the third digit of histology. Can we code the histology based on the terms listed for variant or architecture? |
This is a single thyroid primary. The tumors are both papillary carcinoma with follicular architecture for the most part. Apply Rule M6 and abstract a single primary. | 2013 |
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