MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type?
For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types.
Multiple primaries--Lymphoma: Is mediastinal large B-cell lymphoma followed by classical Hodgkin lymphoma reportable as one or two primaries? See Discussion.
Diagnosed 06/06/2006 with mediastinal large B-cell lymphoma, 9679/36. On 05/10/2007, another mediastinal lymph node biopsy done and the diagnosis was recurrent malignant lymphoma, classical Hodgkin's. A Hematopatholgy Consultant states, "it appears likely that the preceding mediastinal diffuse large B-cell lymphoma and the current classical Hodgkin's lymphoma are clonally related and represent different manifestations of the same entity. One might also place this in the spectrum of 'mediastinal gray zone lymphoma' described by Dr. Jaffee and colleagues."
For cases diagnosed prior to 1/1/2010:Report this case as two primaries. Report non-Hodgkin lymphoma followed by Hodgkin lymphoma as separate primaries.
According to the Table of Single and Subsequent Primaries for Hematologic Malignancies, mediastinal large B-cell lymphoma and Hodgkin disease are "D" - Different disease processes.
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.
Reportability/Histology--Hematopoietic: If a JAK2 positive myeloproliferative disorder is reportable, how should histology be coded?
Please discuss the significance of JAK2 point mutation.
Example: Bone marrow biopsy showed hypercellular marrow with increased megakaryocytes associated with JAK2 point mutation consistent with myeloproliferative syndrome. Path comment: While the morphologic changes would be compatible with a myeloproliferative syndrome, they are not specific for this as similar findings can be seen in reactive conditions. However, a molecular diagnostic test demonstrated a positive JAK2 point mutation which would support the diagnosis of myeloproliferative syndrome. In summary, the combined histologic and molecular diagnostic findings support a myeloproliferative syndrome. The differential diagnosis would be between polycythemia vera and essential thrombocythemia. Subsequent clinical diagnosis: polycythemia vera.
For cases diagnosed prior to 1/1/2010:Follow the instructions in the SEER manual on pages 1-4 to determine reportability.
Code the histology using all information available for the case. If the clinician reviews the case and states a particular histology based on his/her review, code that histology.
The clinician has access to all of the information available for this case. He/she uses his/her expertise to form a clinical diagnosis.
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--Breast: Is a ductal carcinoma diagnosed in August, 2008 following a lobular-ductal primary diagnosed in February 2007 a new primary? See Discussion.
Patient has two right breast tumors excised in February, 2007. One is lobular and the other ductal - abstracted as single primary per rule M10. Patient presents with new right breast tumor in August, 2008. This is a ductal carcinoma stated to be a recurrence. Would we again stop at M10 (single primary) or continue on to M12 and make this a new primary (difference at third number)?
For cases diagnosed 2007 or later:
Stop at rule M10 -- this is the first rule that applies. The 2008 diagnosis is not a new primary.
Surgery of Primary Site--Breast: How is this field coded when a re-excision follows a prior mastectomy?
Code the most extensive surgery in Surgery of Primary Site. This is a cumulative field. Assign the appropriate code including all surgeries of the primary site performed during the first course of treatment.
The correct code for mastectomy followed by re-excision will depend on the extent of the re-excision. For example, if the re-excision removed muscle, code radical mastectomy.
First course treatment/Histology--Lymphoma: What treatment, if any, is coded for a patient with methotrexate induced lymphoma when the treatment plan is to take the patient off methotrexate? Also, is there a specific histology for drug induced lymphoma? See Discussion.
Diffuse Large B-cell Lymphoma of soft palate & nasal septum, methotrexate induced, in 5/07. Patient was taken off methotrexate with complete resolution of disease. No other treatment was given. Patient was on methotrexate for treatment of rheumatoid arthritis.
For cases diagnosed prior to 1/1/2010:Treatment: Code the treatment fields to 00 [not done] in this case.
Document the discontinuation of methotrexate for rheumatoid arthritis in a text field.
Histology: Assign code 9680/36 [Malignant lymphoma, large B-cell, diffuse, NOS]. There is no specific histology code for therapy-related lymphoma.
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.
Multiplicity Counter: Is there a time frame for the Multiplicity Counter or is it related to the duration for counting new tumors (i.e. 5 years for breast, etc) to capture the number of "local recurrences"?
Record the number of tumors counted as a single primary at the time the case is abstracted. Later, if additional tumors are determined to be the same primary, update this field once. Do not update the multiplicity counter more than once.
Reportability--Lung: Is carcinoid tumorlet of the lung a reportable disease? See Discussion.
The literature on this is rather ambiguous as to whether these tumorlets (defined as <0.5 cm) are benign, such as atypical hyperplasia, or actual carcinoid tumors.
Carcinoid tumorlets are not reportable. The histology can be similar to typical carcinoids; however, they are <5 mm in diameter and are benign/nonreportable.
MP/H Rules--Breast: How many primaries should be abstracted when a patient has a mass at 6:00 that showed poorly differentiated ductal carcinoma and a hypoechoic nodule at 9:00 that was excised with no real tumor present there though path showed angiolymphatic invasion by carcinoma throughout the entire specimen? See Discussion.
Palpable mass in right breast at 6:00. Path stated 'poorly differentiated ductal carcinoma with extensive necrosis and extensive angiolymphatic invasion. Focal high grade comedocarcinoma (1%)'. Another hypoechoic nodule was seen at the 9:00 position. This mass was excised from surrounding tissue. This mass was more like an inflammatory mass; there was no real tumor present there. Path report stated "Breast mass 9:00 excisional biopsy - angiolymphatic invasion by mammary carcinoma throughout the entire specimen."
Is this two primaries because of the two different histology codes: 8500 and 8010?
For cases diagnosed 2007 or later, abstract as a single primary using rule M3 (a single tumor is always a single primary). There was one tumor present according to the information provided. The second specimen was not a separate tumor ("There was no real tumor present there").
An official website of the United States government
Home