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Report Produced: 11/25/2024 07:47 AM

Report Question ID Question Discussion Answer Year
20130104 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of intrasinusoidal diffuse large B-cell lymphoma involving lymph nodes, the liver and the bone marrow? See Discussion.

Intrasinusoidal DLBCL was diagnosed by liver biopsy. The bone marrow was involved based on abnormal cytogenetic findings. Per a physician's note, a PTA CT Abd/Pelvis showed hepatosplenomegaly and mild periportal/peripancreatic lymphadenopathy. A GI physician stated the lymphoma involves the veins of the liver.

Should the primary site be coded to the liver [C220] and the histology to 9680/3 [DLBCL]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to the intra-abdominal lymph nodes [C772] per Rule PH20.

Code the primary site to the specific lymph node region when multiple lymph node chains within the same region as defined by the ICD-O-3 are involved. Periportal and peripancreatic nodes are both intra-abdominal region nodes.

Based on the information provided, there is involvement of lymph nodes, the liver, spleen and bone marrow, but no other documentation of the primary site. Given that a primary lymphoma of the liver is very rare; it is unlikely that this lymphoma arose from the liver. Involvement of the liver and spleen is very common for patients with lymphoma. The involvement of the liver, spleen and bone marrow is coded in the CS fields as Stage IV involvement.

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
20130112 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of post-transplant lymphoproliferative disorder (PTLD) diagnosed on an inguinal lymph node biopsy with CT scan evidence of lymphadenopathy in the chest, abdomen and pelvis if the bone marrow is also involved?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to multiple lymph node regions, NOS [C778] per Rule PH21 when multiple lymph node regions, as defined by the ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated

In the Abstractor Notes section in the Heme DB for PTLD it states PTLD commonly involves lymph nodes, GI tract, lungs and the liver. This patient has extensive lymph node involvement. Rule PH26 states to code the primary site to the bone marrow when ONLY the bone marrow is involved; however, that does not apply in this case.

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
20130055 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a lymphoma with multifocal bone and epidural involvement but no lymph node involvement if the physician does not clearly state the primary site? See Discussion.

MRI Lumbar spine: Bony metastatic disease most evident at L5, L3 and T10. There is marrow tumor in the posterior elements of T12 and T10. The 14 mm epidural mass represents epidural tumor, likely metastatic, extending into the left intervertebral foramen at T12-L1.

PET scan: Hypermetabolic activity corresponding to epidural mass at the level of T12 and L1 concerning for malignancy. Other small areas of hypermetabolic activity in the left mandible and both femoral necks. There is no hypermetabolic activity corresponding to the areas of abnormal marrow edema in the vertebral bodies which enhanced on MRI scan in the lumbar and lower thoracic spine. No lymph nodes mentioned.

Biopsy epidural mass: Diffuse large B-cell lymphoma with a background of follicular lymphoma, consistent with a large cell transformation. Flow cytometry confirms a mixed large and small cell population of lymphoma (55% large cells).

T12/L1 Bone Biopsy: Bone and marrow with atypical paratrabecular lymphoid infiltrates, suspicious for involvement by follicular lymphoma. Negative for large cell lymphoma.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site of the diffuse large B-cell lymphoma [9680/3] to C809 [unknown primary site] per Rule PH27. The patient has involvement of multiple bones and an epidural mass with no evidence of nodal involvement. Code the primary site to unknown [C809] when multiple organs are involved without any lymph node involvement, even when there is no statement from the physician regarding 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.

 2013
20130096 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a mantle cell lymphoma found in the sigmoid colon on colonoscopy with biopsy?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to the sigmoid colon [C187] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ. Based on the information provided, the lymphoma is present only in the sigmoid colon.

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
20100048 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a patient diagnosed with Langerhans cell histocytosis/eosinophilic granuloma involving both the seventh rib and the right temporal bone? See Discussion. Patient was diagnosed with Langerhans cell histiocytosis/eosinophilic granuloma following a biopsy of the seventh rib on 3/22/10. On 4/13/10 the patient had a right external ear canal mass (right temporal bone) biopsy with same diagnosis. Should the primary site be coded to bone, NOS [C419]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Per Rule PH30, use the Heme DB to determine the primary and code it to bone, NOS [C419]. Langerhans cell histiocytosis can occur as a solitary lesion, multifocal lesions, or multisystem disease. In this case, the patient has multifocal disease of the bone. The abstractor notes in the Hematopoietic DB were used as a reference for this answer.

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
20120075 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for chronic lymphocytic leukemia/small lymphocytic lymphoma when a lymph node biopsy was positive for CLL/SLL but no bone marrow biopsy was performed? See Discussion. A right neck lymph node biopsy and flow cytometry proved CLL/SLL. The PET scan showed multiple involved lymph nodes in the right cervical, mediastinal and para-aortic areas. No bone marrow biopsy was done. Per the Hematopoietic DB, Module 3, the histology should be coded 9823/3 [CLL/SLL], but how is primary site coded? The manual states to code the primary site to the involved lymph node region when there is no bone marrow involvement, but it does not specifically address how to code the primary site when no bone marrow biopsy or peripheral blood smear was done.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C77.8 [multiple lymph node regions, NOS].

Per Rule PH6, code the primary site to the involved lymph node region(s) when there is no bone marrow involvement or when it is unknown whether the bone marrow is involved. To determine the more specific lymph node subsite to code, use Rule PH21. It indicates one is to code the primary site to C778 [multiple lymph node regions, NOS] when multiple lymph node regions, as defined by the ICD-O-3 (see Table C1: Lymph Node/Lymph Node Chain Reference Table in Appendix C), are involved and it is not possible to identify the lymph node region where the lymphoma originated.

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.

2012
20130032 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for plasma cell myeloma with radiologic evidence of multiple lytic lesions? See Discussion.

Patient complained of pain in the right side and back right upper flank area. CT shows an anterior mediastinal mass and abnormal appearance of skeleton. CXR: Age indeterminate T8 compression fracture. CT chest: abnormal appearance of skeleton. Correlate clinically for myeloma or mets. Acute T5 or T8 compression fractures. Anterior mediastinal mass which may represent thymoma, lymph nodes or metastases. 03/22/12 Metastatic Series: Nonspecific hypodensities in pelvis, left hip and right acromion. Possibility of myeloma can't be totally excluded. Bone marrow right post iliac crest core biopsy, clot section and aspirate: plasma cell myeloma.

Should the primary site be coded to the bone marrow because the diagnosis of plasma cell myeloma was supported by radiologic evidence of multiple lytic lesions? The bone marrow biopsy confirmed the radiology reports.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C421 [bone marrow] per the Heme DB and Rule PH30. The Primary Site(s) section in the Heme DB indicates the primary site for plasma cell myeloma is C421 [bone marrow].

The Primary Site Coding Instructions in the Heme Manual (Rule 1) states that when a specific code is listed under the Primary Site(s) section of the Heme DB it is the only primary site code that can be assigned for that leukemia, myelodysplastic syndrome or myeloproliferative syndrome. Applying the PH Rules will result in the same answer for primary site, bone marrow [C421].

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
20130019 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when a patient has a lymph node biopsy and peripheral blood that are positive for B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma but refuses a bone marrow biopsy?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C421 [bone marrow] per Rule PH5. Note 1 for Rule PH5 states CLL always has peripheral blood involvement. If the peripheral blood is positive for CLL/SLL and no bone marrow biopsy is done, code the primary site 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.

2013
20110035 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when both a lymph node biopsy and peripheral blood are positive for CLL/SLL? See Discussion. Per Module 3, Rules PH5 and PH6 in the Hematopoietic Manual, it states that CLL has peripheral blood involvement and SLL does not.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C421 [bone marrow] and histology to 9823/3 [CLL/SLL]. Per Rule there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s) but as long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow (C421).

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.

2011
20130131 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded, and which PH rule applies, when chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is diagnosed simultaneously by biopsies of both lymph node(s) and the bone marrow?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C421 [bone marrow] per Rule PH5 when CLL/SLL [9823/3] involves the bone marrow.

In the later stages of CLL/SLL, there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s). As long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow.

WHO states that the diagnostic criteria for CLL versus SLL is not clearly defined. According to WHO guidelines, it is better to code to CLL/SLL and code the primary site to bone marrow when the marrow is involved and to lymph nodes, organ, or tissue when there is no bone marrow involvement.

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