Refer to the Hematopoietic Database and Manual to determine the primary site.
Leukemias are coded to C421 [bone marrow]. The ONLY neoplasm that is coded to C420 [blood] is Waldenstrom's macroglobulinemia [9761/3].
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.
Histology (Pre-2007)--Breast: What code is used to represent the histology "Ductal carcinoma in situ; 6 mm focus of invasion is a pure mucinous carcinoma that appears to have arisen in the background of encysted papillary carcinoma."
Code to mucinous (8480) since that is the only clearly invasive component of this diagnosis.
According to our pathologist consultant, "Encysted papillary carcinoma is the same thing as intracystic papillry carcinoma, which I think of as an intraductal papillary carcinoma which has greatly expanded the duct to form a cyst-like structure. It generally behaves in an in-situ rather than an invasive fashion. The only clearly invasive component is the mucinous carcinoma, which is what I would code."
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 2018/Prostate Pathologic Extension--Prostate: Is a pathology report from a prostate biopsy/transurethral resection of the prostate that states "with intraductal spread" extraprostatic/extracapsular extension or localized?
Code as a localized, intracapsular tumor as ductal carcinoma in situ does not invade. Intraductal spread is describing the neoplasm spreading through the acinar/ductal cells in the prostate specimen. It is an in-situ type of spread and not invasive but almost always presents with an invasive tumor.
Reportability--Brain and CNS: Is a skull tumor schwannoma an intracranial reportable benign tumor if the physician states it arose in the occipital nerve?
No. These schwannomas are not intracranial and therefore, are not reportable to SEER. The occipital nerve is not one of the 12 intracranial nerves (i.e., Abducens, Auditory (vestibulocochlear), Facial, Glossopharyngeal, Hypoglossal, Oculomotor, Olfactory, Optic, Spinal Accessory, Trigeminal, Trochlear, and Vagus).
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when bilateral breasts are involved with MALT lymphoma and the bone marrow is negative?
Per Rule M2, this is a single primary because there is a single histology mentioned. The histology is coded to 9699/3 [MALT lymphoma]. Code the primary site to C509 [breast] per Rule PH24 which states to code the primary site to the organ when lymphoma is present only in an organ.
Unless your software has edits that prevent coding laterality for lymphomas, code the laterality as bilateral. Up to half of extranodal, extragastric MALT lymphomas occur in multiple sites, particularly in paired sites (breast is an example).
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.
Unless the disease is specified as primary, idiopathic, essential, or the physician states there is a myeloproliferative neoplasm, the term thrombocytosis, NOS is not reportable. Thrombocytosis, NOS, is the presence of high platelet counts in the blood. Thrombocytosis can be associated with chronic infections and other diseases as well as with myeloproliferative disease. Thrombocytosis, NOS is listed in Appendix F as a Non-Reportable Term.
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--Heme & Lymphoid Neoplasms: Should all cases of precursor B acute lymphoblastic leukemia diagnosed 1/1/10 and later with histology coded to 9836/3 have the values changed to 9811/3 per the Heme DB Abstractor Notes section or should they remain coded 9836/3.
For cases diagnosed 2010 and forward, code histology to 9811/3 [B lymphoblastic leukemia/lymphoma, NOS] which is the new classification for pre-BALL. The histology code 9836/3 is obsolete as of 2010 and should not be used for cases with diagnosis date after 12/31/2009.
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/Histology--Lung: What is the histology code for "heterologous biphasic sarcomatoid carcinoma of the lung with prominent rhabdomyoblastic and adenoca differentiation"?
The expert pathologist recommends coding histology to 8980/3 [Carcinosarcoma] for this combination histology.
Expert consultation: The designation "carcinosarcoma" is given when the pathology shows differentiation in both the sarcomatous (rhabdomyoblastic) and carcinomatous (adenoca) elements. This is emphasized in the path for this case with the term "biphasic." The term "heterologous" mean that the sarcomatous component is of a type not normal to lung. Rhabdomyoblastic means skeletal muscle differentiation. Because skeletal muscle is not normally found in lung it is heterologous. If it were smooth muscle, it would be homologous because smooth muscle is found in lung (as a part of the bronchi).
Histology (Pre-2007): What code is used to represent the histology if the final diagnosis between an electron microscopy report and the immunocytochemistry (ICC) differs and both histologies are specific (e.g., one report states papillary carcinoma and the other states squamous cell carcinoma)?
For tumors diagnosed prior to 2007:
There is no established hierarchy between electron microscopy and ICC findings. Contact the pathologists involved in these types of cases to determine the final histologic diagnosis.
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.
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