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.
Reportability/AmbiguousTerminology: Because there is a caveat in the SEER PCM, 3rd edition to ignore adverbs such as "strongly" when assessing reportability, should a term such as "likely" cancerous be reportable given than the expression "most likely" cancerous is reportable?
"Likely cancerous" is NOT reportable.
The CoC, NPCR and SEER have agreed to a strict interpretation of the ambiguous terms list. Terms that do not appear on the list are not diagnostic of cancer.
Radiation: Is "consolidated" radiation therapy coded as part of first course therapy when there is no documentation of "planned treatment" and the radiation is done 4 months after the initiation of treatment?
Yes, "consolidation" treatment is part of a planned treatment regimen. A treatment regimen may consist of the four following phases:
Grade/Histology (Pre-2007)--All Sites: What code is used to represent these fields for the histology "High grade dysplasia (adenocarcinoma in situ)" or "AIN III/High grade AIN"?
For tumors diagnosed prior to 2007:
Code the Histology field for the first example to 8140/2 [Adenocarcinoma, NOS, in situ] and for the second example to 8077/2 [AIN, grade III]. For both of the cases code the Grade, Differentiation field to 9 [Cell type not determined not stated or not applicable]. The 6th digit (grade code) of ICD-O-3 describes how much or how little a malignant tumor resembles the normal tissue from which it arose. In contrast, "grade" is used in the examples above to describe the degree of dysplasia, from mild dysplasia (low grade) to severe dysplasia (high grade). Do not record the degree of dysplasia in the 6th digit grade field.
For tumors diagnosed 2007 or later, refer to the MP/H rules for histology coding instructions. 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.
Reportability/Histology--Vulva: Is angiomyxoma (8841/1), such as aggressive angiomyxoma of vulva diagnosed in 2022, reportable?
Do not report superficial angiomyxoma (8841/0) or aggressive angiomyxoma (8841/0). WHO Classification of Female Genital Tumors, 5th edition, defines deep (aggressive) angiomyoma as a benign, infiltrative, myxoid spindle cell neoplasm that occurs in deep soft tissue of the pelviperineal region.
Reportability--Skin: Is atypical intradermal smooth muscle neoplasm (AISMN) of the skin reportable? The comment on the path report states: Atypical intradermal smooth muscle neoplasm (AISMN) was previously termed "cutaneous leiomyosarcoma."
Atypical intradermal smooth muscle neoplasm (AISMN), previously termed "cutaneous leiomyosarcoma," is not reportable. It is classified as a borderline, /1, neoplasm.
MP/H Rules/Histology--Thyroid: How many primaries are to be reported and what histology is to be coded for an anaplastic/undifferentiated thyroid carcinoma with sarcomatoid transformation likely arising in association with a papillary thyroid carcinoma? Thyroid contains one tumor: 12.5 cm in greatest dimension...almost completely replaces entire thryroid gland.
For cases diagnosed 2007 or later:
This is a single primary using rule M2; a single tumor is always a single primary.
The histology code for this case is 8260/3 [Papillary carcinoma of thyroid]. Begin with Histology Coding rule H8. Stop at rule H17 and code the histology with the numerically higher ICD-O-3 code.
Reportability--Ovary: Is immature teratoma of the ovary reportable if a subsequent comment states that "the teratoma shows immature neuroepithelium, but no malignant elements"?
There is conflicting information for this case. The final diagnosis conflicts with the comment. Go back and check with the physician to clarify his/her intent. If no further information can be obtained, the final diagnosis is preferred over the comment. This case is reportable based on the final diagnosis: "immature teratoma."
First Course Treatment: If an "aromatase inhibitor" used as a complement to Tamoxifen is treatment, how should it be coded?
When an aromatase inhibitor is part of the planned first course of therapy, code it under hormone treatment.
When a change of drug is PLANNED, it is part of the same course even if subcategories change. This is the usual situation with Tamoxifen and aromatase inhibitor (for example: Femara). The switch to Femara is planned, so it is not a new course. When a drug change happens that is not planned, it is still the same course if both drugs are in the same category and subcategory. An unplanned drug change to a different subcategory would be a new course.
Histology--Head & Neck: How do you code histology for a myofibroblastic sarcoma of the soft tissue of the head and neck?
Assign code 8825/3 [Myofibroblastoma, malignant]. According to the WHO Classification of Soft Tissue Tumors, "Low grade myofibroblastic sarcoma represents a distinct atypical myofibroblastic tumor often with fibromatosis-like features and predilection for the head and neck." Also called myofibrosarcoma.