Report | Question ID | Question | Discussion | Answer | Year |
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20110096 | Behavior--Lung: How is behavior to be coded for a diagnosis of adenocarcinoma of a lung tumor that is further classified per the CAP protocol as, "non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)" while the pathologist also classifies the tumor as pT1b, pN0? See Discussion. | Is the following case coded with an invasive or in situ behavior when a RUL lobectomy specimen reveals adenocarcinoma and the Histologic Type per the CAP protocol layout is non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)? The stage per the pathologist is pT1b, pN0. Per the COMMENT section in the pathology report, "The terminology adenocarcinoma in situ is based on a recent publication in the Journal of Thoracic Oncology (Volume 6, #2, February 2011). Based on this criterion, the behavior represents adenocarcinoma in situ with no evident invasive component." | Code the behavior as in situ. The pathologist has the final say on the behavior of the tumor. This pathologist is indicating that in his opinion based on a recent publication, this tumor is in situ. | 2011 |
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20110135 | MP/H Rules/Histology--Lung: Per SINQ 20110115, why is micropapillary adenocarcinoma of the lung coded to 8260 [papillary adenocarcinoma] rather than 8050 [papillary carcinoma]? |
The histology codes for lung tumors are based on the World Health Organization Classification of Lung Tumors. Chart 1 in the MP/H Lung Equivalent Terms, Definitions, Charts, Tables and Illustrations (2007 MP/H Rules Manual) illustrates the WHO Classification of Lung Tumors. Using Chart 1, note that papillary adenocarcinoma [8260] is located under the Adenocarcinoma (NOS) branch. The histology in question was stated to be "micropapillary adenocarcinoma" and not "papillary carcinoma." Papillary carcinoma, NOS [8050] is not actually located on the chart. However, papillary squamous cell carcinoma is listed under the Squamous Cell Carcinoma, NOS branch, histology code 8052. Next, look up papillary carcinoma [8050] in the Morphology - Numerical listing section of the ICD-O-3. Papillary carcinoma, NOS is a Squamous Cell Neoplasm. (Refer also to SINQ 20091040.) The key word used to determine the appropriate histology in this case is "adenocarcinoma." This is a papillary adenocarcinoma and not a papillary squamous neoplasm. |
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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20110106 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site to be coded for a 2010 diagnosis of follicular lymphoma involving the spleen and lymph nodes above and below the diaphragm? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Use Rule PH21 to code the primary site to C778 [lymph nodes of multiple regions]. The spleen is not listed under the Primary Site(s) section in the Heme DB for follicular lymphoma. Per Rule PH21 code the primary site to multiple lymph node regions, NOS (C778) when multiple lymph node regions, as defined by ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated. The spleen is a primary site for only a few lymphomas (noted in the Heme DB). Because the spleen filters blood, it is often reactive (splenomegaly) or frankly involved with the lymphoma. That reaction or involvement, however, does not affect the primary site coding. Only the involved nodes are used in coding primary site.
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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20110081 | MP/H Rules/Histology--Pancreas: What is the correct histology code for pancreatic neoplasia III (PanIN III) for cases diagnosed in 2007 and later? | Code histology for PanIN-III to 8148/2 [Glandular intraepithelial neoplasia, grade III]. 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 a pancreas primary, use the Other Sites Histo rules to determine the histology code because pancreas does not have site specific rules.
Go to the SINGLE TUMOR: IN SITU ONLY module, start at rule H1. Code 8148/2 [Glandular intraepithelial neoplasia, grade III]. There is only one histologic type identified.
In the next version of the MP/H rules, the H22 rule "Code 8148/2 (Glandular intraepithelial neoplasia grade III) for in situ glandular in sites such as the (PAIN III)" will be included under H2 as well. Currently the rule is only in the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module and should also be include under the SINGLE TUMOR: IN SITU only module. |
2011 | |
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20110143 | Multiple primaries--Heme & Lymphoid Neoplasms: How many and what primary site(s) are to be accessioned when biopsies of clavicular and neck skin lesions are both consistent with mycosis fungoides? See Discussion. |
Per the Heme DB and Manual, this is a single primary; however, per the MP/H Rules, this would be multiple primaries. Which rules apply to this case? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. When there is a question of whether the SEER MP/H Rules or Hematopoietic and Lymphoid Neoplasm Rules apply, check the histology and refer to the Case Reportability Instructions in the Hematopoietic and Lymphoid Neoplasm Manual. All ICD-O-3 morphology codes in the range 9590 - 9992 are included in the Hematopoietic Rules. Mycosis Fungoides [9700/3] is included in this range. Therefore, the SEER MP/H Rules do not apply to mycosis fungoides. This case should be accessioned as a single primary: mycosis fungoides [9700/3] of the skin, NOS [C449]. Per Rule M2 abstract a single primary when there is a single histology. Note that in the Primary Site(s) section of the Heme DB, it states the primary site must always be coded to skin (C440 - C449) for mycosis fungoides. Because the primary site is stated in this section of the Heme DB, it is not necessary to use the Primary Site Rules to determine the primary site. Code the primary site to C449 [skin, NOS] because the patient has multiple sites of skin involvement and there is no documentation indicating which subsite of skin was the origin of the mycosis fungoides. 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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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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20110038 | Reportability/Behavior: Is a "minimally invasive thymoma" a reportable malignancy if the pathology report does not specifically state it is malignant? See Discussion. |
For example, are Types A, B1, B2 and B3 reportable if the pathology report does not state the tumor is a "Malignant Thymoma"? |
For cases diagnosed prior to 2021 According to our expert pathologist consultant, code using the terms in the pathology report. Do not try to second guess the pathologist.
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2011 |
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20110016 | Behavior--Brain and CNS: Can hemangioblastomas occurring in the CNS be coded as /3 (malignant) based on a radiologic or clinical diagnosis by the physician? See Discussion. | Hemangioblastomas are borderline (/1) according to ICD-O. The standard matrix rule in ICD-O directs registrars to change the behavior code to malignant when a malignant (/3) behavior is stated by a physician for a morphology code that appears in ICD-O with a non-malignant behavior code. The "malignant" hemangioblastomas we see are not pathologically confirmed; they are radiological or clinical diagnoses confirmed when renal cell carcinoma is a disease process listed in the malignant differential diagnoses. | The behavior code for hemangioblastoma can be coded to /3 when a pathologist indicates that the behavior is malignant. The behavior code should be based on a pathologist's opinion. It is usually not possible for a radiologist or patient care physician to make this determination clinically.
The histologic appearance of hemangioblastoma may resemble metastatic renal cell carcinoma; therefore, one will often see renal cell carcinoma listed as a possible diagnosis. This does not indicate that the hemangioblastoma is malignant. Do not code the behavior as /3 based on a differential diagnosis of renal cell carcinoma. |
2011 |
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20110115 | MP/H Rules/Histology--Lung: How is micropapillary adenocarcinoma of the lung coded given that a literature search indicates that this is a distinct subtype of adenocarcinoma of the lung with poor prognosis? | Code the histology to 8260/3 [papillary adenocarcinoma]. An expert pathologist states that the WHO notes micropapillary to be a pattern seen in papillary carcinomas, but does not specify it as a separate histologic type. | 2011 |