Report | Question ID | Question | Discussion | Answer | Year |
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20100049 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a lymph node biopsy reveals "malignant lymphoma, peripheral T-cell type, with some features of angioimmunoblastic T-cell lymphoma and follicular T-cell lymphoma," the bone marrow biopsy was negative for involvement, and the oncologist states this patient has "peripheral T-cell lymphoma"? See Discussion. |
CT scan showed retroperitoneal and inguinal adenopathy. Right inguinal lymph node biopsy revealed "malignant lymphoma, peripheral T-cell type, with some features of angioimmunoblastic t-cell lymphoma and follicular t-cell lymphoma." Flow cytometry studies showed no evidence of B-cell lymphoma and atypical CD3+/CD10+/CD7-/CD4+/CD56+ T cells are detected (19%). The bone marrow biopsy was negative for involvement. Patient was staged as Stage II Peripheral T-Cell lymphoma by the oncologist and started chemotherapy. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the oncologist's clinical diagnosis of peripheral T-cell lymphoma.
The definition for this neoplasm is "A large group of lymphomas which we collectively refer to as peripheral T-cell lymphomas with the optional addition of "unspecified" to emphasize that these cases do not belong to any better defined entities. Attempts to distinguish between them on morphological basis have met with poor reproducibility."
Per the Abstractor Notes in the Heme DB: Patients present with peripheral LN involvement. The diagnosis of PTCL, NOS is made ONLY when other specific entities have been explored.
This fits your case; attempts to find a more specific disease (flow cytometry; BM biopsy) were negative and gave no further information that could be used to assign a more specific classification.
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. |
2010 |
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20100050 | Reportability--Colon: Would a carcinoid tumor, NOS, of the appendix with perineural or angiolymphatic invasion be reportable if there is no mention of malignancy in the pathology report? |
Carcinoid, NOS, of the appendix diagnosed in 2015 or later is reportable.
For cases diagnosed prior to 2015
Carcinoids of the appendix are reportable when they meet any of the following conditions.
Note that the implants/involvement must be designated as malignant. Many benign tumors will spawn implants that are also benign. If implants are benign, this is not a reportable tumor. |
2010 | |
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20100052 | Reportability/Primary Site: What is the reportability status and primary site for a papillary carcinoma of thyroid tissue arising in an otherwise benign mature monodermal cystic teratoma (struma ovarii)? See Discussion. | Final diagnosis on the pathology report states, "One ovary showing mature monodermal cystic teratoma composed of thyroid tissue (struma ovarii)." The pathology COMMENT section states, "There is a 0.1 cm focus of thyroid tissue within the struma ovarii showing cytologic features of papillary carcinoma. This finding is likely of no clinical consequence." | A papillary carcinoma of thyroid tissue in benign struma ovarii (mature cystic teratoma) is reportable.
These ovarian tumors contain a diversity of tissues including hair, teeth, bone, thyroid, etc. This reportable malignancy arose in thyroid tissue within the ovarian tumor. Code the primary site to ovary. Code to the actual organ in which the cancer arose. This will keep the case in the appropriate category for surgery coding, regional nodes, staging, etc. |
2010 |
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20100053 | Primary site--Heme & Lymphoid Neoplasms: How is primary site coded for a myeloid sarcoma (granulocytic sarcoma) arising in the chest wall in a patient that has a negative bone marrow biopsy? See Discussion. | Patient was diagnosed with Myeloid Sarcoma (granulocytic sarcoma) by chest wall biopsy. This is an extramedullary manifestation of acute leukemia and is not in the bone marrow (bone marrow is negative).
How should primary site be coded? The Heme DB states that almost any part of the body can be involved. It also states to not code primary site to C421. In this case the only involvement is the chest wall [C493]. However, use of the primary site code C493 triggers an edit error questioning this site/histology combination. If the primary site is coded to C421 [bone marrow], there is no edit error. Please explain the site code and rationale. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Unless there are scans showing involvement of a lymph node or tissue other than the chest wall, the histology should be coded myeloid sarcoma [9930/3] and the primary site to C493 [soft tissue of chest wall]. Per Rule PH 30, use the Heme DB to determine primary site and histology when rules PH1-PH29 to not apply. Override the edit.
Per the Abstractor Notes section in Heme DB, for myeloid sarcoma [9930/3] the most frequently affected sites are skin, lymph nodes, gastrointestinal tract, soft tissue, and testis.
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. |
2010 |
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20100054 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a pathology specimen reveals an infiltrating mammary carcinoma with mixed tubular and lobular features, 2.3 cm, low grade cribriform in situ ductal carcinoma, and Paget disease of the overlying skin with ulceration? See Discussion. | According to SINQ 20081134 the histology would be 8524 if this is one primary. | For cases diagnosed 2007 or later, this is a single primary.
In order to determine whether this case represents a single or multiple primary, you must first determine the correct histology code for the underlying tumor. Using rule H9, ignore the DCIS.
See Table 3 in the equivalent terms and definitions. Infiltrating lobular, tubular, and Paget are coded to a single histology code (8524/3). Our current multiple primary rules do not say infiltrating lobular and tubular and Paget are a single primary. This was an omission and will be corrected in a future revision. Thank you for bringing this omission to our attention. |
2010 |
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20100056 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a case with pathologic diagnosis of "anaplastic large cell lymphoma, ALK-negative" involving the brain and a clinical statement of involvement in the right inguinal lymph nodes and the right lower extremity by a cutaneous lymphoma? See Discussion. |
The final diagnosis on the pathology report for a brain biopsy is "Anaplastic large cell lymphoma, ALK-negative." Per a progress note: right inguinal lymphadenopathy. CT scan is consistent with multiple lymph node groups enlarged. Right lower extremity cutaneous nodular lesion; cutaneous lesions likely cutaneous lymphoma.
Should the histology be coded 9702/3 [anaplastic large cell lymphoma, ALK-negative], and the primary site C447 [skin of leg]? Or is the physician using "cutaneous lymphoma" as a general term indicating infiltration and the primary site is really C779 [lymph nodes, NOS]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code to primary site to C447 [skin of leg]) per Rule PH25 and histology to 9702/3 [anaplastic large cell lymphoma, ALK-negative]. Per the Abstractor Notes section in Heme DB, these are the usual presentations for this disease. It also states this disease presents with peripheral node involvement and is often generalized with infiltrates in the bone marrow, liver, spleen, and extranodal tissue. Less frequently involved sites are lung, salivary gland and CNS.
Per PH25, code the primary site to the organ when the lymphoma is present in an organ (skin, right leg) and that organ's regional lymph nodes (inguinal). Distant lymph nodes or other organs may also be involved, but should be disregarded for coding primary site.
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. |
2010 |
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20100057 | First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease? | Clobetasol is not cancer-directed treatment at this time.
Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides. |
2010 | |
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20100058 | Grade: Can the nuclear grade value be coded in the grade field for any site, or is it restricted to sites where it is specifically listed as an option in the coding manual, i.e., breast, kidney, urinary sites, etc.? | There is no restriction on sites for which nuclear grade can be coded in the grade field. If both differentiation and nuclear grade are specified, differentiation takes priority. | 2010 | |
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20100059 | Surgery of Primary Site--Brain and CNS: How should this field be coded when the procedure is stated to be a "stereotactic CORE biopsy" of a brain tumor? See Discussion. | The most recent version of the Brain Site Specific Surgery schema has a note that states "Assign code 20 [Local excision of tumor, lesion, or mass, excisional biopsy] for stereotactic biopsy of brain tumor." Does this also apply to a stereotactic CORE biopsy?
SINQ 20081118 also states that a stereotactic biopsy should be coded as Surgery of Primary Site code 20. |
Assign code 20 [Local excision of tumor, lesion, or mass, excisional biopsy] for a stereotactic core biopsy of brain tumor. | 2010 |
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20100061 | MP/H Rules/Histology: The 2010 SEER Manual has omitted some useful information in the Histologic Type ICD-O-3 section, specifically the statement of "Do not revise or update the histology code based on subsequent recurrence(s)". Will this statement be added to the revisions of the MPH rules? See Discussion. | Example: A 2005 diagnosis of left breast lobular carcinoma [8520/3], followed by a 2009 diagnosis of left breast ductal carcinoma [8500/3]. Rule M10 states this is a single primary, but there is no information in the Histology rules (Multiple Tumors Abstracted as a Single Primary) that the original histology should be retained, thus a person could potentially use these rules to change the original histology to 8522/3 [duct and lobular carcinoma] per rule H28. | We will reinstate the instruction not to change the histology code based on recurrence in future versions of the histology coding instructions. However, this instruction may not be applicable to all anatomic sites. It will be reinstated on a site-by-site basis. You may also refer to the instructions on Page 7 of the 2010 SEER Manual under the heading "Changing Information on the Abstract." | 2010 |