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20100108 | MP/H Rules/Histology--Brain and CNS: How is histology coded for a left occipital parietal area tumor stated to be a "low grade neuroectodermal neoplasm most consistent with neuronal tumor but lacking classic features of ganglioma" if the pathologist states the tumor is not malignant? | Code 9505/0 [Ganglioglioma, benign] is the best option according to our pathology expert. He states, "There recently has been a spate of tumors called low grade glio-neuronal tumors that are not PNETs and have no propensity to become malignant." | 2010 | |
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20100006 | MP/H Rules/Multiple primaries--Kidney: In a patient with a history of renal cell carcinoma, would a new primary be accessioned per Rule M10 for a soft tissue mass in the renal fossa not stated to be a metastasis but that was referred to as recurrent renal cell carcinoma, clear cell per the excision pathology report? See Discussion. |
This patient was diagnosed with clear cell carcinoma of the right kidney in 2003, treated with nephrectomy. The tumor was limited to the kidney. An FNA of the pancreas in 11/07 was consistent with metastatic renal cell carcinoma. In 2009 the patient was diagnosed with a right renal fossa mass by CT. The mass was excised on 8/26/09 and showed, "recurrent renal cell ca, clear cell." The path specimen was labeled as, "soft tissue, rt renal fossa." The original 2003 slides were not reviewed and the renal fossa mass was not described as being metastatic. If the renal fossa soft tissue mass is a new tumor, the MP/H rules for Other Sites directs you to code it as a new primary per rule M10 [Tumors diagnosed more than one (1) year apart are multiple primaries]. Would this be a new soft tissue tumor per rule M10? Or would this be a recurrence of the original kidney primary? |
For cases diagnosed 2007 or later: This is not a new primary. The patient has metastatic disease from the 2003 kidney primary. Clear cell carcinoma metastasized to the pancreas in 2007 and to the right renal fossa in 2009. |
2010 |
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20100042 | Reportability--Heme & Lymphoid Neoplasms: Given that there appears to be many differences in the reportability of these case types pre- and post-2010 (e.g., [refractory] thrombocytopenia), is there a list available that gives the reportability dates for these diseases? See Discussion. |
For cases diagnosed prior to 2010 "thrombocytopenia" was not reportable. According to the Heme Database, the term "refractory thrombocytopenia" is now reportable for cases diagnosed 1/1/10 and later. It would be helpful to have a list of diagnosis date requirements for the different hematopoietic diseases. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Thrombocytopenia (NOS) is not reportable per Appendix F. However, the term "refractory thrombocytopenia" [9992/3] is reportable for cases diagnosed 2010 or later.
There has been no change in the reportability for thrombocytopenia. The hematopoietic "help" system lists all of the synonyms, variants, and abbreviations for diseases.
See the Hematopoietic & Lymphoid Neoplasm Coding Manual for changes in reportability associated with these cases.
Terms and codes in Appendix D are effective 01/01/10 and later. Refractory thrombocytopenia is included in D1a and D1b. The notes for D1a and D1b provide explanation and reiterate the dates these terms are effective.
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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20100043 | Primary site--Heme & Lymphoid Neoplasms: When only pathology reports are available, how should the primary site be coded when a both a bone marrow biopsy and colon biopsy demonstrate "mantle cell lymphoma"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
For this case, code primary site to C189 [colon, NOS] per Rule PH24.
Mantle cell lymphoma usually begins with lymph node involvement and spreads to other tissue. However, it can begin in a lymphocyte such as those in the GI tract. Per the Abstractor Notes section in the Heme DB, patients usually present with advanced disease. About half will have some combination of B symptoms. Swelling of lymph nodes and spleen are usually present. Bone marrow, liver and GI tract involvement occurs in a very high percentage
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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20100094 | Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case? |
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]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is 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. |
2010 | |
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20100019 | Histology--Ovary: How is histology coded for an ovarian mucinous neoplasm of low malignant potential (borderline mucinous cystadenoma) that shows extensive intraepithelial carcinoma and focal microinvasion? See Discussion. | At surgery a 25 cm left ovarian mass is found adherent to the anterior abdominal wall. The final diagnosis per the pathology report is, "Mucinous neoplasm (26 cm) of low malignant potential (borderline mucinous cystadenoma) with extensive intraepithelial ca and focal microinvasion. Right ovary, fallopian tubes, uterus, omentum, biopsies of diaphragm, 28 para-aortic and pelvic LNS and peritoneal fluid are all negative for malignancy." | Histology code 8470/3 [mucinous cystadenocarcinoma] is the best choice in this case. There is a mucinous cystadenoma [8470/0] with intraepithelial carcinoma and focal microinvasion. 8470/3 comes as close as possible to the description of the tumor. | 2010 |
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20100075 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when a 1/27/10 bone marrow biopsy, FISH and cytogenetics reveals chronic myelogenous leukemia (CML), BCR/ABL positive, t(9;22)(q34;q11) and a 4/15/10 bone marrow biopsy reveals B-acute lymphoblastic leukemia (Blast phase of CML)? | 1/27/10 BM biopsy: CML BCR/ABL+ FISH positive for BCR/ABL and cytogenetics showing the t(9;22)q34q11.2 translocation. Treated with Imatinib. 4/15/10 BM biopsy: B-acute lymphoblastic leukemia (Blast phase of CML). Would the term "blast phase of CML" indicate the 4/15/10 bone marrow biopsy showed CML or would a new primary be abstracted with histology coded 9811/3 [B lymphoblastic leukemia/lymphoma, NOS]?
Applying rule M10, this is a new primary, but note 2 states transformations are defined in the Heme DB. The Abstractor Notes section indicates CML has three phases: chronic, accelerated, and the blastic phase or blast crisis. The accelerated phase can last weeks to months. In the chronic phase the involvement is usually limited to blood, bone marrow and spleen although the liver may be infiltrated. During the blastic phase, lymph nodes and tissue may be involved. The blastic phase is a disease progression from the chronic phase. The disease, however, remains the same histology, chronic myelogenous leukemia. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case represents a multiple primary per Rule M15 which states you are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14.
The histology for the first primary is coded to 9875/3 [chronic myelogenous leukemia, BCR-ABL1 positive].
The histology for the second primary is 9811/3 [B lymphoblastic leukemia/lymphoma, NOS] in the absence of further documentation that the B-ALL was also positive for the t(9;22) translocation.
The histology code 9806/3 [Mixed phenotype acute leukemia with t(9;22)(q34;q11.2); BCR-ABL1] cannot be used for the second primary because there is no documentation that the B-ALL diagnosed on 04/15/2010 also had the t(9;22) translocation and this histology cannot be used in patients ." Per the Definition section in the Heme DB, in order to use histology code 9806/3 "This leukemia meets the criteria for mixed phenotype acute leukemia (MPAL) in which the blasts also have t(9;22) translocation of BCR-ABL1 rearrangement. Some patients with chronic myeloid leukemia may develop or even present with a mixed blast phase that would meet criteria for MPAL; however, this diagnosis should not be made in patients known to have had CML."
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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20100089 | Primary site--Heme & Lymphoid Neoplasms: How is primary site coded when lymphoma is initially found in both lymph nodes and bone marrow, the pathology report is unavailable, and the physician only states that both areas are involved? See Discussion. | For many consultations and/or class 2 cases, the pathology report is not available to help determine the primary site. Should the primary site be automatically coded to C421 over C77_ when both are involved? The Abstractor Notes state the primary site can be either bone marrow or lymph nodes. The physician states only that both are involved. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Because both the bone marrow and LN are involved, code the primary site to C779 [lymph nodes, NOS] per Rule PH22. You are to code specific nodes if a specific region is specified; however, if no region is specified, code to lymph node, NOS [C779]). When you are having problems coding primary site, go to Module 7 Primary Site Rules for Lymphomas Only. See Rule PH26. It states that you code the primary site to bone marrow when ONLY the bone marrow is involved.
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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20100018 | Reportability/Heme & Lymphoid Neoplasms--Hematopoietic, NOS: Is light chain disease reportable if it is treated with chemotherapy agents? See Discussion. | A patient was diagnosed in 2010 with light chain disease based on SPEP and urine testing. Bone marrow aspiration and biopsy were done. Flow cytometry, cytogenetic studies and FISH for plasma cell disorders are all normal. Medical oncologist states diagnosis is light chain disease. Patient was started on Revlimid, dexamethasone and Velcade.
In reviewing the case reportability instructions, this seems to fall under Instruction 1, note 1. Immunoglobulin deposition disease, preferred term for light chain disease, is coded as 9769/1. This is normally a non-reportable diagnosis, but the patient was given cancer-directed treatment. Would this case be accessioned using the above morphology code and primary site of bone marrow [C42.1]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case is not reportable. The histology is 9769/1 [light chain disease] in the Heme DB.
Light chains are produced in neoplastic plasma cells (multiple myeloma) and are called Bence-Jones proteins. The physician did the cytogenetic studies and FISH to rule out plasma cell disease. 50-60% of people with Light-chain deposition disease (LCDD) have an associated lymphoproliferative disorder, most commonly multiple myeloma. The remaining patients develop LCDD in the setting of progression of monoclonal gammopathy of unknown significance (MGUS) with no evidence of neoplastic plasma cell proliferation. This patient falls in this category, MGUS, which is not reportable. |
2010 |
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20100065 | Reportability--Heme & Lymphoid Neoplasms: Is "myeloproliferative syndrome, NOS" synonymous with "myeloproliferative syndrome" and "myeloproliferative disease" and, therefore, reportable under the new hematopoietic rules? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Myeloproliferative syndrome and the myeloproliferative diseases were used in the past to describe myeloproliferative neoplasms. For cases diagnosed 2010 and forward, although the term "myeloproliferative syndrome" is not currently used to describe this disease, the synonyms "myeloproliferative syndrome" and "myeloproliferative disease" were added to the database for myelodysplastic/myeloproliferative neoplasm, unclassified [9975/3].
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. |
2010 |
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