Report | Question ID | Question | Discussion | Answer | Year |
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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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20110040 | Reportability--Melanoma: Is a pathology report with a final diagnosis stating only non-reportable terms, followed by a re-excision pathology report that indicates "no residual melanoma" reportable? See Discussion. |
Is a case reportable if the final diagnosis on an initial pathology report states a non-reportable term (e.g., evolving melanoma, early/evolving melanoma or melanocytic nevus) and followed by a subsequent re-excision pathology report stating there is "No residual melanoma"? There is no mention in the clinical history on the subsequent pathology report that the diagnosis was thought to be melanoma following the first procedure. The first mention of the reportable term was in the final diagnosis of the subsequent pathology report that stated "no residual melanoma." |
No. This case is not reportable based on the information provided. "No residual melanoma" is not diagnostic of a reportable neoplasm. We recommend that you try to obtain more information from the clinician/pathologist for this case due to the poor documentation. Check for any additional resection performed. |
2011 |
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20110013 | MP/H Rules/Histology--Testis: Which MP/H rule applies in coding the histology described as a "malignant mixed germ cell tumor with the following features: Histologic type: embryonal carcinoma (97%) and yolk sac tumor (3%)"? See Discussion. |
Per MP/H rule H16, code the appropriate combination/mixed code (Table 2) when there are multiple specific histologies or when there is a non-specific histology with multiple specific histologies. The combination embryonal carcinoma and yolk sac tumor is not listed in Table 2, even though the pathology report indicates this is a mixed germ cell tumor.
Should rule H17 be applied and the numerically higher histology code be used? |
As of 2016: Code histology to 9085/3 [mixed germ cell tumor]. Combine 9065 and 9085 for analysis purposes. |
2011 |
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20110047 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a patient is diagnosed with NHL, large B-cell lymphoma in 3/2010 followed by a "recurrence of previously diagnosed" NHL per a 12/2010 liver biopsy? See Discussion. |
Are there timing rules related to the comparison of slides from a subsequent hematopoietic primary diagnosis to the slides from the original hematopoietic primary diagnosis that impact the number or primaries reported? For example, how many primaries are reported for a patient was diagnosed in 3/2010 with large B-cell lymphoma who underwent 7 rounds of chemo. Per 10/2010 PET scan, there was no evidence of disease. In 12/2010 a liver biopsy revealed, "features consistent with recurrence of previously diagnosed non-Hodgkin lymphoma." The pathologist did not compare slides to the original, but several immunoperoxidase stains were done to obtain the final diagnosis in 12/2010. Does timing or comparison to the original slides matter for Heme & Lymphoid Neoplasms? Is a comparison of slides needed as required for solid tumor "recurrences"? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. This case should be accessioned as one primary per Rule M15, 9680/3 [diffuse large B-cell lymphoma]. Per Rule M15 one is 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 12/2010 liver diagnosis of NHL, NOS [9591/3] is the same primary per the Multiple Primaries Calculator. There are no timing rules for lymphoma other than rules M8-M13 which deal with the timing of chronic and acute diagnoses. 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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20110065 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a skin (right thigh) biopsy is consistent with mycosis fungoides (cutaneous T-cell lymphoma)? See Discussion. | Applying rule M15 (multiple primaries calculator) indicates this is two primaries. Is this correct? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C447 [skin of lower limb] and code histology to 9700/3 [mycosis fungoides]. he pathologist wrote in parentheses that this was cutaneous (i.e. primary site is skin) and that it is a T-cell lymphoma (mycosis fungoides is a T-cell lineage). So the parenthetical statement was not a separate diagnosis; rather a general classification of the mycosis fungoides. "CTCL" is listed under the Alternate Names section of the Heme DB. CTCL is an abbreviation for cutaneous T-cell lymphoma. CTCL is a synonym for mycosis fungoides. This is a single primary per M2 which states to abstract a single primary when there is a single histology.
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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20110150 | Ambiguous Terminology--Heme & Lymphoid Neoplasms: As ambiguous terminology is not used to code histology for Heme & Lymphoid primaries, how is the histology coded when a patient has a clinical diagnosis of "consistent with a myelodysplastic syndrome"? See Discussion. | The physician states the "patient's clinical picture certainly is most consistent with MDS." Several FISH probes were performed on peripheral blood, specifically looking for the 5q minus syndrome as well as other molecular rearrangements to suggest or confirm MDS. These studies came back as normal. The initial bone marrow also came back negative. The physician then states, "The suspicion was that this represented a myelodysplastic syndrome despite the normal cytogenetics. Additional studies performed on the date of the clinic visit included the FISH for the 5q minus syndrome as well as CD59 to exclude PNH. Both of these were negative. Therefore, at this juncture, the patient has a macrocytic anemia not yet requiring transfusion support with a normal white count and an elevated platelet count and a hypercellular bone marrow. This is certainly consistent with a myelodysplastic syndrome."
Per coding guidelines, ambiguous terminology is not used to code histology, only for reportability. What is the histology code for this case? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology as Myelodysplastic syndrome, unclassifiable [9989/3].
Ambiguous terminology is used to accession cases (determine reportability). While ambiguous terminology is generally not used to code a specific histology, it can be used to code histology if it is the .
The statement that you do not use ambiguous terms to code histology is intended for those NOS histologies with an ambiguous term being used to describe the subtype. For example, if the physician states this is a myelodysplastic syndrome, NOS, refractory thrombocytopenia. The correct histology would be MDS, NOS [9989/3] and not refractory thrombocytopenia [9992/3].
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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20110057 | MP/H Rules/Behavior--Appendix: How do you code mucinous cancers of the appendix? Is a "low grade mucinous appendix tumor/neoplasm" with peritoneal spread reportable? See Discussion. |
Low grade mucinous neoplasms can spread to the peritoneal cavity and in that sense are metastatic but histologically have bland/benign features (may be a benign cystadenoma that ruptured and spread by rupturing) are not a carcinoma. Thus, some have termed this group as DPAM (diseminated peritoneal adenomucinous) and not a true carcinoma. Others indicate that if you have metastasis the tumor is a carcinoma. |
For cases diagnosed 2007 or later, low-grade mucinous tumors of the appendix are a /1, borderline/uncertain behavior, and not reportable. These tumors do spread to the peritoneal cavity (pseudomyxoma peritonei). This spread, or deposits, or implants are also borderline/uncertain behavior and do not make the appendiceal tumor reportable. By contrast, a high-grade mucinous tumor of the appendix may produce malignant/invasive pseudomyxoma peritonei. When the pseudomyxoma peritonei are diagnosed as invasive or malignant, the mucinous tumor in the appendix is reportable as a /3. |
2011 |
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20110111 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be abstracted for a patient with a history of right breast ductal carcinoma in situ diagnosed in 2007 treated with bilateral mastectomies and a right chest wall mass excised in 2010 that revealed infiltrating ductal carcinoma? See Discussion. |
The patient's right breast DCIS in 2007 was treated with bilateral mastectomies with negative lymph nodes and negative margins. The patient refused Tamoxifen at that time. In 2010 a right chest wall mass excision revealed infiltrating ductal carcinoma with negative axillary lymph nodes. The physician states this is a recurrence. Per MP/H rule M8 this invasive tumor must be abstracted as a new primary. Would the primary site of the 2010 tumor be coded to breast or chest wall given that the patient has a previous mastectomy? |
This tumor in 2010 represents a recurrence; it is not a new primary. This second tumor would be coded as a new primary ONLY if the pathology report states that it originated in breast tissue that was still present on the chest wall. When there is no mention of breast tissue in a subsequent resection, the later occurring tumor is regional metastases to the chest wall (i.e., a recurrence of the original tumor). In turn, this means that there was at least a focus of invasion present in the original tumor that was not identified by the pathologist. The behavior code on the original abstract must be changed from a /2 to a /3 and the stage must be changed from in situ to localized. |
2011 |
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20110035 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when both a lymph node biopsy and peripheral blood are positive for CLL/SLL? See Discussion. | Per Module 3, Rules PH5 and PH6 in the Hematopoietic Manual, it states that CLL has peripheral blood involvement and SLL does not. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C421 [bone marrow] and histology to 9823/3 [CLL/SLL]. Per Rule there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s) but as long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow (C421).
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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20110146 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when a patient was diagnosed in 2003 with malignant lymphoma, mixed cell type, follicular in the inguinal lymph nodes and was recently diagnosed with follicular lymphoma (by a neck lymph node biopsy) involving the neck and mediastinal lymph nodes? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as a single primary: malignant lymphoma, mixed cell type, follicular [9691/3] diagnosed in 2003. The following describes how this determination was made.
This case is one in which the terminology for follicular lymphoma has changed over time. In 2003, follicular lymphoma was classified as small cleaved cell, large cell, or mixed cell (both small cleaved and large cell). Those designations are no longer used. This disease process is currently classified as follicular lymphoma NOS, grade 1, grade 2 or grade 3. The change was simply a change in classification/terminology.
Appendix A, Table A3 (Obsolete Terms as Defined in ICD-O-3, Lymphoid Neoplasm Obsolete Terms) should be used to determine the current term when an obsolete term is known/given. Per the Table, "Mixed cell type follicular lymphoma" is currently known as "Follicular lymphoma, grade 2" and the correct histology code is 9691/3. This is the correct histology for the 2003 primary.
Per Rule M15, the histologies must be check in the Multiple Primaries Calculator to determine the number of primaries. Enter [follicular lymphoma, grade 2 (malignant lymphoma, mixed cell type, follicular)] for Histology Code 1 and [follicular lymphoma, NOS] for Histology Code 2. The result is "Same Primary." As a result, accession a single 2003 diagnosed primary with the histology follicular lymphoma, grade 2 [9691/3] when the patient is subsequently diagnosed with follicular lymphoma, 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 |