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Report Produced: 10/19/2024 06:16 AM

Report Question ID Question Discussion Answer Year
20100101 Multiple primaries--Heme & Lymphoid Neoplasms: Is a 10/2010 diagnosis of accelerated phase of CML following a 4/2010 diagnosis of blast phase CML a new primary? See Discussion.

Patient was diagnosed in the blast phase of CML on a 4/2010 bone marrow biopsy. Pt failed Gleevec and progressed to the accelerated phase of CML in 10/2010.

Is this a single primary? This is not addressed in the hematopoietic rules. If this is a multiple primary, what rule should be applied?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Per Rule M2 this is a single primary because there is only a single histology represented for this case.

Under the Alternate Names section in the Heme DB for chronic myelogenous leukemia (CML), NOS [9863/3 and chronic myelogenous leukemia, BCR-ABL1 positive [9875/3] it indicates CML-blast phase, CML-accelerated phase and CML-chronic phase are all synonyms for CML, NOS. Any combination of these terms diagnosed represents one disease process. The Gleevec was given to prevent or delay progression to the accelerated phase.

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
20100031

First course treatment--Anus: Is the topical application of trichloroacetic acid to an anal condyloma with AIN III first course treatment coded to 10 [Local tumor destruction, NOS] in the Surgery of Primary Site field?

Code the trichloroacetic acid treatment of reportable AIN III in the "Other Therapy" field. Assign code 1 [Other].

 2010
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
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
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
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
20100048 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a patient diagnosed with Langerhans cell histocytosis/eosinophilic granuloma involving both the seventh rib and the right temporal bone? See Discussion. Patient was diagnosed with Langerhans cell histiocytosis/eosinophilic granuloma following a biopsy of the seventh rib on 3/22/10. On 4/13/10 the patient had a right external ear canal mass (right temporal bone) biopsy with same diagnosis. Should the primary site be coded to bone, NOS [C419]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Per Rule PH30, use the Heme DB to determine the primary and code it to bone, NOS [C419]. Langerhans cell histiocytosis can occur as a solitary lesion, multifocal lesions, or multisystem disease. In this case, the patient has multifocal disease of the bone. The abstractor notes in the Hematopoietic DB were used as a reference for this answer.

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
20100018 Reportability/Heme & Lymphoid Neoplasms--Hematopoietic, NOS: Is light chain disease reportable if it is treated with chemotherapy agents? See Discussion.

A patient was diagnosed in 2010 with light chain disease based on SPEP and urine testing. Bone marrow aspiration and biopsy were done. Flow cytometry, cytogenetic studies and FISH for plasma cell disorders are all normal. Medical oncologist states diagnosis is light chain disease. Patient was started on Revlimid, dexamethasone and Velcade.

In reviewing the case reportability instructions, this seems to fall under Instruction 1, note 1. Immunoglobulin deposition disease, preferred term for light chain disease, is coded as 9769/1. This is normally a non-reportable diagnosis, but the patient was given cancer-directed treatment. Would this case be accessioned using the above morphology code and primary site of bone marrow [C42.1]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

This case is not reportable. The histology is 9769/1 [light chain disease] in the Heme DB.

Light chains are produced in neoplastic plasma cells (multiple myeloma) and are called Bence-Jones proteins. The physician did the cytogenetic studies and FISH to rule out plasma cell disease. 50-60% of people with Light-chain deposition disease (LCDD) have an associated lymphoproliferative disorder, most commonly multiple myeloma. The remaining patients develop LCDD in the setting of progression of monoclonal gammopathy of unknown significance (MGUS) with no evidence of neoplastic plasma cell proliferation. This patient falls in this category, MGUS, which is not reportable.

2010
20100104 Grade--Heme & Lymphoid Neoplasms: Is the phrase "aberrant T-cell expression" enough to code the grade field to T-cell when the final diagnosis on the pathology report is "AML with aberrant T-cell antigen expression"? Yes. Code grade to 5 [T-cell]. The T cell receptor, or TCR, is a molecule found on the surface of T lymphocytes (or T cells). 2010
20100082 Ambiguous terminology/Reportability--Heme & Lymphoid Neoplasms: Should a case be accessioned as MDS, NOS when a consult uses ambiguous terminology (e.g., probable MDS) to describe the disease process and the bone marrow does not confirm the consult diagnosis? See Discussion. A patient is stated to have "probable MDS" by a hematology oncologist consult during an admission. A bone marrow biopsy was also performed during this admission, the final diagnosis on the pathology report is, "anemia and thrombocytopenia." The patient was not seen again by a hematology oncologist; however the patient's cardiology states, "BM biopsy was not clear whether this is MDS or another etiology."

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

This is not reportable. In effect, the original diagnosis was a rule/out MDS diagnosis. The bone marrow biopsy performed as part of the initial workup, proved that rule/out diagnosis was not valid. The subsequent statement confirms the diagnosis is not clear.

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