Reportability--Bladder: Please explain the reportability of UroVysion for bladder cancer in the following circumstances.
1. Patient has positive UroVysion test and follow up biopsy is negative. Is this case reportable with a diagnosis date the date of the UroVysion?
2. Patient has positive UroVysion test and follow up biopsy is positive for cancer. Is the diagnosis date of the date of the positive UroVysion or the date of the positive biopsy? Thank you.
Do not report a case based on UroVysion test results alone. Report a case when there is positive histology, a physician statement of malignancy, and/or the patient was treated for cancer.
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned for a patient with a history of CLL undergoing chemotherapy who is subsequently diagnosed on a liver biopsy with diffuse large B-cell lymphoma (Richter transformation)?
Abstract the diffuse large B-cell lymphoma (Richter transformation) as a second primary per Rule M10. Rule M10 states to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (CLL) AND there is a second diagnosis of an acute neoplasm (the diffuse large B-cell lymphoma (Richter transformation)) more than 21 days after the chronic diagnosis.
"Richter transformation," also known as "Richter syndrome," is a term that indicates CLL has transformed to DLBCL. Richter syndrome is listed under the Alternate Names section in the Heme DB for DLBCL (9680/3).
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.
MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle?
For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].
According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.
CS Site Specific Factor--Lymphoma: Can the registrar calculate the International Prognostic Index (IPI) score from information found in the H&P or on the back of a TNM form for the SSF 3 field if the physician does not document it in the medical record?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Record the IPI score in SSF3 when the score is documented in the medical record. If the score is not stated, do not calculate it.
MP/H Rules/Multiple primaries--Breast: Is this the same primary per MP/H Rule M10? Ductal carcinoma of the left breast in 2013, treated with a lumpectomy. New tumor with ductal and lobular carcinoma in the same breast in 2016.
The 2016 diagnosis is the same primary. MP/H Rule M10 for breast cancer applies. Do not change the original histology code. Use text fields to document the later histologic type -- duct and lobular.
CS Lymph Nodes--Breast: Must there be a statement of "moveable" present to code 25 in this field and if a lymph node is not stated to be "fixed" is it presumed to be moveable? Please provide an example in your answer of when to use code 25.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
The word "movable" does not have to be used to assign code 25. A "movable" lymph node is an involved lymph node not described as fixed or matted. The general rule is to code the lesser or lower category, which would be the case if neither movability nor fixation is mentioned. See page C-471 of the 2004 SEER Manual.
Code 25 Example: Involved lymph nodes per lymph node dissection. No mention of fixation or matting. Size of largest met within a lymph node is 4mm.
First course treatment/Chemotherapy: Is metronomic chemotherapy coded as chemotherapy?
Code metronomic chemotherapy as chemotherapy. Metronomic chemotherapy, also referred to as low-dose metronomic (LDM) chemotherapy, is an emerging cancer treatment approach which administers relatively low doses of traditional chemotherapy drugs over a long period of time and without ‘breaks’ in treatment. By using lower doses this method of treatment minimizes the side effects of traditional chemotherapy.
Histology: What code is used to represent the histology "endometrioid adenocarcinoma, villoglandular type"?
Assign code 8262/3 [Villous adenocarcinoma].
According to the WHO Classification of Tumours, Breast and Female Genital Organs (2003), villoglandular is one of four variants of endometroid adenocarcinoma. The corresponding ICD-O-3 code according to WHO is 8262/3.
Behavior/Date of Diagnosis--Lung: If the term "Pancoast tumor, NOS" is malignant by definition, should the date of diagnosis be coded to the date of the clinical diagnosis when the clinical diagnosis is made prior to the histologic confirmation of the malignancy?
Yes, Pancoast tumor is by definition malignant. It is defined as a lung cancer in the uppermost segment of the lung that directly invades into the brachial plexus (nerve bundles) of the neck, causing pain. If a Pancoast tumor was identified on imaging prior to the biopsy, the date of diagnosis should be linked to the Pancoast tumor report.
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