Report | Question ID | Question | Discussion | Answer | Year |
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20110070 | MP/H Rules/Histology--Endometrium: How is histology coded when clear cell adenocarcinoma [8310/3] is stated to involve a "1.5 cm endometrial polyp"? See Discussion. | The CAP formatted pathology report histology field states, "Clear cell adenocarcinoma, NOS 98310/3)" and the tumor size comment field states, "Carcinoma involves a 1.5 cm endometrial polyp." Does rule H11 apply? Is the histology coded to clear cell adenocarcinoma [8310/3] because this is one histologic type identified in the CAP formatted histology field? Or should rule H12 apply and the histology coded as clear cell adenocarcinoma arising in a polyp [8210/3]? Or should we code the higher histology per rule H17 apply because clear cell adenocarcinoma and adenocarcinoma in a polyp are two specific histologies?
For colon primaries, whether or not the tumor arose in a polyp is quite important. Is this also the case for primaries listed in the Other Sites category? |
Code histology to 8310/3 [clear cell adenocarcinoma]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later.
The following steps are used to determine the histology code:
Open the Multiple Primary and Histology Coding Rules manual. For an endometrial primary, use the Other Sites Histo rules to determine the histology code because endometrium does not have site specific rules.
Go to the SINGLE TUMOR: INVASIVE ONLY module, which starts at Rule H8.
. Code clear cell adenocarcinoma [8310/3] because only one histologic type is identified. |
2011 |
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20110078 | MP/H Rules/Histology--Bladder: What is the histology code for "high-grade urothelial carcinoma, plasmacytoid variant"? See Discussion. | Per the MP/H Manual, Urinary Equivalent Terms & Definitions, Table 1, plasmacytoid is a specific type of Urothelial/Transitional Cell Tumor. What is the correct histology, and rule used, when a bladder resection pathology report states, "high-grade urothelial carcinoma, plasmacytoid variant"? | Code the histology to 8082/3 [urothelial carcinoma, plasmacytoid].
The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later. Unfortunately, in this case there is no current rule that directs you appropriately to Table 1 from Rule H7 to find this histology combination. We need to add an example under Rule H7 that instructs you to "See Table 1" for an urothelial carcinoma diagnosis that mentions a more specific cell type (e.g., plasmacytoid). We will add a reference to Table 1 in Rule H7 in the updates to MP/H Rules. |
2011 |
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20110002 | Surgery of Primary Site--Penis: How is CO2 laser treatment coded for penile cancer? | Assign code 14 [laser] for CO2 laser treatment given for primary penile cancer. The CO2 is the method used to deliver the laser. | 2011 | |
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20110131 | Reportability--Heme & Lymphoid Neoplasms: Does a change in the 2008 diagnosis from refractory anemia with excess blasts (RAEB I) to a subsequent diagnosis of RAEB II in 2011 need to be reported to the state if the Hematopoietic Database indicates these diagnoses represent the same primary? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
RAEB I and RAEB II [9983/3] have the same histology code per the Heme DB. They are synonyms. Per Rule M2 one abstracts a single primary when there is a single histology. There is no change to report to the state regarding histology.
The I and II designators indicate the number of blasts in the bone marrow. In RAEB, the number of blasts measures the severity of the disease and is also a predictor of the chance of a genetic transformation to AML.
In this case, the patient's disease has progressed to a more severe phase - similar to a solid tumor progressing from Stage II to Stage III.
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. |
2011 | |
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20110108 | Primary site--Heme & Lymphoid Neoplasms: What is the primary site for a bone marrow biopsy positive for systemic mastocytosis that also involves the spleen and lymph nodes with associated leukocytosis, mild anemia and thrombocytopenia? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule PH30, one is to use the to determine the primary site and histology when rules PH1-PH29 do apply. Code the primary site to C421 [bone marrow] because that is the only site listed under the Primary Site section of the Heme DB.
Under the Abstractor Notes section in the Heme DB, it indicates that the bone marrow is always involved, and the white and red pulp of the spleen may be involved with systemic mastocytosis. This is how this patient presented; therefore, the bone marrow is the primary site. The spleen is secondarily involved because the spleen cleanses the blood and the neoplastic cells have infiltrated the red and white pulp of the spleen. The same is true for the lymph nodes. Although the lymph nodes are rarely involved, they may be involved when the patient has systemic mastocytosis.
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. |
2011 | |
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20110008 | MP/H Rules/Histology--Vulva: How is histology coded for VIN III with focal invasion? See Discussion. | Per SINQ 20000442, the histology for CIN III with microinvasion is coded to 8077 [squamous intraepithelial neoplasia, grade III] per the matrix system rules, with a behavior code of /3 [malignant]. Coding the histology to 8077/3 per the matrix principle causes IF25_3 and MorphICDO3_P1 edits to fail. Flagging the first error resolves any reporting issue. How is the MorphICDO3_P1 edit resolved? | Assign 8076/3 [squamous cell carcinoma, microinvasive] for VIN III with focal invasion. This applies to all terminologies listed under 8077/2. The SINQ question from 2000 will be retired. | 2011 |
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20110024 | MP/H Rules/Histology--Breast: How is histology coded, and which MP/H rule applies for a diagnosis of ductal carcinoma in situ with clear cell features? See Discussion. | None of the histology rules for in situ breast seem to apply to this case:
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For cases diagnosed 2007 or later: Code 8523/2 [intraductal carcinoma mixed with other types of in situ carcinoma]. Rule H6 should apply to this case.
The wording in the Rule H6 needs to be clarified to handle a case of intraductal carcinoma with one or more subtypes that are not ductal. This will also require a modification to Table 3. A row needs to be added to the table labeled, "Intraductal and one or more of the histologies in Column 2." The Column 3 text for the newly added row would read, " Intraductal mixed with other types of carcinoma." The appropriate histology code to be reported per Column 4 would be 8523/2. This will be done in the next revision of the rules. |
2011 |
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20110092 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned when a pathology specimen reveals one tumor with invasive mucinous carcinoma [8480/3] and a second tumor with in situ ductal carcinoma, solid and cribriform types [8523/2]? |
For cases diagnosed 2007 or later, accession two primaries, invasive mucinous carcinoma [8480/3] and in situ ductal carcinoma, solid and cribriform types [8523/2]. The steps used to arrive at this decision are: Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor (8480/3 and 8523/2). Start at the MULTIPLE TUMORS module, rule M4. These tumors have ICD-O-3 histology codes that are different at the second (xxx) and third (xxx) number and are, therefore, multiple primaries. |
2011 | |
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20110010 | Multiple primaries--Heme & Lymphoid Neoplasms: Is a recently diagnosed granulocytic sarcoma followed by a diagnosis of AMLÂ two primaries? See Discussion. |
6/10/10 Axillary lymph node biopsy was compatible with AML. The physician noted that the patient was diagnosed with granulocytic sarcoma [9930/3] in the axillary node. 6/15/10 Bone marrow biopsy compatible with AML FAB M1 [9873/3]. After induction, a second bone marrow biopsy on 6/30/10 shows persistent/refractory AML. The physician noted that the second biopsy is compatible with AML FAB M7 [9910/3]. Is the granulocytic sarcoma a chronic form of the disease? If so, do we have one primary diagnosed 6/10/10 with primary site coded to C42.1 and histology coded to 9873/3? Does the second biopsy on 6/30/10 represent the same primary even though the persistent disease is now FAB M7? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Granulocytic sarcoma does not transform into AML. Per the Abstractor Notes section in the Heme DB under the term "granulocytic sarcoma," it indicates that "Myeloid sarcoma (also known as granulocytic sarcoma) may occur de novo; it may precede or coincide with AML, or represent an acute blastic transformation of myelodysplastic syndromes." This means that when granulocytic/myeloid sarcoma is seen with AML, it represents a solid manifestation of the systemically involved AML. In other words, it is all the same disease process (coded to AML) if it occurs simultaneously (i.e., at the same time or within 21 days of on another). Apply Rule M3 to this case which states to abstract a single primary when a sarcoma is diagnosed simultaneously or after a leukemia of the same lineage. Code the primary site to C421 [bone marrow] with histology coded to 9873/3 [acute myeloid leukemia, M1]. The FAB category is an older classification that is seldom used. Changes from FAB 1 to FAB 7 do not constitute a new 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. |
2011 |
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20110080 | Grade--Kidney, renal pelvis: How is this field coded for a non-invasive high grade papillary urothelial carcinoma of the renal pelvis? See Discussion. | Per instructions in the 2010 SEER Manual, Appendix C, Coding Guidelines for Bladder, "Code grade 9 (unknown) for non-invasive urothelial (transitional) tumors." The Coding Guidelines listed under Renal Pelvis, Ureter are only for Kidney [C649]. Do the grade instructions under bladder apply to ALL non-invasive urothelial tumors, or are we to use the kidney grading instructions to code grade for renal pelvis and ureter malignancies? | Code grade to 4 [high grade]. Follow the instructions in the main part of the 2010 SEER Manual under the data item Grade (pages 73 - 76). There are no specific instructions for coding grade for renal pelvis. Apply the general instructions in the absence of site-specific instructions. | 2011 |