Report | Question ID | Question | Discussion | Answer | Year |
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20081004 | First course treatment/Histology--Lymphoma: What treatment, if any, is coded for a patient with methotrexate induced lymphoma when the treatment plan is to take the patient off methotrexate? Also, is there a specific histology for drug induced lymphoma? See Discussion. | Diffuse Large B-cell Lymphoma of soft palate & nasal septum, methotrexate induced, in 5/07. Patient was taken off methotrexate with complete resolution of disease. No other treatment was given. Patient was on methotrexate for treatment of rheumatoid arthritis. | For cases diagnosed prior to 1/1/2010:Treatment: Code the treatment fields to 00 [not done] in this case. Document the discontinuation of methotrexate for rheumatoid arthritis in a text field. Histology: Assign code 9680/36 [Malignant lymphoma, large B-cell, diffuse, NOS]. There is no specific histology code for therapy-related lymphoma. 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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20010132 | Histology (Pre-2007)--Kidney: What code is used to represent the histology "renal cell carcinoma with granular cell morphology"? Kidney primary with diagnosis of renal cell CA with granular cell morphology. Do we code as granular cell carcinoma? Is the term "morphology" synonymous with "type"? See discussion. | Do we code this type of tumor as a granular cell carcinoma [8580/3]? | For tumors diagnosed prior to 2007:
Code the Histology field to 8320/3 [granular cell carcinoma]. Renal cell carcinoma is a non-specific term that has several specific cellular subtypes, one of which is granular cell [8320/3].
Note: Do not code to granular cell tumor [9580/3], which is not a histology related to renal cell carcinoma.
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. |
2001 |
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20010129 | Histology (Pre-2007)--Breast: What code is used to represent the histology "duct carcinoma, colloid type"? See discussion. | Do we use 8480/3 [colloid carcinoma] or 8523/3 [duct carcinoma] mixed with other types of carcinomas? | For tumors diagnosed prior to 2007:
Code the Histology field to 8480/3 [colloid carcinoma] per Rule 4. The lesion is colloid type of ductal carcinoma, not ductal carcinoma mixed with colloid carcinoma.
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. |
2001 |
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20021092 | Histology/Primary Site--CLL/SLL: How should these fields be coded for a "chronic lymphocytic leukemia/small lymphocytic lymphoma" [CLL/SLL] diagnosed on a lymph node biopsy that is referred to by the clinician as CLL? See discussion. | Does the clinician's reference to this disease as CLL change the SEER rule to code to SLL if the disease arises in a lymph node or solid tissue? | For cases diagnosed prior to 1/1/2010:Code the Histology field to 9670/3 [Malignant lymphoma, small lymphocytic, NOS] and the Primary Site field to C77._ [lymph nodes] when CLL/SLL is diagnosed in lymph node or solid tissue, even if the clinician refers to CLL. When CLL/SLL is diagnosed in the blood, code as leukemia.
Refer to clarification #6 on the ICD-O-3 Errata and Clarifications. "...if disease is diagnosed only in the blood or bone marrow, code the primary site to C42.1, bone marrow and assign the leukemia morphology code. If the diagnosis is made on any other tissue (typically lymph nodes, lymphatic structures, breast, and stomach), code to the tissue involved and assign the lymphoma morphology. If the diagnosis is made on both blood or bone marrow and a tissue biopsy, code the tissue involved and assign the lymphoma morphology." For cases diagnosed 2010 forward, 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. |
2002 |
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20120018 | MP/H Rules/Histology--Breast: How is histology coded if a lumpectomy reveals multifocal ductal carcinoma in situ spanning an area of 0.9-1.2 cm with close margins and a subsequent mastectomy reveals only a single focus of lobular carcinoma in situ measuring 0.2 cm in the UOQ, remote from all surgical margins? See Discussion. | Does the general instruction apply in this case that indicates the histology is coded from the most representative tumor specimen resulting in the histology coded to 8500/2 [DCIS]? Or is the histology coded to 8522/2 [duct and lobular carcinoma in situ] per Rule H28 because there is any combination of lobular [8520] and duct carcinoma [8500]? | Code the histology to duct and lobular carcinoma in situ [8522/2].
For cases diagnosed 2007 and later, the steps used to arrive at this decision are:
Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS Module Rule M4 because the patient had multiple foci of DCIS and a separate, single focus of LCIS. The rules are intended to be reviewed in consecutive order within the applicable Module. Tumors that are lobular and duct are a single primary.
Go to the Breast Histology rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module Rule H20 because the patient has multiple foci of DCIS and LCIS. Code the histology as 8522/2 [duct and lobular carcinoma in situ] when there is any combination of lobular [8520] and duct carcinoma.
The DCIS and LCIS are separate tumors. The DCIS was removed by the lumpectomy and the LCIS by the mastectomy. The most representative specimen for the DCIS is the lumpectomy. The most representative specimen for the LCIS is the mastectomy. Both pathology reports must be used in this case to determine the histology. |
2012 |
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20120001 | Multiple primaries/Recurrence--Heme & Lymphoid Neoplasms: How many primaries are abstracted if a patient was diagnosed with diffuse large B-cell lymphoma in 2001 and was diagnosed with diffuse large B-cell lymphoma involving the larynx in 2011? See Discussion. | Does the medical oncologist's statement that this is a second malignancy, rather than a recurrence, given the length of the disease-free interval, affect the number of primaries abstracted? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Abstract a single primary per Rule M2; a single histology is a single primary diagnosed. The histology code for both the 2001 and 2011 diagnoses is 9680/3[diffuse large B-cell lymphoma]. Case is coded as diagnosed in 2001.
The hematopoietic physician experts say that the issue with lymphomas is that the patient may be disease-free then recur years later. Even though years have passed, this is still a recurrence or relapse. Currently, there are no molecular markers that are able to distinguish "new primaries" from recurrences. There are also no established criteria for timing rules that could be used to determine a new primary from a recurrence.
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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20000440 | Grade, Differentiation--Brain and CNS: Can grade IV be implied for brain primaries with the histology of glioblastoma multiforme, even if there is no statement of grade in the path report? See discussion. | Dr. Platz has instructed the Iowa registry to code glioblastoma multiforme to grade IV, even when there is no corroborating statement of grade in the path report. This is also supported in some references. | Code the Grade, Differentiation field to 9 [Cell type not determined, not stated or not applicable] in the absence of a stated grade on the pathology report. If a grade is stated, code the stated grade. SEER does not recommend adopting the rule in the Discussion. | 2000 |
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20041005 | EOD-Extension--Retroperitoneum: Does the presence of "necrotic masses, NOS" in the blood, which are not pathologically evaluated, affect the coding of this field? See Description. | Encapsulated malignant tumor within the retroperitoneum was removed. Surgical report: "In the abdomen, blood had necrotic masses floating freely and encapsulated a 3-4" mass." No pathologic assessment of the necrotic masses is available. | For cases diagnosed 1998-2003: Necrotic masses do not affect the EOD-extension code. | 2004 |
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20031153 | Laterality/Multiple Primaries (Pre-2007)--Ovary: Are ovarian primaries with bilateral involvement always coded to laterality 4 (bilateral)? See Description. | Example: "Right ovary with mass replacing majority of ovarian tissue consistent with serous adenoca. Lt ovary with foci of adenoca." No specific statement of primary. Can we assume that the malignancy originated in the right ovary since it is more extensively involved or should laterality be coded 4 because both ovaries have tumor? | For tumors diagnosed prior to 2007:
If one ovary is listed as the primary site, code laterality to that ovary. The example above is one of those times when you would code to the single ovary. The issue of one or both ovaries being involved is handled in staging.
Abstract the example above as a single primary with code 1 [Right] for laterality.
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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20000532 | EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined: Should a lymph node biopsy be counted in these fields or are these fields for lymph node dissections only? See discussion. | Example: 1) Lymph node biopsy: adenocarcinoma. 2) Lymph node dissection: 4/15 regional lymph nodes positive for adenocarcinoma. | For cases diagnosed 1998-2003:
These fields record the number of regional lymph nodes examined pathologically whether from a biopsy or from a dissection. If the single lymph node biopsied was a regional lymph node, code the Number of Regional Lymph Nodes Positive field to 05 and the Number of Regional Lymph Nodes Examined field to 16. If the lymph node biopsied was a distant node, code these fields to 04 and 15 respectively. |
2000 |