Histology--Pancreas: How is a "gastrin and somatostatin producing endocrine neoplasm" coded that has lymph node metastasis?
The best code available for this situation is 8153/3 [Gastrinoma, malignant].
Many pancreatic endocrine tumors produce more than one peptide, such as gastrin and somatostatin in this case. ICD-O-3 does not provide a code for pancreatic endocrine tumors which produce more than one peptide. According to the WHO Classification of Tumours of Endocrine Organs, there is a distinct hormonal syndrome associated with gastrin producing tumors, and not with many of the somatostatin producing tumors. Therefore, our pathologist consultant advises us to code to gastrinoma in this case.
Reportability--Hematopoietic, NOS: If the bone marrow biopsy diagnosis is not reportable and cytogenetics studies indicate no clonal abnormality, is a case reportable if only the flow cytometry results show a "small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom macroglobulinemia"? See Discussion.
Bone marrow bx final diagnosis: Markedly hypercellular marrow consisting primarily of erythroid hyperplasia and, also, diffusely distributed small lymphocytes. Addendum comment: Flow cytometry demonstrated a small monoclonal B-lymphocyte population consistent with a lymphoid component of a lymphoplasmacytic lymphoma or Waldenstrom's Macroglobulinemia. Addendum comment: Cytogenetic analysis states no clonal abnormality was apparent. Normal female karyotype.
Question 1: Is this case reportable, and if so, what histology?
Question 2: Is there a hierarchy when flow cytometry and cytogenetics are done, but do not agree?
For cases diagnosed prior to 1/1/2010:This case is not reportable at this point. A lymphoid component is not equivalent to a diagnosis of a reportable disease. In order to be a malignant, reportable disease, the condition must be monoclonal and irreversible. Cytogenetics were negative for malignancy (i.e. no monoclonal abnormality identified which is the criteria used to establish this diagnosis). Use all information available when determining reportability.
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.
MP/H Rules/Histology--Breast: If the abstractor only has the CAP protocol information from a pathology report and it does not include a "final diagnosis" label, which fields of the protocol are used to determine the histology and whether there is carcinoma in situ present in the specimen?
For cases diagnosed 2007 or later, if the CAP protocol is used in lieu of a final diagnosis, use all of the information in the CAP protocol.
CS Extension--Ovary: Are "non-invasive implants" identified per pathology coded differently than "invasive implants"?
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.No, non-invasive and invasive implants are not handled differently in collaborative staging for ovary.
MP/H Rules/Multiple Primaries--Lung: If the biopsy for a lung primary is actually taken from a pleural mass, can the default rule "when there are several lung masses and only one lesion is biopsied, consider this a single primary" apply? See Discussion.
Scenario: A parenchymal lesion in each lung. One lung also has a pleural lesion. MD biopsies the pleural mass only and it is positive for cancer.
For cases diagnosed 2007 or later:
Do not assume the biopsy of the pleural mass is a biopsy of the lung. Apply the 2007 MP/H Lung rules to the lung tumors only. For this case, the pleural lesion would be a metastasis (outside the lung). The 2007 MP/H rules do not apply to metastatic lesions.
The 2007 MP/H Lung rules do not apply to pleura as a primary site. If the pleural lesion is primary, it should be abstracted as a separate primary.
First Course Treatment--Melanoma: How and where is the excision for an in-transit metastasis coded if the in-transit metastasis is coded in CS Lymph Nodes? See Discussion.
Excision of skin of scalp nodule reveals in transit metastasis of melanoma. Patient also has lung metastasis and begins systemic treatment. No primary tumor identified.
Code the excision in Surgical Procedure of Other Site because no primary tumor was identified.
MP/H Rules/Multiple Primaries/Laterality--Brain and CNS: How many primaries are to be abstracted and how is laterality to be coded for two meningiomas, one occurring at the midline and the other in the right termporal region? See Discussion.
MRI of the brain shows two meningiomas: One is stated to be 'midline' (laterality code 9) and one is stated to be in the 'right' temporal region. The rules state if same site (C700), same histology & laterality is same side or one side unknown, then abstract as single primary. Based on this, the MRI findings would be one primary, but how should laterality be coded?
For cases diagnosed 2007 or later, abstract two primaries. The lateralities of both meningiomas are known. Right (code 1) and midline (code 9) are different lateralities.
MP/H Rules/Recurrence: Is a subsequent diagnosis of an in situ tumor (bladder cancers excluded) a "recurrence" if it follows a prior invasive diagnosis of the original primary cancer made 5 years before?
For cases diagnosed 2007 or later, use the 2007 MP/H rules to determine whether or not a subsequent diagnosis (either invasive or in situ) is a new primary or a recurrence. Do not use the statement "recurrence" from the medical record to make this decision.
When evaluating a subsequent diagnosis and the MP/H rules indicate "single primary," the tumor being evaluated is a "recurrence" of the original primary cancer.
Ambiguous Terminology/Date of Conclusive Terminology: If there is an unknown date of diagnosis, should the Ambiguous Terminology field always be coded to 9 and the Date of Conclusive Terminology be coded to 99999999? See Discussion.
Scenario: Mammogram is suspicious for carcinoma, unknown date in 2007. A biopsy prior to admission to reporting facility is positive for carcinoma. Patient seen at reporting facility in June 2007 for treatment.
The purpose of the data item "Ambiguous Terminology" is to flag cases entered into the registry based on a diagnosis with ambiguous terminology. Because the case above was entered into the registry based on conclusive terminology, code Ambiguous Terminology to 0 [Conclusive term] and code Date of Conclusive Terminology to 88888888 [not applicable].
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