Report | Question ID | Question | Discussion | Answer | Year |
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20120058 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when the patient is diagnosed with an acute neoplasm (diffuse large B-cell lymphoma) per a pathology report and is subsequently diagnosed clinically with a chronic neoplasm (chronic lymphocytic leukemia/small lymphocytic lymphoma) less than 21 days later? See Discussion. | The patient was diagnosed with an extranodal DLBCL on a biopsy of the stomach. A bone marrow biopsy performed 16 days later showed no DLBCL, but demonstrated an abnormal CD5-positive B-cell population that was subsequently referred to as CLL/SLL by the physician. The peripheral blood was negative and showed only moderate thrombocytopenia.
Does rule M10 apply in this case? Abstract the acute neoplasm as a single primary (DLBCL) as there was only one pathology specimen (stomach biopsy) proving DLBCL and the bone marrow did not definitively identify CLL/SLL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as two primaries per Rule M11. Code the histology of one primary to 9680/3 [diffuse large B-cell lymphoma], the acute neoplasm. Code the histology for the second primary to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma], the chronic neoplasm.
Per Rule M11, abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach 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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20120059 | Primary site/Reportability--Breast: Is a "right nipple skin" biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See Discussion. | In the 2011 SEER Manual Reportability Examples, example 3, it states a "biopsy-proven squamous cell carcinoma of the nipple" is reportable when the subsequent resection shows "no evidence of residual malignancy in the nipple epidermis." However, this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500. | Because the site is specifically stated to "skin" of nipple [C44.5], this case is not reportable.
If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain a full-thickness of skin and subcutaneous breast (nipple) tissue. If that is the case, this tumor would likely be a reportable squamous cell carcinoma of nipple [C50.0]. If, however, this was a punch biopsy it is more likely a non-reportable squamous cell carcinoma of the skin [C44.5]. |
2012 |
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20120055 | Surgery of Primary Site--Kidney, renal pelvis: How do you code a laparoscopic renal mass core biopsy followed by cryoablation of the tumor? See Discussion. | The note under the local tumor destruction codes states "No specimen sent to pathology from this surgical event 10-15." The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted? | Code for Surgery of Primary Site to 13 [Cryosurgery]. While the core biopsy provided a pathology specimen, it is not coded as surgery of the primary site. | 2012 |
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20120010 | Multiple primaries/Behavior--Ovary: What is the diagnosis date and histology for the primary(ies) abstracted for a patient with a mucinous cystic borderline tumor of the ovary in 2003 and a metastatic ovarian adenocarcinoma in 2011? See Discussion. | The 2011 pathology report: Spine at L3 biopsy: metastatic adenocarcinoma. Per addendum: Prior total abdominal hysterectomy specimen from 2003 was reviewed and showed an ovarian mucinous cystic tumor of borderline malignancy which has a similar morphology to the invasive adenocarcinoma seen on current specimen.
Abdominal tissue and omental biopsy: invasive and non-invasive glandular implants compatible with origin from ovarian mucinous borderline tumor.
The final diagnosis per radiation oncologist was, "recurrent ovarian cancer." |
This is a single primary. The diagnosis date is coded to 2003 and the histology is mucinous cystadenocarcinoma [8470/3]. The bone, abdominal tissue and omentum are metastatic sites. The MP/H Rules do not apply to metastases.
This is a case where an invasive or microinvasive element was missed in the original pathology. Because the entire tumor was not sectioned and placed on slides, the pathologist used their expertise when sectioning and selecting tissue to be examined. It is not a matter of poor judgment, just a fact that it is impossible to review the tissue from the entire tumor. The behavior must be changed to malignant [/3]. |
2012 |
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20120044 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient is diagnosed with acute monocytic leukemia in 2009 and in 2011 has biopsy confirmed granulocytic sarcoma of the cerebellum? See Discussion. |
Is this a recurrence of the patient's leukemia? In 2011, the patient is found to have several masses in the cerebellum, biopsy confirmed granulocytic sarcoma. The physician stated this is an "extramedullary relapse of leukemia." The bone marrow biopsy in 2011 was negative.
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For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession a single primary per Rule M3. Code histology to 9891/3 [acute monocytic leukemia] diagnosed in 2009 and primary site to C421 [bone marrow].
Per Rule M3 a single primary is reported when a sarcoma is diagnosed simultaneously or after a leukemia of the same lineage. Histology 9891/3 [acute monocytic leukemia] is listed as one of the histologies in the "same lineage." Myeloid sarcoma (9930/3) diagnosed simultaneously with or after acute myeloid leukemia (9861/3) or another leukemia of the myeloid lineage (9840/3, 9865/3-9867/3, 9869/3-9874/3, 9891/3, 9895/3-9898/3, 9910/3, 9911/3 and 9931/3).
NOTE: Under the Alternate Names section of the Heme DB, granulocytic sarcoma is a synonym for myeloid sarcoma.
Per PH10, code the primary site C421 [bone marrow] and code the histology acute myeloid leukemia, NOS (9861/3) or any of the specific AML histologies (9840/3, 9865/3-9867/3, 9869/3-9874/3, 9891/3, 9895/3-9898/3, 9910/3, 9911/3 and 9931/3) when the diagnosis is myeloid sarcoma (9930/3) AND there is a simultaneous or previous diagnosis of acute myeloid leukemia.
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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20120090 | First course treatment/Chemotherapy: Can a drug be coded as treatment for primary sites or histologies not listed for that drug in the SEER*Rx Database? See Discussion. | The patient was diagnosed with chronic myelogenous leukemia in 2008 followed by a diagnosis of chronic lymphocytic leukemia in 2011. Per the physician statement, the patient started nilotinib in 10/2011 for CML.
The SEER*Rx Database lists CML and GIST as the only primary site/histology combinations treated using nilotinib. Can nilotinib also be coded as treatment for the CLL primary? |
SEER*Rx lists the approved sites/histologies for each drug. However, if you have a physician statement that indicates the drug was given for another site/histology, code the agent as treatment for that site/histology. | 2012 |
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20120064 | Reportability--Heme & Lymphoid Neoplasms: If hemophagocytic lymphohistiocytosis treated with several rounds of chemotherapy is reportable, what is the primary site? |
Patient was diagnosed with hemophagocytic lymphohistiocytosis on blood and bone marrow biopsy. This was also referred to in the chart as hemophagocytosis and hemophagocytic syndrome. Hemophagocytic syndrome is listed in the Heme DB as 9724/3. The patient had several rounds of fairly aggressive chemotherapy. Would the correct primary site for histology 9724/3 be C421 [bone marrow], or C779 [lymph nodes, NOS]? See SINQ 20100113. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Hemophagocytic syndrome, also known as hemophagocytic lymphohistiocytosis (HLH), is not reportable. Per Appendix F, HLH is caused by an over stimulated immune system (infection, etc.). It is a clinical syndrome associated with a variety of underlying conditions. To be reportable, a child's diagnosis must state "fulminant hemophagocytic syndrome" to be reportable (9724/3). This is not the situation in this case. "Hemophagocytic lymphohistiocytosis" is also listed in 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. |
2012 |
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20120030 | MP/H Rules/Histology- -Melanoma: What is the correct histology code if the final diagnosis for an excisional biopsy specimen is reported as "malignant melanoma, superficial spreading type" but the under the "cell type" section in the CAP protocol layout of the pathology report it lists "cell type: epithelioid"? See Discussion. |
The MP/H rules do not address the concept of "cell type" for melanomas when the pathologist uses the CAP protocol to report findings and the cell type listed in that section of the report differs from the specific cell type mentioned in the final diagnosis. Does a case have two specific cell types when the final diagnosis and the "cell type" sections of a single pathology report indicate two more specific melanoma histologies? Pre-2007 SINQ entries indicate the cell type should be coded. However, if it differs from the specific cell type listed in the final diagnosis does it matter? Do the MP/H rules still take the cell type into account? |
Code the histology to malignant melanoma, superficial spreading type [8743/3] based on the final diagnosis. For cases diagnosed 2007 or later, the steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules manual. For a melanoma primary, use the Melanoma Histology rules to determine the histology code because there are site specific rules for cutaneous melanomas. Start at Rule H1. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H10. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the more specific histologic term when the diagnosis is melanoma, NOS [8720] with a single specific type (i.e., superficial spreading) mentioned in the final diagnosis. The final diagnosis takes precedence over the CAP protocol. The CAP protocol may be used when it provides additional or noncontradictory information, but that does not apply in this case. |
2012 |
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20120018 | MP/H Rules/Histology--Breast: How is histology coded if a lumpectomy reveals multifocal ductal carcinoma in situ spanning an area of 0.9-1.2 cm with close margins and a subsequent mastectomy reveals only a single focus of lobular carcinoma in situ measuring 0.2 cm in the UOQ, remote from all surgical margins? See Discussion. | Does the general instruction apply in this case that indicates the histology is coded from the most representative tumor specimen resulting in the histology coded to 8500/2 [DCIS]? Or is the histology coded to 8522/2 [duct and lobular carcinoma in situ] per Rule H28 because there is any combination of lobular [8520] and duct carcinoma [8500]? | Code the histology to duct and lobular carcinoma in situ [8522/2].
For cases diagnosed 2007 and later, the steps used to arrive at this decision are:
Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS Module Rule M4 because the patient had multiple foci of DCIS and a separate, single focus of LCIS. The rules are intended to be reviewed in consecutive order within the applicable Module. Tumors that are lobular and duct are a single primary.
Go to the Breast Histology rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module Rule H20 because the patient has multiple foci of DCIS and LCIS. Code the histology as 8522/2 [duct and lobular carcinoma in situ] when there is any combination of lobular [8520] and duct carcinoma.
The DCIS and LCIS are separate tumors. The DCIS was removed by the lumpectomy and the LCIS by the mastectomy. The most representative specimen for the DCIS is the lumpectomy. The most representative specimen for the LCIS is the mastectomy. Both pathology reports must be used in this case to determine the histology. |
2012 |
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20120050 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what histology codes apply if a patient has a 1998 diagnosis of essential thrombocythemia and a recent clinical diagnosis of secondary myelofibrosis? See Discussion. | The patient has a history of essential thrombocythemia (ET) since 1998. This has been treated daily with aspirin. A recent bone marrow biopsy was consistent with myeloproliferative disorder with excess blasts, marked extensive reticulin marrow fibrosis with osteosclerosis, excess blasts (11%) in the marrow aspirate and peripheral blood. JAK2 mutation was present in a small minority of cells. The physician stated patient was, "considered to have secondary myelofibrosis and was started on Jakafi." | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, a secondary myelofibrosis is not a reportable case.
Secondary myelofibrosis is not listed as a synonym for primary myelofibrosis in the Heme DB. The term "secondary myelofibrosis" means that the myelofibrosis was caused by, in this case, the essential thrombocythemia.
The diagnosis "consistent with myeloproliferative disorder" is also not a new reportable diagnosis. "Myeloproliferative disorder" refers to a group of diseases (an NOS category) that includes essential thrombocythemia, which was originally diagnosed in 1998, prior to reportability for this disease type.
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 |