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20081121 | Multiple primaries/Histology--Lymphoma: How many primaries should be abstracted and how should the histology field(s) be coded in this situation? How would the bone marrow involvement by only NHL be handled? Composite lymphoma (9596) as defined by SEER and ICD-O is NHL and HD in one node which fits the final impression on the removed cervical node. See Discussion. |
Patient presented with cervical, supraclavicular & superior mediastinal lymphadenopathy. A cervical node was excised for pathological review. The final impression on that node was Composite lymphoma characterized by (1) Nodular Lymphocyte Predominant Hodgkin Lymphoma [HD] (2) CLL/SLL [NHL]. Then, a bone marrow aspirate/bx was performed revealing CLL/SLL [NHL]. | For cases diagnosed prior to 1/1/2010:This is a single primary. The histology code is 9596/3 [composite Hodgkin and non-Hodgkin lymphoma]. According to the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9596/3 followed by 9670/3 is one primary. 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. |
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20081120 | MP/H Rules--Sarcoma: How many primaries should be abstracted for chondrosarcoma of right toe in 2002, of right lower leg in 2006 and right tibia in 2007? See Discussion. | A patient had a myxoid chondrosarcoma of the right toe in 2002. This was amputated and staged as T2 - high grade. Patient had a recurrence in the lower right leg in 2006. At this time he had a below knee amputation. The tumor in 2006 was stated to be similar histologically to the 2002 tumor with pathologic comparison done. Then in 2007 the patient presents with pain in right knee and stump. CT says compatible with recurrent disease, but no copies of path sent. Patient then had an above knee amputation, with diagnosis of clinically recurrent chondrosarcoma of tibia. How many primaries should be abstracted? Is 2007 diagnosis a new primary? | For cases diagnosed 2007 or later: Abstract two primaries in this case, 2002 and 2007. The first primary was diagnosed in 2002. The 2006 diagnosis would not be a new primary according to the rules in effect at that time (2004 SEER manual, page 11, rule 5, exception 1). Use the current MP/H rules to compare the 2007 diagnosis to the 2002 diagnosis. Start with rule M3 and stop at rule M10. The 2007 diagnosis is a separate primary. |
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20081119 | Reportability/Date of diagnosis--Liver: Does the final diagnosis of a scan have higher priority than the findings in the discussion in the body of the report? See Discussion. |
A patient with liver cancer becomes transplant eligible when the tumor is 2 cm in size. Frequently, liver tumors will be watched (no biopsy) for months until they meet the 2 cm size criteria. In the meantime, multiple scans will describe the tumor using variations of ambiguous terms that drift in and out of reportablility. One day the tumor is labeled "presumed hepatocellular carcinoma." Weeks later it is back to "worrisome for hepatoma." A single scan will use different terms in different sections of the report. Example case: Abdominal CT reveals a 1 cm liver lesion. Per the discussion portion of the scan, the lesion is consistent with hepatocellular carcinoma. Per final diagnosis: 1 cm liver lesion, possibly hepatocellular carcinoma. Is this report diagnostic of cancer? Would the date of this report be the date of diagnosis? (Patient did receive a liver transplant for hepatocellular carcinoma months later.) |
When a reportable ambiguous term is used in one part of a report or the medical record and a non-reportable ambiguous term is used in another part of the report or the medical record, accept the reportable term and accession the case. The example above is reportable. "Consistent with" is a reportable ambiguous term. Accept "consistent with" over the non-reportable term "possibly." The date of this report would be the date of diagnosis if this is the earliest report using reportable terminology. |
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20081118 | Surgery of Primary Site--Brain and CNS: How is this field to be coded when a patient undergoes stereotactic biopsy of a brain tumor? Path specimen consists of four fragments of tissue measuring .7, .6 and .3 cm. | Assign code 20 [Local excision (biopsy) of lesion or mass. Specimen sent to pathology from surgical event 20]. | 2008 | |
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20081117 | Histology--Brain and CNS: How is histology to be coded for a pituicytoma WHO grade I, of the pituitary? | Assign code 9380/1 [glioma, borderline]. According to our pathologist consultant, the term pituicytoma is restricted to low-grade glial neoplasms of the neurohypophysis or infundibulum. The best category currently available for these is glioma. |
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20081116 | CS Extension--Brain and CNS: How is this field coded for a malignant brain tumor that presents as a lesion with significant pressure on the left frontal ventricle and dilation of the right ventricles? See Discussion. | CS Extension code 30 includes tumor that invades or encroaches upon the ventricular system. Does significant pressure mean the same thing as encroach? | 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.Do not assign extension code 30 in this case unless there is evidence elsewhere of ventricular system involvement. "Significant pressure" is not synonymous with encroachment or involvement. See the list of ambiguous terms for CS staging on page 121 of the 2007 SEER manual. |
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20081115 | CS Extension--Brain and CNS: How is this field coded for a malignant tumor presenting as a confluent lesion over right parietal, posterior frontal and thalamic regions? | 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. Assign CS extension code 40 [Tumor crosses the midline; Tumor involves contralateral hemisphere; Tumor involves corpus callosum (including splenium)] The thalamus is located between the corpus callosum and the cerebellum and brain stem. A supratentorial tumor extending to the thalamus involves the corpus callosum (extension code 40) but has not yet reached the cerebellum or brain stem. Code 40 applies, but code 50 or any higher code is not applicable in this case. |
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20081114 | Reportability--Brain and CNS: Is hygroma reportable? See Discussion. |
Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. However, per I&R: "Most cystic hygromas (9173/0) are fetal malformations and occur in patients less than two years old. If this patient was an adult, they are primarily treated with surgery. Hygroma (used in a general sense) is a response to trauma (i.e., subdural hematoma) and as such, is not a "new growth" and would not be reportable either as a cyst or as a neoplasm. Unless the patient had some sort of operation, I'd hesitate to include the case as a reportable benign tumor." How is the cancer registrar to distinguish between reportable and non-reportable hygromas? Example: Brain MRI showed diffuse cerebral volume loss and incidental bilateral frontal subdural hygromas (histology code 9173/0). Reference: I&R 14825 |
Hygromas are not reportable. This instruction will be added to the next revision of the benign brain rules. According to an expert in the field, hygromas are not neoplastic. Hygromas are cystic dilations of a localized subarachnoid or subdural accumulation of clear fluid related to an excess accumulation of CSF, typically related to an old hemorrhage that somehow prevents reabsorption of CSF. |
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20081113 | Reportability--Brain and CNS: Is a cavernoma reportable as a benign brain tumor? See Discussion. |
Cavernous hemangiomas are typically described as vascular malformations in the brain. Per a search of the literature, cavernoma, cavernous hemangioma and cavernous malformation are all synonymous. There is some controversy as to whether cavernomas are vascular malformations or tumors. Cavernous hemangioma (9121/0) has been assigned a code in the ICD-O-3. The other terms are not even listed. Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. Would we report a lesion that is labeled cavernous hemangioma but not one that is labeled carvernoma? Are cavernous malformations of the brain to be reported as benign brain tumors? The MP/H guidelines for benign brain tumors do not include blood vessel tumors in chart 1. Are the following tumors reportable? If so, what is the primary site? Example 1: Patient admitted for resection. Clinical diagnosis is left temporal cavernous hemangioma. Path diagnosis is cerebral cortex and white matter showing cavernoma. Example 2: Patient admitted for resection with clinical diagnosis of parietal cavernous hemangioma. Path shows A-V malformation. Example 3: Patient had T4 spinal tumor removed. Path showed cavernous angioma. Reference: I&R 18109 and 23460 |
Cavernoma is a reportable benign brain tumor. According to our pathologist consultant, cavernoma is synonymous with cavernous hemangioma. Examples 1. Reportable. Primary site - C710 [cerebrum] 2. Not reportable. Path dx disproves clinical diagnosis. 3. Not reportable. Not a brain tumor. |
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20081112 | MP/H Rules--Breast: Is a 2008 invasive ductal carcinoma counted as a new primary when it follows a 2005 invasive lobular carcinoma diagnosed in the same breast? See Discussion. | The patient has invasive lobular breast carcinoma excised in 2005. She returns in 2008 with a new invasive ductal carcinoma tumor same breast. Following MP/H rules, M10 seems to apply, which states this is still a single primary. Does this mean that this invasive ductal carcinoma is ignored and the patient remains in the registry with only a lobular carcinoma primary? | For cases diagnosed 2007 or later: Rule M10 applies. The 2008 diagnosis is not a new primary. The abstract for the 2005 diagnosis should be annotated to include the new information. |
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