Report | Question ID | Question | Discussion | Answer | Year |
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20091083 | Grade/Cell indicator--Lymphoma: How is Grade/Cell indicator coded for anaplastic large cell lymphoma? See Discussion. | The SPCM states cell indicator codes take precedence over grade/differentiation codes for lymphoma and leukemia cases. | For cases diagnosed prior to 1/1/2010:Because there is no cell indicator information, code 9 [cell type not determined] in the grade/cell indicator field. Do not code grade for lymphoma. For lymphoma and leukemia this field is the cell indicator. 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. |
2009 |
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20000561 | EOD-Pathologic Extension--Prostate: Can a pathological extension code be assigned when a retropubic prostatectomy is done? See discussion. | The TNM manual states, "Total prostatoseminalvesiculectomy and pelvic lymph node dissection are required for pathologic staging." | For cases diagnosed 1998-2003:
The pathology report from a retropubic prostatectomy should be used to code the Pathologic Extension field. This field is coded using pathology report information from the prostatectomy operation regardless of the surgical approach and regardless of whether or not a pelvic lymph node dissection was performed. This is one area in which TNM rules for pathologic staging and SEER rules for EOD are slightly different. |
2000 |
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20120091 | Reportability/Behavior--Kidney: Is epithelioid angiomyolipoma (AML) of the kidney a reportable malignancy? See Discussion. | The addendum final diagnosis on a pathology report for a kidney core needle biopsy included the results of additional stains performed on the tissue. It indicated the morphology was most consistent with epithelioid angiomyolipoma. Further comments in the body of the report indicate these tumors are now considered malignant neoplasms with the capacity to be locally aggressive and they can potentially metastasize. There is no mention of a metastasis in this particular case. | Epithelioid angiomyolipoma (AML) [8860/0] of the kidney is not reportable unless stated to be malignant.
If the pathologist confirms this is a malignancy, apply ICD-O-3 Rule F (Matrix principle) and assign the behavior code /3. If confirmation is received, accession the case using the morphology code 8860/3 [malignant angiomyolipoma]. |
2012 |
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20130098 | Histology--Heme & Lymphoid Neoplasms: Why did the hematopoietic histology rule change regarding the coding of small lymphocytic lymphoma/chronic lymphocytic leukemia (SLL/CLL) from the lymphoma code (9670/3) to leukemia (9823/3) when both tissue and bone marrow are involved? See Discussion. | The answer in SINQ 20110035 that instructs us to code the primary site to bone marrow [C421] is the opposite of what has been coded for years. After all the years of coding SLL/CLL as a lymphoma when both tissue and bone marrow/blood are involved, why has the change to coding this to the leukemia code (9823/3) been made? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
There has been a change in coding practice based on a change in clinical classification of leukemia/lymphomas. In the past, we did, indeed, default to lymphoma when both tissue and bone marrow were involved. The problem was that when only bone marrow was involved, the case was coded to leukemia with a primary site of bone marrow. When lymphoma symptoms developed later, there was a lot of inconsistency in how registries handled these cases. Some coded a new primary "lymphoma;" while others ignored the lymphoma calling it progression.
The clinical world, including the hematopoietic experts in the World Health Organization and the Inter-Lymph Consortium, agreed that for certain neoplasms (CLL/SLL being one of them) it was not useful or practical to code the leukemia and lymphoma separately OR to capture only one of the neoplasms (because these neoplasms almost always progress to lymphoma); so new codes for the leukemia/lymphoma were developed. According to the experts, 9823/3 most accurately portrays the neoplastic process for the neoplasms assigned to a lymphoma/leukemia code.
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. |
2013 |
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20140013 | Primary site--Brain and CNS: How should primary site be coded for a medulloblastoma described as a "posterior fossa mass" and "centered within the fourth ventricle"? See discussion. | The associated site code for medulloblastoma in the ICD-O-3 is C716. However, the SEER Manual specifically instructs to ignore the associated site code if a different primary site is noted. Although most medulloblastomas appear to arise in the cerebellum, when described as "centered within the fourth ventricle" can we assume that is the primary site and not simply invasion of the fourth ventricle from the cerebellum? | Code the primary to C717 for this case. Code the primary site according to the origin of a particular medulloblastoma when it differs from the site code listed in ICD-O-3. The description "centered within the fourth ventricle" suggests that this medulloblastoma originated in the fourth ventricle. |
2014 |
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20130121 | Reportability--Heme & Lymphoid Neoplasms: Is "early essential thrombocythemia" reportable? See Discussion. | The bone marrow biopsy diagnosis was, "Combined bone marrow morphologic, flow cytometric, immunohistochemical, molecular and cytogenetic findings are most consistent with early or evolving essential thrombocythemia with low level JAK2 V617F mutation documented on molecular testing." The physician is calling this a benign process. Is this reportable as essential thrombocythemia? Are the terms early or evolving ignored? Does the presence of a JAK2 mutation make this reportable? Without JAK2 testing is this case reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Yes, this is a reportable case. The histology is coded to 9962/3 [essential thrombocythemia]. The positive JAK2 mutation testing and bone marrow biopsy results taken together support the diagnosis of essential thrombocythemia in this case.
In the Abstractor Notes section of the Heme DB, it indicates that only 50-60 percent of patients with essential thrombocythemia will have a positive JAK2 mutation. A diagnosis of essential thrombocythemia can still be made in the absence of a JAK2 mutation. For example, if the bone marrow biopsy final diagnosis or a physician's clinical diagnosis is essential thrombocythemia, despite a negative JAK2 mutation test, the neoplasm is still reportable.
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. |
2013 |
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20130029 | Reportability--Heme & Lymphoid Neoplasms: Is "post polycythemic myelofibrosis" reportable? See Discussion. | The bone marrow biopsy showed post polycythemic myelofibrosis. JAK2 mutations were present confirming the diagnosis of post polycythemic myelofibrosis. The patient does have a history of polycythemia vera (PV). | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Polycythemia Vera (PV) [9950/3] is reportable. The Abstractor Notes section in the Hematopoietic Database for PV indicates there are three phases of PV. The third phase is referred to as the "spent" or "post-polycythemic myelofibrosis phase". This patient appears to be in the third phase of PV. This would not be reported as a new primary if PV has already been reported.
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. |
2013 |
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20000852 | Histology (Pre-2007)/Grade, Differentiation: What code is used to represent the histology "cystadenocarcinoma with multiple foci of high grade anaplastic and undifferentiated sarcoma"? See discussion. | The case was presented at tumor conference. The physicians indicated that the patient would not have the same disease course as a patient with cystadenocarcinoma of the ovary. The physicians advised the use of a mixed histology code. However, there is no appropriate mixed histology code for cystadenocarcinoma, anaplastic carcinoma, and sarcoma. It doesn't seem as though these cases should be grouped and analyzed with cases having a single histology of cystadenocarcinoma. | For tumors diagnosed prior to 2007:
Code the Histology and Grade, Differentiation fields to 8440/34 [cystadenocarcinoma, anaplastic] because a combination code for the specified histologic type does not exist.
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. |
2000 |
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20051010 | Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion. | The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant? | Code the breast subsite from the pathology report (C501, central). The priority order for coding subsite from conflicting reports is 1. Pathology report 2. Operative report 3. Physical examination 4. Mammogram, ultrasound The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor. |
2005 |
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20041019 | EOD-Extension--Lung: Is this field coded to 10 [tumor confined to one lung] or 20 [Tumor involving main stem bronchus >= 2 cm from carina] when there is no mention of the mainstem bronchus and a lobectomy is performed? See Discussion. | The clinical work-up shows a mass at the left medial apex extending into the left lung. No mention of the main stem bronchus. Because a lobectomy was performed, we assume, per Note 2, that the tumor was greater than or equal to 2 cm from the carina. | For cases diagnosed 1998-2003: Code the EOD-Extension field to 10 [tumor confined to one lung] for the case example. The EOD-Extension code 20 [Tumor involving main stem bronchus >= 2 cm from carina] applies to tumors involving the main stem bronchus. | 2004 |