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Report Produced: 11/24/2024 20:55 PM

Report Question ID Question Discussion Answer Year
20100098 Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a 2008 diagnosis of small B cell leukemia, most consistent with mantle cell leukemia that only involved the bone marrow? See Discussion. A bone marrow biopsy was done on 6/18/2008 and showed only small B cell leukemia, most consistent with mantle cell leukemia. ICD-O-3 does not list a histology code for small B cell leukemia or mantle cell leukemia.

Code the histology to 9673/3 [mantle cell lymphoma] and the primary site to C421 [bone marrow].

Mantle cell lymphoma can present in a leukemic phase. The only code available is for mantle cell lymphoma and the only primary site that could be coded would be bone marrow.

2010
20100100 Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a Langerhans cell histiocytosis diagnosed on an excisional biopsy of the T8 vertebral bone? See Discussion. The patient had an excisional biopsy of the T8 vertebral bone, but no other tissue biopsy. The doctor confirms the case is malignant. However, Langerhans cell histiocytosis, NOS is listed as /1 (borderline) in the ICD-O-3.

For cases diagnosed 2010 and forward, do not use the ICD-O-3 book to determine the hematopoietic and lymphoid histology codes. Use the Hematopoietic Database and access it at http://seer.cancer.gov/seertools/hemelymph.

Code the histology to 9751/3 [Langerhans cell histiocytosis] and the primary site for unifocal disease to C412 [bone, vertebral column]. Per Rule PH 30, use the Heme DB to determine the primary site and histology when PH1-PH29 do not apply. Per the Abstractor Notes section in the Heme DB, lytic bone lesions are the most common 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
20110107 Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a precursor T lymphoblastic leukemia involving the bone marrow and peripheral blood (per pathology) with a clinically noted large mediastinal mass and cervical lymphadenopathy? See Discussion. The patient had a large mediastinal mass and cervical lymphadenopathy, however, no biopsy was performed of either area nor was there a specific statement indicating involvement. The bone marrow biopsy showed 100% cellular marrow with involvement by precursor T lymphoblastic leukemia. The peripheral blood also showed precursor T lymphoblastic leukemia. The discharge summary and office notes state the diagnosis as T-cell acute lymphoblastic leukemia.

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

Code the histology to 9837/3 [adult T cell leukemia/lymphoma] and the primary site to C778 [lymph nodes, multiple regions]. Per Rule PH8, code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. A statement of "mediastinal mass" and lymphadenopathy for lymphoma primaries is equivalent to lymph node involvement. To identify the more specific primary site, you need to move to Rule PH21 that indicates you are to code the primary site as multiple lymph node regions, NOS [C778] when multiple lymph node regions, as defined by ICD-O-3, 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.

2011
20110015 Primary site/Histology: Do the 4/1/09 changes in the ICD-O-3 Site/Type Validation table regarding the coding of primary site for intestinal type adenocarcinoma mean that the former valid site/histology combinations are now impossible and require review from a given diagnosis date forward? See Discussion.

Per the SEER Errata for ICD-O-3 Site/Type Validation List, April 1, 2009, adenocarcinoma, intestinal type, was removed as a valid site/histology combination for the following primary sites: C150-C155, C158-C159, C170-C173, C178-C179, C180-C189, C199, C209, C210-C212, C218.

  • Does this mean that these combinations cannot be used? If so, then why is an override allowed for these site/type combinations? Shouldn't these site/type combinations be added to the impossible site/type combinations table?

  • SINQ 20081085 states that "8144/3 will be removed from the valid site/histology list for large intestine, small intestine, and rectum." It appears from the Site/Type Validation table that a decision was made to also remove esophagus sites as a valid combination with histology code of 8144. Please explain the rationale.

  • Cases that were miscoded to 8144/3 will need to be identified for correction. What date of diagnosis should be the reference point used in making the necessary corrections related to this change? Do we only need to review cases diagnosed 1/1/2009 forward or should all cases be corrected regardless of date of diagnosis?

    • The site/type edit identifies unlikely combinations of primary site and histologic type.

  • Intestinal type adenocarcinoma occurs in the stomach. It would be rare in another primary site, but not impossible.

  • It was decided that all digestive organ sites, except stomach, would be removed from the list. That is why esophagus is not listed as a valid site.

  • The site/type edit is for all years. Cases for all years have to be reviewed for combinations of site and type that are no longer on the list. If it is documented in the medical record that the primary site and histology combination are valid, set the over-ride flag so that the case will not come up for review again.

    		• 2011
    		20081074 Primary site/Histology: Does SEER accept the site/type combination of lymph nodes (C77.0-C77.9) with the histology of either 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) or 9827 (Adult T-cell leukemia/lymphoma)? See Discussion. There is a discrepancy between the SEER Site/Type table and the CS histology codes under Lymph Nodes.

    For cases diagnosed prior to 1/1/2010:These are not "impossible" site/histology edits. You can override them. However, if the lymph nodes are involved and a lymphoma histology is available, the lymphoma histology should be coded rather than leukemia histology. For example, assign histology code 9670 (Malignant lymphoma, small B lymphocytic, NOS) instead of 9823 (B-cell chronic lymphocytic leukemia/small cell lymphocytic lymphoma) if the disease is identified in the lymph nodes.

    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.

    		 2008
    		20120059 Primary site/Reportability--Breast: Is a "right nipple skin" biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See Discussion. In the 2011 SEER Manual Reportability Examples, example 3, it states a "biopsy-proven squamous cell carcinoma of the nipple" is reportable when the subsequent resection shows "no evidence of residual malignancy in the nipple epidermis." However, this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500.

    Because the site is specifically stated to "skin" of nipple [C44.5], this case is not reportable.

    If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain a full-thickness of skin and subcutaneous breast (nipple) tissue. If that is the case, this tumor would likely be a reportable squamous cell carcinoma of nipple [C50.0]. If, however, this was a punch biopsy it is more likely a non-reportable squamous cell carcinoma of the skin [C44.5].

    		2012
    		20081105 Primary site/Surgery of Primary Site--Lymphoma: What is the primary site for lymphoma involving lymph nodes and tonsil? Is a tonsillectomy coded as surgery for lymphoma? See Discussion.

    6/1/2008 cervical lymph node biopsy showed lymphoma. A 6/3/2008 CT Chest/abdomen showed mediastinal and mesenteric lymphadenopathy. A 6/15/2008 tonsillectomy is performed for markedly enlarged right tonsil. Tonsil pathology reveals extensive lymphoma involvement.

    Nothing in the chart specifies the primary site.

    Should this be a C778 primary because of 3 lymph node areas plus tonsil (a lymphatic organ)? Or should it be coded to C099 Tonsil?

    Is this tonsillectomy coded as surgical therapy? If so, is it surgery of primary site or surgery of other site?

    For cases diagnosed prior to 1/1/2010:Code the primary site to tonsil (C099). This advanced stage lymphoma involves an extranodal site (tonsil) and that site's regional lymph nodes (cervical). The lymphoma has also spread to non-regional lymph nodes (mediastinal and mesenteric). Code the tonsillectomy as surgery of primary site.

    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.

    		 2008
    		20031113 Primary site/Surgery of Primary Site/Surgical Procedure of Other Site--Unknown & ill-defined site: How are these fields coded for this type of primary site when a tumor excision and lymph node dissection is performed? See Description. Patient had a left parotidectomy w/ neck dissection in 02/2003. Findings showed a 10x5cm neck mass over the angle of the mandible as well as a 1.5 cm level 4 mass. Path showed invasive mod diff squamous cell ca. with posterior soft tissue margin positive for tumor; small portion of salivary gland had no tumor. Metastatic SCCa in 5 of 34 lymph nodes of neck dissection; no tumor in parotid lymph nodes. Pathology report says this could be a parotid carcinoma because the bulk of the disease is in the parotid, but it could also be metastatic...correlate with clinical findings. Doctor calls this unknown primary of the head and neck. Is this C80.9 or C76.0?

    For cases diagnosed 1998-2003: The data item "Surgery of Primary Site" is intended to record only surgeries of the primary site. If the primary site is unknown or ill-defined, it is impossible to determine whether or not a particular surgery was performed on the primary site. "Surgical Procedure of Other Site" collects much less specific information; however, this is the correct data item to record surgery performed when the primary site is unknown or ill-defined.

    For the case example, code the primary site as C76.0 [Head, face or neck, NOS]. Code Surgery of Primary Site as 98 [All unknown and ill-defined disease sites, with or without surgical treatment]. Code Surgical Procedure of Other Site as 1 [Non-primary surgical procedure performed].

    		 2003
    		20041095 Primary site: How is this field coded for a malignancy described as a "intracranial squamous cell carcinoma (8070) arising in a previous epidermoid cyst"? See Discussion.

    4-5-02 MRI Brain: Enhancing mass is probably a recurrence of the original tumor resected in 1983 (benign). 4-8-02 Gross resection. Lesion was coming up against her brain stem: Removed it grossly.

    Path: 4-8-02 Brain tumor, left temporal: SCC arising from a previous epidermoid cyst of the brain. XRT began 4-25-02.

    Path states: "Squamous lesions suspicious for malignant transformation of old epidermal cyst (1983). It has been reported in literature that epidermoid cysts in the brain can undergo a malignant transformation which is what happened in this case."

    It appears the patient has an intracranial epidermoid cyst that is now

    giving rise to SCC. Squamous cell carcinoma (8070) of the brain (C71_) fails the edit Primary Site, Morphology-Imposs ICDO3 (SEER IF38).

    		 Code the primary site to C760 [Ill-defined site; Head, face or neck, NOS]. There is an intracranial malignancy arising from a previously resected epidermoid cyst. Squamous cell carcinoma, primary of the brain, is a non-overridable edit error. 2004
    		20110071 Primary site: How is this field coded for an adenocarcinoma arising in a chronic perianal fistula without extension to the anal canal, but stated to arise in "ectopic rectal tissue"? See Discussion.

    The patient underwent a resection of a perineal mass. Per review of slides it was stated to be "primary mucinous adenocarcinoma arising in a chronic perianal fistula." The adenocarcinoma was invasive into the dermal connective tissue and skeletal muscle, but there was no extension into the anal canal. The discharge diagnosis from the reporting facility called this adenocarcinoma of "ectopic rectal tissue in perianal area."

    Should the primary site be coded to skin based on the dermal involvement and lack of anal or rectal involvement? Or, should the primary site be coded to rectum based on the physician's assessment that this adenocarcinoma arose in ectopic rectal tissue?

    For cases diagnosed 2007-2014:

    Code the Primary Site field to C210 [Anus, NOS]. This is an unusual and rare presentation. According to our expert pathologist, "There is no ideal site code [for] this case. I would code to C210. In this location it can at least be located by anyone who wants to get a look at such lesions. Because of the unusual location of this tumor, I would like to be able to code it to perineum, but it will be totally lost in those site codes as they represent extensive areas beyond perianal (skin of trunk, soft tissue of pelvis, and pelvis, respectively)... I would not code to rectum [because it would be] lost among too many primary rectal carcinomas."

    		 2011