Report | Question ID | Question | Discussion | Answer | Year |
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20110046 | MP/H Rules/Multiple primaries--Stomach: If there is no statement of recurrence, how many primaries are to be abstracted when a patient is diagnosed with multiple gastric carcinoid tumors between 12/2003 and 3/2009? See Discussion. |
Are the multiple primary rules applicable when a patient has multiple gastric carcinoid tumors? The patient was diagnosed with carcinoid tumors starting in 12/2003 through 3/2009. According to the 2004 SEER Manual, rule 5, if a tumor with the same histology is identified in the same site at least two months after the original diagnosis, this is a separate primary. The physician does not indicate that the pre-2007 carcinoid tumors were recurrent. The patient does not have familial polyposis syndrome. Should each of the following tumors be a separate primary? 12/2003 - Gastric Polyp Removal - Path: Gastric carcinoid tumor 05/2004 - Stomach body polyp removal - Path: Carcinoid Tumor (endocrine cell tumor) 09/2004 - Single polyp in body removal - Path: Gastric carcinoid 03/2005 - Multiple gastric body polyps removed - Path: Carcinoid tumor 07/2005 - 3 small polyps in fundus removal - Path: Carcinoid tumor 02/2007 - Localized nodularity in lesser curvature - Path: Carcinoid (neuroendocrine) tumor 03/2009 - Stomach body polypectomy - Path: Carcinoid tumor |
Code as a single primary. The histology is carcinoid. Our expert pathology consultant replied as follows: "This patient clearly has a condition driving the proliferation of neuroendocrine cells. Possibilities include hypergastrinemia from a gastrinoma or from response of antral gastrin cells due to achlorhydria from long standing chronic atrophic gastritis, or multiple endocrine neoplasia (MEN1) syndrome (genetically driven). How should these cases be coded given we do not have a way to code the inciting situation. (I suspect the gastroenterologist knows what it is, but we haven't obtained that information.) We do not have an ICD-O-3 code for the underlying condition, MEN1 or hypergastrinemia. Therefore, the only choice is to code the resulting tumor, carcinoid [8240/3]." |
2011 |
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20110054 | First course treatment/Other therapy--Heme & Lymphoid Neoplasms: Is a transfusion coded as first course treatment for multiple myeloma? See Discussion. | Per the SEER Manual, First Course for Leukemia and Hematopoietic Diseases definitions, Other Hematopoietic states that transfusions are coded as "other" in the Other Treatment fields. Does this mean that a transfusion for chemotherapy-related anemia is coded as treatment for patients with multiple myeloma? | Do not code transfusions as treatment. According to hematopoietic specialty physicians, transfusions are given for such a variety of reasons (anemia, etc.) and should not be coded as other treatment. | 2011 |
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20110153 | Reportability--Heme & Lymphoid Neoplasms: Is macrocytic anemia reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Macrocytic anemia is not reportable. Anemia refers to a condition of having a low count of red blood cells. The term "macrocytic" refers to the enlarged size of the red blood cells. Macrocytic anemia is usually caused by vitamin deficiencies, alcohol use, medications or thyroid disorders.
See 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. |
2011 | |
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20110074 | First course treatment/Date therapy initiated--Breast: How is the Date of Initiation of Hormone Therapy field coded when a patient undergoes "Tamoxifen blunting" to achieve better MRI imaging after a biopsy but prior to definitive surgery which is followed by adjuvant Tamoxifen therapy? See Discussion. | Patients are prescribed two weeks of "Tamoxifen blunting" to achieve better MRI imaging after biopsy confirmation of an ER/PR positive breast carcinoma. The Tamoxifen is subsequently discontinued and the patient has definitive surgery. Following surgery, maintenance Tamoxifen is initiated. Which date should be recorded for the Date of Initiation of Hormone Therapy field? Is it the first date when Tamoxifen blunting started or the post-surgical date when maintenance Tamoxifen is initiated? | Use the post-surgical start date of maintenance Tamoxifen to code the Date of Initiation of Hormone Therapy field. The actual hormone treatment begins after surgery when Tamoxifen blunting was performed. The low dose administered prior to surgery does not affect the cancer. | 2011 |
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20110061 | Primary site/Histology--Heme & Lymphoid Neoplasms: Should the primary site and histology codes be updated when a patient with a history in 2005 of a bone marrow diagnosis of chronic lymphocytic leukemia later presents in 2010 with lymph node biopsy diagnosis of small B-cell lymphocytic leukemia? |
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 a single histology. Code histology to 9823/3 [CLL/SLL]/ The distinction of CLL vs. SLL cannot be made on bone marrow biopsy in isolation. The pathologist cannot make a diagnosis of CLL vs SLL without having peripheral blood counts available for review. If the patient was treated for CLL in the past, that may alter the peripheral counts seen in 2010 (e.g., lymphocytosis). The distinguishing feature is peripheral lymphocytosis in CLL (not seen in SLL). The disease looks the same and both will often have bone marrow involvement and lymph node involvement. If the patient had true CLL in 2005, then any subsequent lymph node (or other) biopsy consistent with CLL/SLL remains consistent with the original diagnosis of CLL. I would not change the original CLL code. I agree with the previous response. We have to assume the 2005 diagnosis included a peripheral blood supporting that diagnosis. Otherwise, CLL and SLL look the same in nodes and marrow. The interplay between the two "diseases" is expected. This is why they are considered a single disease. 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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20110147 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How is the histology coded when no bone marrow examination is performed but the peripheral blood flow cytometry listed several differential diagnoses and the physician states the diagnosis is small lymphocytic lymphoma? See Discussion. | The peripheral blood flow cytometry results state, "findings consistent with a small mature B-cell neoplasm, differential - marginal zone lymphoma, lymphoplasmacytic lymphoma, and atypical CLL." The physician states the diagnosis is "SLL." No bone marrow examination or CT scan was done to assess whether the patient had lymphadenopathy.
Per Rule PH5, if the diagnosis is B-cell CLL/SLL and peripheral blood is involved, the histology is coded to B-CLL/SLL [9823/3]. Should the primary site and histology be coded to bone marrow [C421] and CLL/SLL [9823/3] per Rule PH5 despite the physician's diagnosis of SLL [9670/3]? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is a single primary and the primary site and histology is coded as bone marrow [C421] and CLL/SLL [9823/3]. The code 9670/3 [malignant lymphoma, small B lymphocytes, NOS] used for SLL is now obsolete.
Per the Abstractor Notes section in the Heme DB indicates that SLL is, "usually associated with CLL and coded CLL/SLL 9823/3. Small lymphocytic lymphoma (SLL) is almost identical to CLL. A somewhat arbitrary distinction is drawn between them based on the relative degree of marrow and nodal involvement and the numbers of circulating cells."
Per the Definition section in the Heme DB it states that, "CLL by definition involves blood and bone marrow at time of diagnosis." Check the PRIMARY SITE and MODULE RULE sections that indicate the primary site is C421, Rule PH5. Per this rule, code the primary site bone marrow (C421) and code the histology B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) [9823/3] when the diagnosis is B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) AND peripheral blood is involved (the bone marrow may also be involved).
This may appear to contradict the physician's diagnosis, but the 2008 WHO no longer codes CLL and SLL as separate neoplasms, rather one neoplasm, CLL/SLL, which reflects the actual neoplastic process. Those patients with SLL usually manifest CLL during the neoplastic process and those patients with CLL usually manifest SLL during the neoplastic process. WHO recommends coding to CLL/SLL rather than coding two primaries when the other neoplasm manifests.
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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20110119 | MP/H Rules/Primary Site--Bladder: How is the primary site coded when a patient is diagnosed with synchronous, non-invasive papillary urothelial carcinomas of the bladder and renal pelvis? See Discussion. | This patient was diagnosed with at least three non-invasive papillary urothelial carcinomas of the bladder in 11/09. The patient subsequently underwent a complete nephroureterectomy in 12/09 showing a single non-invasive papillary urothelial carcinoma of the renal pelvis.
Per the MPH Rule M8, this is a single primary. Is the primary site to be coded C659 [renal pelvis] or C689 [urinary system, NOS]? |
Assign code C68.9 when multiple tumors are found in multiple urinary sites at the same time. | 2011 |
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20110116 | MP/H/Histology--Lung: What is the histology code for "heterologous biphasic sarcomatoid carcinoma of the lung with prominent rhabdomyoblastic and adenoca differentiation"? |
The expert pathologist recommends coding histology to 8980/3 [Carcinosarcoma] for this combination histology. Expert consultation: The designation "carcinosarcoma" is given when the pathology shows differentiation in both the sarcomatous (rhabdomyoblastic) and carcinomatous (adenoca) elements. This is emphasized in the path for this case with the term "biphasic." The term "heterologous" mean that the sarcomatous component is of a type not normal to lung. Rhabdomyoblastic means skeletal muscle differentiation. Because skeletal muscle is not normally found in lung it is heterologous. If it were smooth muscle, it would be homologous because smooth muscle is found in lung (as a part of the bronchi). |
2011 | |
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20110104 | Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C421 [bone marrow] or C770-C779 [lymph nodes] for an adult T-cell leukemia/lymphoma [9827/3] that presented with a positive bone marrow biopsy and involvement of lymph nodes and the lung? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph..
Code the primary site to the involved lymph nodes [C770-C779]. Per Rule PH 8, it indicates you are to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. Note 2 further states that the bone marrow may or may not be involved. If the bone marrow is involved, code this information in the CS Extension field.
Per the Abstractor Notes section in the Heme DB, this is a systemic disease with widespread lymph node involvement as well as involvement of the peripheral blood. In addition, systemic involvement of extranodal sites (including lung) are often 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. |
2011 | |
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20110118 | Reportability--Colon: Is a polypectomy that is suspicious for invasive adenocarcinoma followed by a partial colectomy with no residual neoplasm reportable? See Discussion. |
08/28/2009 Cecum biopsy showed an adenomatous polyp with focal areas suspicious for invasive adenocarcinoma. SINQ 20071060 states a suspicious biopsy that is disproven by a subsequent surgical procedure is not reportable. That does not seem to apply in this case because the patient had a suspicious finding on a surgical procedure (polypectomy), followed by a second surgical procedure that was negative. Is it possible that the polypectomy removed the entire tumor and the suspicious diagnosis should be reported? |
This case is reportable. It is possible that the polypectomy removed the entire tumor. Invasive carcinoma in a polyp does not mean that is has invaded the stalk of the polyp. If the stalk is not invaded, all of the cancer may have been removed by a polypectomy. |
2011 |