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20110010 | Multiple primaries--Heme & Lymphoid Neoplasms: Is a recently diagnosed granulocytic sarcoma followed by a diagnosis of AML 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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20110125 | MP/H Rules/Histology--Lung: What would the histology code be for a wedge bx of the left lung, lower lobe, that was read out as well differentiated adenocarcinoma with micropapillary features? | Code papillary adenocarcinoma 8260/3. The ICD-O-3 codes for micropapillary have specific associations such as ductal, serous or transitional. None of those associations fit lung primaries. | 2011 | |
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20110014 | MP/H Rules/Histology--Corpus Uteri: Which MP/H rule applies in coding histology for a "high grade endometrioid adenocarcinoma with squamous differentiation (adenosquamous carcinoma)"? See Discussion. | Is the pathology describing a specific histology, adenosquamous carcinoma [8560/3]? Or is this a combination/mixed histology code per rule H16? The Rule H16 instruction is to code a mixed histology code, 8323/3 [mixed cell adenocarcinoma] from Table 2 when two or more of the histologies are present (i.e., endometrioid and squamous in this case). | For cases diagnosed 2007 or later: Endometrioid adenocarcinoma with squamous differentiation is coded to 8570 [Adenocarcinoma with squamous metaplasia].
The following row needs to be added to Table 2 in order to be able to correctly use the MP/H rules to reach this conclusion.
Column 1: Endometrioid adenocarcinoma Column 2: Squamous metaplasia Squamous differentiation Column 3: Adenocarcinoma with squamous metaplasia Column 4: 8570
The change will be made in the next revision of the rules. |
2011 |
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20110006 | Reportability--Heme & Lymphoid Neoplasms: Are all stages of CLL reportable? See Discussion. | If a physician notes the patient has Stage 0 CLL (increasing leukocytosis), is this reportable? CLL Stage is not mentioned in the Hematopoietic Manual or Database, but internet research reveals CLL has five stages (Stage 0, I, II, III, and IV). | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Yes. All stages of CLL are reportable. CLL has a unique staging system. The Heme DB and Manual do not address the issue of stage. Therefore, stage information is not reported in the Abstractor Notes section of the Heme DB.
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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20110018 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted for a case with a history of follicular lymphoma, grade 2 and a subsequent splenectomy diagnosis of diffuse large B-cell lymphoma? See Discussion. |
The patient was treated over a period of time for follicular lymphoma, grade 2. The oncologist thought the spleen was congested and removed it. The diagnosis was DLBCL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.. This case is accessioned as two primaries per Rule M10 which states to abstract multiple primaries 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 first primary is follicular lymphoma, grade 2 [9691/3] and it is a chronic neoplasm. The second primary is diffuse large B-cell lymphoma (DLBCL) [9680/3] and it is an acute neoplasm. 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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20110043 | MP/H Rules/Histology--Breast: Which specimen should be used to code histology when a core biopsy revealed an unknown sized DCIS, comedo type and the partial mastectomy specimen showed only a 2mm focus of DCIS, solid pattern? See Discussion. | Should the histology be coded from the needle core biopsy or the partial mastectomy specimen? Patient had a needle core biopsy that revealed DCIS, comedo type, cribriform pattern, no tumor size given. Subsequently, the patient had a partial mastectomy which revealed DCIS, noncomedo type, solid pattern, largest focus of DCIS was 0.2cm.
Should the histology code be 8501/2 or 8230/2? The microscopic description on the partial mastectomy says that the previous core needle biopsy site revealed several foci of DCIS. |
Code the histology from the most representative specimen (the specimen with the MOST tumor tissue). Compare the size of tumor in the two specimens. If the tumor size is not available for both procedural specimens, code histology from the mastectomy specimen rather than the needle biopsy specimen. | 2011 |
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20110028 | MP/H Rules/Histology--Thyroid: How many primaries and what histology(ies) are coded when the pathology report shows a, 1.9 cm Hurthle cell carcinoma, probable follicular variant of papillary carcinoma, with Hurthle cell features and a 2 mm focus of follicular variant, papillary carcinoma? See Discussion. | Right lobectomy pathology report final diagnosis states: 1.9 cm Hurthle cell carcinoma (see comment). Comment: histologic diagnosis Hurthle cell carcinoma, probable follicular variant of papillary carcinoma with Hurthle cell features. Subsequent left lobectomy one week later showed a 2 mm microscopic focus of follicular variant of papillary carcinoma, encapsulated.
None of the rules seems to fit this scenario. The number of primaries reported for this case depends on the histology coded for each tumor. Does Rule M6 (Follicular and papillary tumors in the thyroid within 60 days of diagnosis are a single primary.) or M17 (Tumors with ICD-O-3 histology codes that are at the first (xxx), second (xxx) or third (xxx) number are multiple primaries.) apply? Does the case represent a single primary because both are papillary/follicular tumors or two primaries because one is Hurthle cell carcinoma, and one is papillary/follicular carcinoma (different histology at second digit)?
To code the histology for the larger tumor in the right lobe, which rule do we apply? Rule H11 (single histology of Hurthle cell carcinoma [8290] per path final diagnosis), H15 (tumor has both follicular and papillary carcinoma [8340], per path comment), or H17 (numerically higher code for 8340 because there is both Hurthle cell and papillary/follicular carcinoma)? |
Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary.
The Hurthle cell carcinoma is a synonym for follicular carcinoma according to the WHO. See page 67 of the 2004 WHO Classification of Tumours of Endocrine Organs. The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules manual. For a thyroid primary, use the Other Sites MP rules under one of the three formats (i.e., flowchart, matrix or text) to determine the number of primaries because the thyroid does not have site specific rules.
Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.
. Follicular and papillary tumors in the thyroid within 60 days of diagnosis are a single primary. The patient has a tumor in each lobe of the thyroid with the same histology. Abstract a single primary for this patient.
Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.
Start with the SINGLE TUMOR: INVASIVE ONLY module, Rule H8. The rules are intended to be reviewed in consecutive order within the module from Rule H8 to Rule H18. You stop at the first rule that applies to the case you are processing.
. Code follicular and papillary carcinoma of the thyroid to papillary carcinoma, follicular variant (8340). Use the comment to code the histology for the right lobectomy. "Probable" is an acceptable ambiguous term to use for coding histology. (See the Ambiguous Terms Used to Code Histology section of the General Instructions in the MP/H manual.) |
2011 |
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20110055 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted for a bone marrow biopsy diagnosis of "acute myeloid leukemia (non-M3 type; favor FAB M1), probably arising in myelodysplastic syndrome;" and flow cytometry studies performed the same day were consistent with acute myeloid leukemia? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Ambiguous terminology is NOT used to determine histology for hematopoietic or lymphoid neoplasms. Therefore, the comment that the AML is "probably" arising in myelodysplastic syndrome is not used to determine the histology code. The term "favor" is also an ambiguous term and cannot be used to code histology.
This is a single histology per M2, abstract a single primary when there is a single histology. The histology is coded to 9861/3 [acute myeloid leukemia, NOS]
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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20110004 | MP/H Rules/Histology--Breast: Which MP/H rule applies when coding the histology field for a tumor described as a "metaplastic carcinoma, adenosquamous and spindle cell type"? See Discussion. | Per path comment: "The neoplasm is composed of adenosquamous carcinoma which merges with spindle cell carcinoma. The cystic component shows a mixed squamous and ductal epithelial lining which shows cytologic atypia and mitotic activity and can be seen to merge with invasive carcinoma. The features suggest the possibility that the tumor may have arisen from a sclerosing and cystic papilloma with squamous metaplasia, although a clearly benign component is not evident."
Would MP/H rule H19 apply based on the pathology report comment resulting in histology for the case being coded to 8255 [adenocarcinoma with mixed subtypes]? Or, would MP/H rule H14 apply based on the final diagnosis resulting in histology for the case being coded to 8575 [metaplastic carcinoma] because adenosquamous and spindle cell are not specific types of metaplastic carcinoma? |
This is a metaplastic carcinoma as stated in the path diagnosis. Rule H14 applies. Assign code 8575/3. According to the WHO Classification, metaplastic carcinoma is a general term for a group of neoplasms characterized by a mixture of adenocarcinoma with dominant areas of spindle cell, squamous, and/or mesenchymal differentiation.
Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the histology for this case. Code histology to 8575/3 [metaplastic carcinoma] as stated in the pathology diagnosis.
Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histo rules determine histology for the case.
Go to the SINGLE TUMOR: INVASIVE CARCINOMA ONLY module. The rules are intended to be reviewed in consecutive order within the module from Rule H10 to Rule H19. You stop at the first rule that applies to the case you are processing.
Code the histology when only one histologic type is identified. According to the WHO Classification, metaplastic carcinoma is a general term for a group of neoplasms characterized by a mixture of adenocarcinoma with dominant areas of spindle cell, squamous, and/or mesenchymal differentiation. |
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 |
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