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20100071 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient diagnosed in February 2010 with a plasmacytoma of the frontal skull followed by a diagnosis of smoldering myeloma by bone marrow biopsy? See Discussion. | The patient had a diagnosis of solitary plasmacytoma of the right frontal skull in 2/2010 that was totally resected (the cranial specimen final diagnosis was plasmacytoma). The patient received radiation. While undergoing radiation, the patient was seen by a medical oncologist who did a bone marrow biopsy that revealed 10-15% plasma cells, and was called smoldering myeloma. Watchful waiting was recommended. In 8/2010, the patient had multiple lytic lesions and began systemic treatment.
Per rule M15 and the Multiple primary calculator, 9731/3 [plasmacytoma] and 9732/3 [smoldering myeloma] is accessioned as two primaries. When the manual states, "Use the Hematopoietic Database to determine the primary site and histology when PH1-PH29 do not apply," does this mean to use the calculator not the database itself? By the old rules this was one primary. Did this change for cases diagnosed 1/1/10 and later? Which M rule is the correct rule to apply? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
The smoldering myeloma is a second primary per Rule M10. Accession as multiple primaries because this case was originally diagnosed as a chronic neoplasm (plasmacytoma)phase and there was a second diagnosis of an acute neoplasm (multiple myeloma) more than 21 days after chronic diagnosis. See note 1 which indicates, "This is a change from previous rules." Note that the MP rules and the MP calculator in the Heme DB agree.
When the rules tell you to go to the DB to determine the histology and primary site, you use the DB information. (Don't forget to check the Abstractor Notes). The multiple primaries calculator is used to determine the number of primaries to abstract. Always use the M rules before using the MP calculator.
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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20100105 | Surgery of Primary Site--Brain and CNS: Is "debulking" of a primary brain tumor coded to 21 [subtotal resection of tumor] or 30 [gross resection of tumor]? | Assign code 21 [subtotal resection of tumor, lesion, or mass]. Debulking removes as much of the tumor volume as possible in cases where it is not possible to remove the entire tumor. Debulking should improve the effectiveness of subsequent radiation therapy and/or chemotherapy. | 2010 | |
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20100087 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for one patient with history of marginal zone lymphoma initially diagnosed in 1994, followed by a 2010 diagnosis of large B-cell lymphoma and another patient with both B-cell chronic lymphocytic leukemia/small cell lymphoma (CLL/SLL) and diffuse large B-cell (DLBCL) in 2009? See Discussion. | Case 1 - Patient has a history of marginal zone lymphoma diagnosed in 1994 with recurrences in 2007 and 2009. The patient now presents for a bone marrow biopsy in May 2010 and is found to have large B-cell lymphoma, transformation. The first primary, marginal zone lymphoma, falls under the 2009 rules and the second primary, large B-cell lymphoma, falls under the 2010 and forward rules?
Case 2 - Patient was diagnosed with B-cell CLL/SLL and a DLBCL in 2009. If the 2009 rules only apply, these are a single primary. If the patient is admitted and treated in 2010 are the rules still based on the diagnosis date? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Case 1: Accession two primaries per Rule M10 when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis. The histology for the first primary is 9699/3 [marginal zone lymphoma] represents a chronic neoplasm and the second primary is 9680/3 [diffuse large B-cell lymphoma] is an acute neoplasm which was diagnosed more than 21 days after the first primary.
Case 2: Do not use the Heme DB and Manual rules for this case. Both diagnoses were made prior to 2010. The Heme DB and Manual are only effective for cases diagnosed 1/1/2010 and forward. Use the ICD-O-3 Hematopoietic Primaries Table to determine the number of primaries for this case. Per the Table, a second diagnosis of DLBCL [9680/3] following a diagnosis of CLL/SLL [9823/3] is one primary.
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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20100090 | MP/H Rules/Histology: How is histology coded for a diagnosis of "poorly differentiated endometrioid adenocarcinoma intermixed with osteoid sarcomatous component, consistent with malignant mixed mullerian tumor with heterologous (osteosarcoma) elements"? Is malignant mixed mullerian tumor synonymous with carcinosarcoma? See Discussion. | Given that there is no mixed code for these histologies, can the numerically higher code be used per H17 (malignant mixed mullerian tumor [8950/3]) using the logic of the MP/H rule for other sites? If so, should this histology be coded as 8980/3 [carcinosarcoma] rather than 8950/3 [malignant mixed mullerian tumor]? | For cases diagnosed 2007 or later, code histology to 8980/3 [carcinosarcoma]. Recent literature states that carcinosarcoma is synonymous with mixed mullerian tumor. Mixed mullerian tumor is an obsolete term and should not be used. | 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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20100036 | Behavior--Lung: Can an in situ behavior code be used for a bronchioalveolar carcinoma of the lung when the pathologist appears to use the term bronchioalveolar to describe an in situ pattern of growth exhibited by an adenocarcinoma? Is the use of the term "pattern" in this situation indicative of in situ tumor? See Discussion. | In ICD-O-3, bronchioloalveolar adenocarcinoma is described only by behavior code 3 (invasive). Would the behavior be coded as in situ for the following cases?
Example 1: Left lower lobe, partial resection shows bronchioloalveolar carcinoma with focal areas of fibrosis (see comment). Comment: Although the possibility that these areas represent stromal invasion can not be excluded, we favor the interpretation that these areas do not represent true invasion. Synoptic summary: Minimal pathologic stage: Local Extent.
Example 2: Lung tumor described as adenocarcinoma, predominantly bronchoalveolar pattern. For most sites, the term pattern is used only for in situ cancer and is not a specific term used for invasive tumors. Is the use of the term "pattern" in this situation indicative of in situ tumor? |
Code the behavior indicated in the pathology report. If the pathologist states the bronchioloalveolar carcinoma is in situ, apply the ICD-O-3 matrix rule and assign 8250/2. Otherwise, code 8250/3. Do not use the term "pattern" to infer in situ behavior.
Code behavior /3 for both examples based on information provided. |
2010 |
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20100040 | Histology--Heme & Lymphoid Neoplasms: How is this field coded for a patient with a negative bone marrow and multiple plasmacytomas in different bone sites (e.g., thoracic vertebrae and left femur)? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C419 [Bone, NOS] and the histology to 9731/3 [solitary plasmacytoms].
The vertebral lesions are common for plasmacytomas, as are lesions of the femur. If the patient does not meet the criteria of plasma cell myeloma/multiple myeloma (which is 20% of the leukocyte differential count), do not code the histology to multiple myeloma.
Per Rule M2, abstract a single primary when there is a single histology.
Per Rule PH3, code the primary site to the where the plasmacytoma originated and code the histology of bone () when the diagnosis is multiple plasmacytomas of the bone.
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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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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20100047 | Reportability--Heme & Lymphoid Neoplasms: Is "myelodysplasia" a reportable disease? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
The diagnosis of "myelodysplasia" is not reportable.
Myelodysplasia covers a group of disorders that result in the inability to produce enough healthy mature blood cells. Those disorders include: anemia, leukopenia, thrombocytopenia, MDS, refractory anemia, refractory anemia with excess blasts in transformation, refractory anemia with ring sideroblasts, refractory anemia with excess blasts, chronic myelomonocytic leukemia, acute myeloid leukemia. Follow-back to the physician is necessary to determine whether or not a particular case represents a malignancy.
"Myelodysplasia" is also listed in Appendix F: Non-Reportable List for Hematopoietic Diseases.
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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