MP/H Rules/Multiple Primaries--Breast: How many primaries are abstracted when bilateral breasts contain DCIS? Is a physician statement referring to this situation as one primary ignored? See Discussion.
Patient has microcalcifications both breasts. Has bilateral mastectomy. Path report states Left breast multifocal DCIS predominantly micropapillary. Right breast two foci of DCIS micropapillary.
For cases diagnosed 2007 or later:
There are two primaries in this case.
Using the 2007 MP/H rules for breast, go to the multiple tumors module and start with Rule M4. Stop at rule M7. Tumors on both sides (right and left) are multple primaries.
Always use the 2007 Multiple Primary rules to determine the number of primaries. Do not use the physician statement.
MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion.
Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules.
For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS].
Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites.
In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma.
Surgery of Primary Site--Rectum: How do you code a procedure described as a "transanal resection, debulking of a large rectal mass"? See Discussion.
Patient is not a surgical candidate due to "other medical conditions". Colonoscopy done for anemia and rectal bleeding. At the colonoscopy a "Transanal Resection Debulking of large rectal mass" is performed. Two specimens are sent to the lab. The first is labeled "rectal mass" and is a 2.0 cm diameter spherical fragment of tissue. The second is labeled "transanal debulking rectal mass" and is described as multiple, irregular shaped fragments of tan, rubbery tissue measuring 5.0 x 5.0 x 3.0 cm. Final path diagnosis: Debulking of rectal mass: Adenocarcinoma greater than 2 cm in size, resection margins positive for tumor.
For cases diagnosed 1998-2002, code Surgery of Primary Site to 20 [Local tumor excision, NOS]. Because the procedure was performed via colonoscopy and apparently did not involve proctectomy, the best choice is a local excision.
Multiple primaries/Histology--Lymphoma: How many primaries should be abstracted and how should the histology field(s) be coded in this situation?
How would the bone marrow involvement by only NHL be handled? Composite lymphoma (9596) as defined by SEER and ICD-O is NHL and HD in one node which fits the final impression on the removed cervical node. See Discussion.
Patient presented with cervical, supraclavicular & superior mediastinal lymphadenopathy. A cervical node was excised for pathological review. The final impression on that node was Composite lymphoma characterized by (1) Nodular Lymphocyte Predominant Hodgkin Lymphoma [HD] (2) CLL/SLL [NHL]. Then, a bone marrow aspirate/bx was performed revealing CLL/SLL [NHL].
For cases diagnosed prior to 1/1/2010:This is a single primary. The histology code is 9596/3 [composite Hodgkin and non-Hodgkin lymphoma].
According to the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9596/3 followed by 9670/3 is one primary.
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.
Multiplicity Counter--Lung: How is this field coded when there is no evidence of the primary tumor? See Discussion.
Patient presented with large mediastinal mass. CT showed no intraparenchymal lung tumor. Biopsy of mediastinal mass revealed adenocarcinoma consistent with lung primary.
Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a 2011 diagnosis of systemic mastocytosis? See Discusson.
Patient presented with leukopenia, anemia and monoclonal gammopathy. A bone marrow biopsy in 2011 showed systemic mastocytosis [9741/3]. A subsequent shave biopsy of abdominal skin showed histologic features that were consistent with a diagnosis of mastocytosis. A later bone marrow biopsy was subsequently performed that showed progressive systemic mastocytosis.
Per Rule PH30, use the Heme DB to determine the primary site and histology when rules PH1-PH29 do not apply. The Heme DB indicates the primary site for systemic mastocytosis is always coded to C421 [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.
Surgery of Primary Site/Date Therapy Initiated--Head & Neck: Would a biopsy, NOS, that removed the majority of the tumor be used to code these fields? See Description.
Patient underwent biopsy, NOS, of a carcinoma of the tongue. Subsequent glossectomy revealed microscopic focus of residual squamous cell carcinoma.
If the biopsy NOS removed all macroscopic disease, code the date of the biopsy NOS as the date therapy initiated. If macroscopic disease remained following the biopsy NOS, code the glossectomy date as the date therapy initiated.
MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion.
Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis.
For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis.
EOD-Clinical Extension--Prostate: Is this field coded to 15 [Tumor identified by needle biopsy for elevated PSA] when it is unknown whether or not a TRUS was done? See Description.
Patient was admitted for radiation therapy for prostate cancer. H&P states that patient had elevated PSA. PE showed benign feeling prostate. Stage is clinical T1c. There is no mention of whether or not TRUS had been done.
For cases diagnosed 1998-2003: EOD extension code 15 is correct for this case example. When there is no other documentation available, the AJCC stage may be used to determine extension.
Hormone Therapy--Thyroid: Is pre-op hormone replacement therapy coded in this field? See Description.
Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. FNA suggested carcinoma. Patient's medications included Cytomel and Synthroid.
Do not code hormone replacement given to treat hypothyroidism as cancer treatment. Thyroid hormone therapy is coded as treatment only for follicular and papillary thyroid carcinomas.
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