Report | Question ID | Question | Discussion | Answer | Year |
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20110082 | First course treatment/Other therapy--Skin: How is PUVA [psoralen (P) and long-wave ultraviolet radiation (UVA)] coded when used for skin primaries such as melanoma and mycosis fungoides? | Code PUVA as "Other treatment" with Code 1 - Other. We do not have a code specifically for ultraviolet radiation. | 2011 | |
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20110129 | MP/H Rules/Histology--Lung: How many primaries are accessioned if a pathology report for a right upper lobectomy with a chest wall resection describes the disease as 1) two foci of poorly differentiated non-small cell carcinoma, 2) mixed adenocarcinoma and non-mucinous bronchioalveolar carcinoma, each present as a separate focus? See Discussion. |
This case was abstracted as two primaries, adenocarcinoma, acinar and papillary types [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] per Rules M5 and M10. If this is reported as only two primaries, what is the stage for each tumor? The non-small cell tumors were the most invasive, but they were not a separate primary per Rule M10. Final pathology diagnosis for a RUL lobectomy and chest wall resection: Carcinoma of the lung with the following features: 1. Non-small cell carcinoma, poorly differentiated (see comment). Two foci in same lobe: 10 cm and 3 cm (largest dimensions of each tumor). Invades pleura (PL3), main bronchus and chest wall invasion present. 2. Adenocarcinoma and bronchioloalveolar carcinoma (see comment). Histologic subtype: Acinar and papillary (adenocarcinoma); non-mucinous (BAC). Two foci in same lobe: up to 1.0 cm. Pleural invasion absent, chest wall invasion absent. 3. Metastatic carcinoma in 5/7 peribronchial LN's. Two histologically distinct neoplasms identified in the lobectomy/chest wall resection specimen: Poorly differentiated non-small cell carcinoma, present as two foci; and adenocarcinoma and non-mucinous bronchioloalveolar carcinoma, each present as a separate focus. |
SEER will answer the question about the number of primaries to accession. Submit questions about stage to the CoC CAnswer Forum. For cases diagnosed 2007 or later: Accession two primaries: a mixed adenocarcinoma, acinar and papillary types [8255/3] and a bronchioloalveolar carcinoma, non-mucinous [8252/3]. The steps used to arrive at this decision are: Determine the histology code for each tumor prior to applying the Multiple Primary Rules to determine the number of primaries to accession. There are two non-small cell carcinomas, NOS; the histology code for these two tumors will be 8046/3. There is a single adenocarcinoma with acinar and papillary subtypes tumor, the histology for this tumor will be 8255. There is a single bronchioloalveolar carcinoma, non-mucinous subtype tumor; the histology for this tumor will be 8252/3. Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Lung Multiple Primary rules to determine the number of primaries. Start at the MULTIPLE TUMORS module, Rule M3, because this patient has multiple tumors. The rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] are multiple primaries. Perform a second pass through the Multiple Primary rules to determine whether the two non-small cell carcinomas [8046/3] are multiple primaries or manifestations of the same primaries identified in Step 3. Start at Rule M3 again because this patient has multiple tumors. Again, these rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's non-small cell carcinomas, NOS [8046/3] are a single primary when compared to the adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3]. Both of these histologies are more specific types of non-small cell carcinoma per the Lung Histology Groups and Specific Types Chart (Chart 1). You can also apply Rule M10 for both non-small cell carcinoma, NOS [8046/3] compared to adenocarcinoma with acinar and papillary subtypes [8255/3] and non-small cell carcinoma, NOS [8046/3] compared to non-mucinous bronchioloalveolar carcinoma [8252/3]. |
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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20110011 | Reportability--Heme & Lymphoid Neoplasms: Is a 2010 diagnosis of "thrombocytopenia of unknown etiology" reportable? See Discussion. | No exact match returned after entering the term "thrombocytopenia of unknown etiology" in the Heme DB. However, the program does indicate there are 17 results that could be displayed that show any of the 4 terms entered. Clicking on the search label indicates there are no matches either.
The only result returned after entering "thrombocytopenia" into the search box is "refractory thrombocytopenia." |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
"Thrombocytopenia of unknown etiology" is not reportable. Thrombocytopenia refers to a low platelet count which causes bleeding. Thrombocytopenia can be caused by viral infections, excessive alcohol usage, HIV, and other causes (including chemotherapy). If the diagnosis is not "refractory thrombocytopenia" the case is not reportable. Appendix F lists this term as non-reportable.
If you do not see the term in the Heme DB under either the Name column or the Alternative Names section for the results returned, it is not reportable. The only reportable term that contains the word thrombocytopenia is refractory thrombocytopenia. Therefore, thrombocytopenia of unknown etiology is not reportable.
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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20110141 | Multiple primaries--Heme & Lymphoid Neoplasms: Should a 2010 diagnosis of central nervous system diffuse large B-cell lymphoma be abstracted as a new primary when the patient has a history of cutaneous T-cell lymphoma in the 1980's and a 1991 history of DLBCL of the bowel (NOS)? See Discussion. |
Patient presents in 2010 with the history of cutaneous T-cell lymphoma and DLBCL. The patient is stated to have been in remission from the DLBCL. However, a current CT scan of the brain is consistent with central nervous system DLBCL. Cerebrospinal fluid cytology is consistent with DLBCL. The CT scan of the torso showed no lymphadenopathy or suspicious findings. Does the recently discovered DLBCL disease process in the central nervous system represent a new third primary? Or is this disease recurrence/progression? The patient was referred to a cancer center and there is no additional information available regarding further workup or treatment. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. The patient only has two primaries: cutaneous T-cell lymphoma diagnosed in the 1980s and diffuse large B-cell lymphoma of the bowel diagnosed in 1991. The DLBCL of the brain does not represent a new primary. It is progression of the 1991 disease process with the same histology. Under the Alternate Names section in the Heme DB, one synonym for DLBCL is "Primary DLBCL of the CNS." The histology code for both the 1991 bowel neoplasm and the current CNS neoplasm is 9680/3. Per Rule M2, a single histology is a single 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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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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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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20120012 | Histology--Heme & Lymphoid Neoplasms: How is histology coded if the pathology report shows diffuse large B-cell lymphoma arising in a small cell lymphoma - Richter's transformation, also compatible with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL)? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)].
For CLL (and CLL/SLL), Richter's transformation represents when CLL changes into DLBCL. In this case, there was a biopsy that demonstrated a diagnosis of the chronic disease (CLL/SLL) transforming (Richter's transformation) into an acute disease DLBCL.
Per Rule M8, one is instructed to abstract the acute neoplasm as a single primary when both a chronic (CLL/SLL) and an acute neoplasm (diffuse large B-cell lymphoma (DLBCL)) are diagnosed simultaneously there is documentation of only one positive bone marrow biopsy, lymph node biopsy or tissue biopsy.
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. |
2012 | |
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20120027 | MP/H Rules/Histology--Colon: How is histology coded if a patient has two frank invasive adenocarcinomas in one segment of the colon and multiple tubular adenomas and hyperplastic polyps throughout the entire colon without a diagnosis of familial polyposis [FAP]? See Discussion. | Does Rule H19 apply which indicates the histology is coded to 8221 [adenocarcinoma in multiple adenomatous polyps] because there are multiple polyps (number not specified) throughout the colon? Does tumor have to arise in at least one of the adenomas in order to apply Rule H19? Or, does Rule H22 apply which indicates the histology is coded to 8140 [adenocarcinoma, NOS] because the adenocarcinomas are both frank invasive adenocarcinomas and not adenocarcinoma arising in an adenoma? |
Code the histology as adenocarcinoma, NOS [8140/3].
For cases diagnosed 2007 or later, the steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Colon Histology rules to determine the histology code for this case. The Module you use depends on the behavior and number of tumors identified in the primary site.
Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module Rule H15. The rules are intended to be reviewed in consecutive order from Rule H15 to Rule H24. Stop at the first rule that applies to the case you are processing. Code the histology when only one histologic type is identified. In this case, the only histology present was adenocarcinoma, NOS [8140/3].
Rules H17 through H21 do not apply in this case because there is no malignancy arising in any of the adenomas or polyps scattered throughout the colon. |
2012 |
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20120061 | MP/H Rules/Multiple Primaries--Ovary: How many primaries are accessioned and which multiple primary rule applies for a patient diagnosed with a carcinosarcoma of the left ovary and a serous carcinoma of the right ovary? See Discussion. |
The patient underwent a debulking surgery showing a 20.5 cm carcinosarcoma with focal areas of high grade serous carcinoma and extensive high grade stromal sarcoma in the left ovary. The right ovary showed only a high grade serous carcinoma with extensive involvement of the ovarian parenchyma but no sarcomatous elements. While carcinosarcoma is composed of both epithelial and non-epithelial elements, does the presence of a purely epithelial tumor in the contralateral ovary indicate these are separate primaries per rule M8? |
For cases diagnosed 2007 or later, accession two primaries, carcinosarcoma [8980/3] of the left ovary and serous carcinoma [8441/3] of the right ovary. The steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). After determining the histology of each tumor (8980/3 and 8441/3), go to the Other Sites MP rules because ovary does not have site specific rules developed Start at the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within a module. Stop at the first rule that applies to the case you are processing. Review Table 1 (Paired Organs and Sites with Laterality) to determine whether ovary is a paired site. To locate Table 1, go to Other Site under the Terms & Definitions section of the manual. Ovary is listed as a paired site. Accession multiple primaries when there are tumors on both sides (right and left) of a site listed in Table 1 (Paired Organs and Sites with Laterality). Carcinosarcoma [8980/3] is not an epithelial tumor of the ovary within the range of 8000-8799 and, therefore, Rule M7 does not apply. |
2012 |