Report | Question ID | Question | Discussion | Answer | Year |
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20100074 | Laterality--Melanoma: For a melanoma case, does the term "mid" imply that the tumor is in the midline when the site is the skin of back (trunk)? | Yes. When the location is described as mid-back or mid-chest with no indication of left or right, assign laterality code 5 [midline]. | 2010 | |
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20100067 | MP/H Rules/Reportability--Ovary: Should an ovarian tumor with the histology of mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma be accessioned based on the presence of a foci of intraepithelial carcinoma? See Discussion. | The final diagnosis on the pathology report, "Omentum: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma. Peritoneal fluid for cytology: neoplastic cells present; low grade serous neoplasm. Lymph nodes, right pelvic: one lymph node harboring implants of serous borderline tumor and endosalpingiosis within the subcapsular sinus. Bilateral fallopian tubes and ovaries: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma involving ovarian surface and serosal surface of the tube. Detached fragment of borderline tumor within the tubal lumen. Uterus, cervix, and segment of colon: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma involving parametrial and paracervical tissue, cul de sac, uterine and colonic serosa. Nine pericolonic lymph nodes negative for tumor. Stage III.
I&R # 45622 asked if a mucinous borderline tumor with intraepithelial carcinoma and focal microinvasion is reportable. The answer given on that site was that the case is not reportable. According to MPH, FORDS, and Collaborative Stage, intraepithelial carcinoma is in situ, behavior code 2, and is reportable. Has this changed? |
This case is reportable because there is a diagnosis of carcinoma (intraepithelial carcinoma). | 2010 |
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20100076 | Reportability--Heme & Lymphoid Neoplasms: If not specified as primary, idiopathic, or essential, is thrombocytosis, NOS reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Unless the disease is specified as primary, idiopathic, essential, or the physician states there is a myeloproliferative neoplasm, the term thrombocytosis, NOS is not reportable. Thrombocytosis, NOS, is the presence of high platelet counts in the blood. Thrombocytosis can be associated with chronic infections and other diseases as well as with myeloproliferative disease. Thrombocytosis, NOS is listed in Appendix F as a Non-Reportable Term.
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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20100034 | MP/H Rules/Multiple primaries--Esophagus: Should two separate nodules of adenocarcinoma with one at the GE junction [C160] and one arising in Barretts esophagus of the distal esophagus [C155] be accessioned as a single primary because these sites are now grouped together in the same stage grouping per the AJCC 7th Edition? See Discussion. | Per notes included in CSv2, the cardia/EGJ, and the proximal 5cm of the fundus and body of the stomach [C16.0-C16.2] have been moved from the Stomach chapter and added to the Esophagus chapter effective with AJCC TNM 7th Edition. A new schema, EG Junction, was created in CSv2 to accommodate this change. Tumors arising at the EGJ, or arising in the stomach within 5 cm of the EGJ and crossing the EGJ are staged using the schema for EG Junction. MP/H Rule M11 states that tumors with ICD-O-3 topography codes that are different at the second (Cxxx) and/or third characters (Cxxx) are multiple primaries.
In light of the fact that tumors of the GE junction are now included with tumors of the esophagus in AJCC 7th Edition, will the MP/H rules also be adjusted to reflect that change? |
For cases diagnosed 2007 or later, use the multiple primary rules to determine the number of primaries. Use staging resources for staging. Abstract two primaries for the case example using Rule M11. | 2010 |
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20100081 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: Should a single primary be accessioned with the histology coded 9732/3 [multiple myeloma] when a patient is diagnosed initially with a plasmacytoma on an excision and a single bone marrow biopsy showed only 4% plasma cells, then the subsequent workup led to a clinical diagnosis of multiple myeloma? See Discussion. | This patient had a plasmacytoma removed from the sphenoid sinus and was started on Dexamethasone. The patient had a bone marrow biopsy with 4% plasma cells. A statement in the hematology notes read, "it can increase the rate of false negative results with a bone marrow biopsy." The bone marrow biopsy was done 15 days after the surgery for the plasmacytoma.
Workup yielded the diagnosis of multiple myeloma. Per a statement in hematology notes, "I found her having 4% blasts, atypical plasma cells in the bone marrow biopsy and also lytic lesions involving the T7 and lucencies involving L4 and L5 vertebral bodies and also the upper sacrum. The PET-CT scan did not show significant metabolic activities in those lesions. The patient had a small amount of Bence-Jones in the urine and also an abnormal kappa to lambda ratio in the serum. The ratio was 12 to 1. The beta 2 microglobulin was 1.4. The albumin in the serum was 3.4. Based on that, the patient has been diagnosed with Durie-Salmon stage III in ISS stage II multiple myeloma."
The abstractor notes for multiple myeloma state that the diagnosis is made when the proportion of plasma cells in the bone marrow is 10% or greater. Should a diagnosis of MM be accessioned and coded when the bone marrow is less than 10% plasma cells, but a clinical diagnosis of MM is made? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accept the physician's diagnosis of multiple myeloma [9732/3]. Code the multiple myeloma as a single primary using rule M8 if there was only ONE positive biopsy. Code as multiple primaries (both the solitary plasmacytoma and multiple myeloma) using Rule M11 if there are TWO positive biopsies, one confirming the chronic neoplasm and the other confirming the acute neoplasm.
Per the Heme DB Abstractor Notes: The registrar DOES NOT CODE plasma cell myeloma based on the percentage of plasma cells. There must be a diagnosis of plasma cell myeloma. In addition, a clinical diagnosis of plasma cell myeloma may be made based on amyloidosis with associated renal impairment, anemia and/or hypercalcemia supported by radiologic evidence of multiple lytic bone lesions. he biopsy confirmed plasma cell malignancy (plasmacytoma) and the clinical workup confirmed myeloma.
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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20100085 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are these field coded when a biopsy of a substernal mass and the pericardium show T-cell lymphoblastic lymphoma/leukemia, the CT scan showed mediastinal and hilar adenopathy and no bone marrow biopsy was done? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9837/3 [T lymphoblastic leukemia/lymphoma].
To determine the primary site for leukemia/lymphoma histologies, first go to Module 4. Per Rule PH8, code the primary site to the site of origin when lymph nodes, tissue or organs are involved. To determine a more specific histology, go to Module 7, rules for coding primary site for lymphomas. Per Rule PH20, code the lymph node region when multiple lymph node chains within the same region are involved. Mediastinal and hilar lymph nodes are intrathoracic lymph nodes. The substernal mass is also intrathoracic and is presumed to be a lymph node mass which involved the pericardium. For this case, code the primary site to C771 [Intrathoracic lymph nodes].
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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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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20100024 | Histology: How is this field coded for a perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential that is malignant based on the presence of metastases? See Discussion. |
In 11/2006 the patient had surgery for a 6cm mass in the RUQ arising in the falciform ligament. The pathologic final diagnosis was: Perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential. In 10/2009 a liver biopsy showed metastatic perivascular epithelioid cell neoplasm. |
Assign histology code 8005/3 [malignant clear cell tumor]. According to our expert pathology consultant, this is the best histology code available at this time for the occasional tumor which is designated as malignant. The appearance of metastatic disease clearly defines this case as malignant. |
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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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 |