Report | Question ID | Question | Discussion | Answer | Year |
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20100007 | MP/H Rules/Histology--Melanoma: Regarding SINQ #20081044, when would you apply Rule H6 rather than Rule H5 for a cutaneous malignant melanoma given that you normally always have a specific cell type mentioned? | For cases diagnosed 2007 or later, Rule H6 is used when you do not have a specific cell type other than regressing melanoma, or malignant melanoma, regressing. If you have regressing melanoma with a specific cell type, apply rule H5. | 2010 | |
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20100089 | Primary site--Heme & Lymphoid Neoplasms: How is primary site coded when lymphoma is initially found in both lymph nodes and bone marrow, the pathology report is unavailable, and the physician only states that both areas are involved? See Discussion. | For many consultations and/or class 2 cases, the pathology report is not available to help determine the primary site. Should the primary site be automatically coded to C421 over C77_ when both are involved? The Abstractor Notes state the primary site can be either bone marrow or lymph nodes. The physician states only that both are involved. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Because both the bone marrow and LN are involved, code the primary site to C779 [lymph nodes, NOS] per Rule PH22. You are to code specific nodes if a specific region is specified; however, if no region is specified, code to lymph node, NOS [C779]). When you are having problems coding primary site, go to Module 7 Primary Site Rules for Lymphomas Only. See Rule PH26. It states that you code the primary site to bone marrow when ONLY the bone marrow is involved.
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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20100070 | Histology--Heme & Lymphoid Neoplasms: How is this field coded for a follicular lymphoma, grade 2 of 3, predominantly nodular? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code histology to 9691/3 [Follicular lymphoma, grade 2]. Nodular lymphoma is an obsolete term once used to describe follicular lymphoma. (See Appendix A, Table A3)
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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20100033 | Histology--Heme & Lymphoid Neoplasms: How is this field coded for a case described as follicular lymphoma, grade 3a/3 [9698/3], with focal areas of diffuse large B cell lymphoma [9680/3] (approximately 10%)? Does the term "focal" have the same significance in Heme cases as it does for solid tumors? See Discussion. |
Per rule PH11, "Code the primary site to the site of origin (lymph node region(s), tissue, or organ) and code the histology diffuse large B-cell lymphoma (DLBCL) (9680/3) when DLBCL and any other non-Hodgkin lymphoma are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow."
Should the focal diffuse large B cell lymphoma be ignored in this case and rule PH11 not be applied? To apply rule PH11, does the follicular lymphoma have to be NOS [9690/3] or does PH11 include all grades of follicular lymphoma [9695/3, 9691/3, 9698/3]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
First, you need to determine how many primaries are to be accessioned. Per Rule M4, abstract a single primary* when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location(s), such as the same lymph node or lymph node region(s), the same organ(s), and/or the same tissue(s).
Code the histology to 9680/3 [Diffuse large B cell lymphoma] per rule PH11 when DLBCL and any other non-Hodgkin lymphoma are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow. Follicular lymphoma (FL), which is a non-Hodgkin lymphoma, includes FL, NOS, FL grade 1, FL grade 2 and FL grade 3.
Focal, foci, and focus are not used in the hematopoietic rules, meaning that you DO NOT ignore histology terms described as focal, foci, or focus.
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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20100050 | Reportability--Colon: Would a carcinoid tumor, NOS, of the appendix with perineural or angiolymphatic invasion be reportable if there is no mention of malignancy in the pathology report? |
Carcinoid, NOS, of the appendix diagnosed in 2015 or later is reportable.
For cases diagnosed prior to 2015
Carcinoids of the appendix are reportable when they meet any of the following conditions.
Note that the implants/involvement must be designated as malignant. Many benign tumors will spawn implants that are also benign. If implants are benign, this is not a reportable tumor. |
2010 | |
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20100006 | MP/H Rules/Multiple primaries--Kidney: In a patient with a history of renal cell carcinoma, would a new primary be accessioned per Rule M10 for a soft tissue mass in the renal fossa not stated to be a metastasis but that was referred to as recurrent renal cell carcinoma, clear cell per the excision pathology report? See Discussion. |
This patient was diagnosed with clear cell carcinoma of the right kidney in 2003, treated with nephrectomy. The tumor was limited to the kidney. An FNA of the pancreas in 11/07 was consistent with metastatic renal cell carcinoma. In 2009 the patient was diagnosed with a right renal fossa mass by CT. The mass was excised on 8/26/09 and showed, "recurrent renal cell ca, clear cell." The path specimen was labeled as, "soft tissue, rt renal fossa." The original 2003 slides were not reviewed and the renal fossa mass was not described as being metastatic. If the renal fossa soft tissue mass is a new tumor, the MP/H rules for Other Sites directs you to code it as a new primary per rule M10 [Tumors diagnosed more than one (1) year apart are multiple primaries]. Would this be a new soft tissue tumor per rule M10? Or would this be a recurrence of the original kidney primary? |
For cases diagnosed 2007 or later: This is not a new primary. The patient has metastatic disease from the 2003 kidney primary. Clear cell carcinoma metastasized to the pancreas in 2007 and to the right renal fossa in 2009. |
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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20100057 | First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease? | Clobetasol is not cancer-directed treatment at this time.
Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides. |
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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20100107 | MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tumor described as "renal cell carcinoma, clear cell with rhabdoid features"? See Discussion. | Is the statement "with __ features" indicative of a specific type of renal cell carcinoma (that is not represented by a specific histology code) or a second histologic type? Per ICD-O, "malignant rhabdoid tumor" is coded 8963/3. "Rhabdoid" is not listed in Table 1 in the MP/H rules as a specific type of renal cell carcinoma. |
Rhabdoid features occur in about 5% of all renal cell cancers and indicate a more aggressive tumor. Per WHO, these tumors comprise approximately 2% of all pediatric tumors with a median diagnosis age of 1-2 years old. This diagnosis is highly suspect in patients over age 3. Most previously reported rhabdoid tumors over age 5 have subsequently proven to be renal medullary carcinomas.
For cases diagnosed 2007 or later, if the patient in this case is a child, apply Kidney Rule H7 and code histology to 8963/3 [malignant rhaboid tumor]. Otherwise, we strongly suggest you consult with the pathologist to determine if this is truly a rhabdoid rather than a medullary tumor. |
2010 |