Other Therapy: What code is used to represent treatment with "Epithilone" or "Epothilone"?
Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)], until the exact mechanism of action is determined for this drug. This drug is in phase I clinical trials. It has a similar action to Taxol, but is derived from a different source.
Date Multiple Tumors--Prostate: For a prostate biopsy done 10/20/08, both lobes involved with tumor, unknown how many tumors, what would be coded in date of multiple tumors?
In this case, code the date of the biopsy in Date of Multiple Tumors [10202008]. When the number of tumors is unknown, code the date of diagnosis as the Date of Multiple Tumors. This is the date on which it was determined that there were an unknown number of tumors. This instruction will be added to next edition of the MP/H manual.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Lung: How is histology coded for the tumor(s) that exist if a left upper lobe of lung resection final diagnosis states the patient has a moderately differentiated adenocarcinoma and the path indicates there are "multiple carcinoid tumorlets"?
For tumors diagnosed prior to 2007:
Histology is coded 8140/3 [adenocarcinoma]. This is one reportable tumor of the left lung. According to our pathologist consultant, the tumorlets are collections of cells which appear to be of neuroendocrine origin, but are not malignant.
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.
Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case?
Code the primary site to C421 [bone marrow]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow.
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.
Grade--Heme & Lymphoid Neoplasms: Why isn't "T-cell granular lymphocytic leukemia" (9831/3) coded as "5 T-cell" instead of "9" as specified in the Heme database? My path department did not specify any type of grade, but since "T-cell" is part of the name, wouldn't you code it to "5"?
Assign code 5 when the diagnosis on the pathology report specifies "T-cell granular lymphocytic leukemia." The Heme DB grade instruction states "Code grade specified by pathologist. If no grade specified, code 9." In this case, T-cell was specified - code it. The code for T-cell (5) was not automatically assigned in the Heme DB because of the alternate names for this neoplasm. Some of these include NK-cell. Assign code 8 for alternate names with NK.
The alternate names are: Chronic lymphoproliferative disorder of NK cells, Chronic NK-cell lymphocytosis, Chronic NK-large granular lymphocyte (LGL) lymphoproliferative disorder, CLPD-NK, Indolent large granular NK-cell lymphoproliferative disorder, NK-cell lineage granular lymphocyte proliferative disorder, NK-cell LGL lymphocytosis
MP/H Rules/Histology--Skin: How is the histology coded for "infiltrative carcinoma with ductal alterations compatible with squamoid eccrine ductal carcinoma" of the skin?
Code the histology to 8413/3 [eccrine adenocarcinoma]. This is the most specific code available for this diagnosis.
According to our expert pathologist advisor, "The adnexal glands in the skin, sweat (eccrine) glands and apocrine glands, all have ducts which connect the business portion of each gland to the skin surface. Some of the adnexal tumors have features of differentiation which appear to be duct-like, hence the designation 'ductal.'"
In addition, "The 'squamoid' simply indicates some degree of squamous differentiation, but doesn't alter the usefulness of [code 8413/3] because we have no way of coding anything more specific in this case anyway."
Histology (Pre-2007)--Stomach: What code is used to represent the histology of "mucin-secreting adenocarcinoma, intestinal type "for a stomach primary?
For tumors diagnosed prior to 2007:
For this specific example, code histology to 8481 [Mucin-producing adenocarcinoma] as it is a more specific cell type with inherent prognostic information.
Code 8255/3 [Adenocarcinoma with mixed subtypes] is not appropriate for this case because "intestinal type" is a more specific description of this cancer and not another type of cancer. There are two broad categories of gastrointestinal adenocarcinomas: Intestinal and Diffuse.
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.
Smoldering multiple myeloma [9732/3] has always been a reportable neoplasm. Per the Abstractor Notes section in the Heme, smoldering multiple myeloma is a variant of multiple myeloma in which the diagnostic requirements for multiple myeloma are met, but there is no organ damage. The patient is usually asymptomatic.
Smoldering myeloma is listed under the Alternate Names section in the Heme DB for multiple myeloma [9732/3] to clarify that it is a reportable neoplasm.
Report all new diagnoses of smoldering multiple myeloma now. Registries are not required to spend time and effort to find these cases if they have not been reporting them in the past. However, report earlier earlier cases if encountered today while performing casefinding or chart review procedures.
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--Thyroid: Is a "papillary carcinoma of the thyroid" coded to 8260/3 [Papillary adenocarcinoma] per the ICD-O-3 because it lists "papillary carcinoma of the thyroid" as a synonym for that code or should it be coded to 8050 [Papillary carcinoma, NOS]?
For cases diagnosed 2007 or later, assign code 8260 [papilary carcinoma of the thyroid].
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