Report | Question ID | Question | Discussion | Answer | Year |
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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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20100010 | MP/H Rules/Multiple primaries--Ovary: How many primaries are to be abstracted when a patient is diagnosed with serous cystadenocarcinoma [8441] of the right ovary and clear cell adenocarcinoma [8310] of the left ovary? See Discussion. |
Patient had bilateral ovarian tumors. The right ovary had serous cystadenocarcinoma and left ovary had clear cell adenocarcinoma. The pathology COMMENT section stated, "Based on the histologic differences of the tumors within each ovary, feel these represent two distinct separate primaries. Lymph node metastases are clearly serous ca." The physician staged the right ovary as T2a N1 M0 and left ovary as T1c N0 M0. Do we accession one primary per rule M7 [Bilateral epithelial tumors (8000-8799) of the ovary within 60 days are a single primary]? What is intention of Rule M7? If the histology in each ovary is different but within the range (8000-8799), is that supposed to be accessioned as one primary? Or is the intention of Rule M7 that tumors in both ovaries must have the SAME histology within that histology range to be a single primary? |
For cases diagnosed 2007 or later, apply rule M8 and abstract this case as multiple primaries. Rule M7 does not apply when each ovary has a distinctly different histology, even when both histologies are with the specified code range. This clarification will be added to the next version of the rules. |
2010 |
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20100045 | Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for for DLBCL.
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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20100110 | Reportability--Esophagus/Stomach: Are the terms "high grade dysplasia" and "severe dysplasia" synonymous with in situ for tumors in the gastrointestinal tract? See Discussion. |
SINQ 20000245 states that high grade or severe dysplasia in not synonymous with in situ disease. However, per page 109 in the 7th edition of AJCC Cancer Staging Manual, high grade dysplasia is the only term listed under Tis. A note on that page explains that "high-grade dysplasia includes all noninvasive neoplastic epithelia that was formerly called carcinoma in situ, a diagnosis that is no longer used for columnar mucosae anywhere in the gastrointestinal tract."
There has been considerable pressure from registrars at larger reporting facilities to re-address this issue. The pathologists at these facilities state that they are correctly documenting the presence of in situ disease when they use the term high grade dysplasia for gastrointestinal tract tumors. In their opinion, it is not necessary to add the term in situ in parentheses following the use of the term high grade dysplasia to clarify the behavior of these lesions in their pathology reports. If the term "carcinoma in situ" is no longer being used by many pathologists for sites in the gastrointestinal tract, won't this lead to underreporting of in situ disease for these sites unless the reportability guidelines are changed? |
For cancer reporting purposes, the terms "high grade dysplasia" and "severe dysplasia" are not synonymous with in situ for tumors in the gastrointestinal tract. These cases are only reportable when the pathologist documents carcinoma in situ or intraepithelial neoplasia grade III, or when the registry includes in their policies and procedures the pathologist's statement that he/she uses HGD to mean the same as CIS.
Reportability laws are customarily based on ICD-O. Because "high grade dysplasia" and "severe dysplasia" are not designated as in situ in the ICD-O, there is no legal authority to report these cases in most states.
NAACCR is reviewing this issue. See #5 on page 11 of the December 1, 2013 NAACCR Implementation document, http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466 |
2010 |
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20100083 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient with a longstanding history of follicular cell non-Hodgkin lymphoma followed by a 2010 diagnosis of "B-cell lymphoma with prominent large cell component, compatible with primary cutaneous follicle center cell lymphoma"? See Discussion. | Patient has a history of follicular cell non-Hodgkin lymphoma dating back to the 1990s. The patient was treated with chemotherapy and bone marrow transplantation, radiation and rituximab. The patient had no evidence of recurrence. In April 2010 a lesion appeared on the side of the scalp above the left ear with a diagnosis of "B-cell lymphoma with prominent large cell component, compatible with primary cutaneous follicle center cell lymphoma." The oncology diagnosis is "primary cutaneous follicle center lymphoma."
Would the Multiple Primaries Calculator be used in this case? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession two primaries per Rule M15. Per the Multiple Primaries Calculator, primary cutaneous follicle center lymphoma [9597/3] following a diagnosis of follicular lymphoma, NOS [9690/3] is a new primary.
While the pathologic diagnosis was B-cell lymphoma "compatible with" primary cutaneous follicle center cell lymphoma and ambiguous terms cannot be used to identify a more specific histology, the physician confirmed the more specific diagnosis without ambiguous terminology. Therefore, this diagnosis should be coded.
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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20100020 | Histology/Behavior--Brain and CNS: How are these fields coded for a "cystic glioma"? | Code the histology 9380/3 [Malignant glioma; Glioma, NOS]. There is no specific code for cystic glioma. | 2010 | |
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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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20100091 | Reportability/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and how is histology coded when a patient has a history of chronic myelogenous leukemia diagnosed in 1997 and a "blast crisis with myeloid markers" of this disease in 2010? See Discussion. | The patient was initially diagnosed with CML in 1997. In February 2010 the disease went into a "blast crisis with myeloid markers." The patient received induction chemotherapy and the disease went back into a chronic phase. To capture the 2010 diagnosis of a blast crisis, is the histology code 9875/3 [chronic myelogenous leukemia, BCR/ABL1 positive] or 9861/3 [acute myeloid leukemia, NOS] used? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M2, there is a single primary. Code histology to 9863/3 [CML, BCR-ABL1 status unknown, Blastic phase (BP)]. The blast phase is not recorded as a new primary because this disease does NOT change histologies.
Code 9875 [Chronic myelogenous leukemia, BCR-ABL1 positive] does not apply to the 2010 diagnosis because BCR/ABL status unknown. Code 9861/3 [Acute myeloid leukemia, NOS] also does not apply because the diagnosis was not acute.
It is not clear which chronic myelogenous leukemia (CML) this patient has. Each CML is unique in that it has a blast phase without the histology itself changing. See the Abstractor Notes section in the Heme DB under any of the chronic myelogenous leukemias for a further explanation of this disease process.
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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20100027 | Reportability: Is AIN III reportable if it arises in the perianal skin? See Discussion. | Physical exam states patient has a suspicious area of anal skin. Operative findings show a raised, suspicious lesion in the right perianal region. Our interpretation of the primary site would be skin and therefore not reportable. However, the final diagnosis on the pathology report indicates "AIN III/squamous cell carcinoma with focal areas suspicious for microinvasion. "SINQ #20041056 states that AIN III is reportable. | AIN III of the anus or anal canal (C210-C211) is reportable. AIN III (8077) arising in perianal skin (C445) is not reportable. | 2010 |