Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20120052 | Ambiguous Terminology/Histology--Heme & Lymphoid Neoplasms: What is the histology code if the final diagnosis is "non-Hodgkin lymphoma NOS," but after further genetic and immunohistochemistry studies were performed the pathology report diagnosis COMMENT section stated the immunohistochemistry findings were "compatible with follicular lymphoma"? See Discussion | Ambiguous terminology is not to be used to code a more specific histology. However the immunohistochemistry results (the definitive diagnostic method for follicular lymphoma) seem to clarify the non-specific diagnosis of non-Hodgkin lymphoma. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Ambiguous terms are not used to code a specific histology. This includes ambiguous terminology used as a result of immunophenotyping or genetic studies. However, a definitive clinical diagnosis can be used to code a more specific histology.
In this example, the histology is coded to non-Hodgkin lymphoma, NOS [9591/3] because the pathology final diagnosis was non-Hodgkin lymphoma, NOS even though it was followed by further genetic and immunohistochemistry studies that were "compatible with" (ambiguous terminology) follicular lymphoma.
However, if there was a subsequent non-ambiguous clinical diagnosis, the histology would be coded to the more specific diagnosis. For example, if the pathology final diagnosis was non-Hodgkin lymphoma, NOS, and there was a subsequent clinical diagnosis of follicular lymphoma or the patient was treated for follicular lymphoma, then the histology should be coded to 9690/3 [follicular lymphoma, NOS]. Document either of these in a text field to support the histology code chosen. Follicular lymphoma is a specific type of non-Hodgkin lymphoma. If you do have a confirmed diagnosis of follicular lymphoma, code that specific cell type per rule PH29.
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 |
|
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 |
|
20120081 | Reportability: Is VIN II-III reportable? |
For cases diagnosed 2021 and later VIN II-III is reportable based on ICD-O-3.2 which lists squamous intraepithelial neoplasia, grade II as 8077/2 making it reportable. Also see SINQ 20120094. |
2012 | |
|
20120035 | Reportability--Pancreas: What is the histology code if well differentiated pancreatic endocrine neoplasms (PanNETs) are reportable?
|
Pancreatic (neuro)endocrine neoplasms (PanNETs) are reportable. The correct histology code is 8240/3. The grade is coded as 1 [well differentiated].
|
2012 | |
|
20120020 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a lumpectomy shows a single 6 mm "infiltrating mammary adenocarcinoma, histologic type: ductal (tubular)" tumor, and "peritumoral microscopic foci of solid type ductal carcinoma in situ"? See Discussion. |
Per SINQ 20091117, tubular (ductal) carcinoma would be coded to 8211/3 [tubular]. However, in that case the tubular/ductal carcinoma is composed of a single tumor. In this case, the foci of DCIS were specifically stated to be peritumoral, and not a part of the infiltrating tubular carcinoma. Are these microscopic foci of DCIS a separate primary per Rule M12 and SINQ 20110092 [two primaries are accessioned when one tumor is invasive and another is in situ, and histology codes differ at 1st, 2nd or 3rd numbers]? Does the size of the DCIS matter when there are two distinct histologies? Abstracting a second primary for these microscopic foci seems like over-reporting. |
The following answers depend on what this pathologist means by "ductal (tubular)." According to the WHO classification, tubular is not a duct subtype. Check with the pathologist if possible to determine if the intended meaning is "tubular carcinoma" or "duct carcinoma". If the pathologist uses the expression "ductal (tubular)" as an equivalent of "tubular carcinoma": Accession two primaries, a tubular carcinoma [8211/3] and a ductal carcinoma in situ, solid type [8230/2]. For cases diagnosed 2007 and later, the steps used to arrive at this decision are: Determine the provisional histologies of these tumors in order to apply the Multiple Primary rules. Open the Multiple Primary and Histology Coding Rules manual. For a breast primary, use the Breast Histology rules to determine the histology codes because there are site specific rules for breast primaries. Determine the histology of in situ carcinoma, solid type ductal carcinoma in situ. Start at Rule H1. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the more specific histologic term when the diagnosis is intraductal carcinoma and a type of intraductal carcinoma. Solid is a specific type of DCIS. The histology is 8230/2. Determine the histology of the invasive carcinoma, tubular carcinoma. Start at Rule H10. Code the histology when only one histologic type is identified, Tubular carcinoma was the only type identified. The histology is 8211/3. Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor. Start at the MULTIPLE TUMORS Module, Rule M4, because the patient has a single invasive tumor and separate foci of DCIS. These tumors have ICD-O-3 histology codes that are different at the third (xxx) number and are, therefore, multiple primaries. If the pathologist uses the expression "ductal (tubular)" as an equivalent of "duct carcinoma": Accession a single primary, a duct carcinoma [8500/3]. 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 has a single invasive duct carcinoma and separate foci of solid type ductal carcinoma in situ. Multiple intraductal and/or duct carcinomas are a single primary. Table 1 identifies solid type as a specific type of intraductal carcinoma. 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. Code the invasive histology when both invasive and in situ tumors are present. Code the histology as 8500/3 [duct carcinoma]. |
2012 |
|
20120083 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient is diagnosed with follicular lymphoma, grade 3 in 2006 and is subsequently diagnosed with follicular lymphoma, grade 2 in 2011? See Discussion. | June 2006, the patient was diagnosed with follicular lymphoma, grade 3 by cervical lymph node biopsy and bone marrow biopsy. The patient refused treatment but was followed.
May 2007, the patient had another cervical LN biopsy with a diagnosis of follicular lymphoma, grade 2.
July, 2009, a neck mass excision was diagnosed as follicular lymphoma, grade 3.
June 2011, another neck lymph node was excised and diagnosed as follicular lymphoma, grade 2.
According to the MP calculator, FL grade 3 [9698/3] is a separate primary from FL grade 2 [9691/3]. Is the June 2011 diagnosis of FL grade 2 a new primary? |
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 per Rule M15. The histology is coded to 9698/3 [follicular lymphoma, grade 3] diagnosed in 2006. The 2011 diagnosis of follicular lymphoma, grade 2 [9691/3] is not a new primary.
Follicular lymphoma, grade 2 [9691/3] is listed under the Same Primaries section of the Heme DB for 9698/3 [follicular lymphoma, grade 3]. To confirm this, Rule M15 indicates we are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries because none of the rules from 1-14 apply. Per the calculator, these histologies represent the same 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. |
2012 |
|
20120042 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded if a pelvic mass biopsy is positive for B-cell non-Hodgkin lymphoma and a mediastinal lymph node biopsy is positive for follicular lymphoma, grade 1? See Discussion. | CT guided core biopsy of pelvic mass is positive for B-cell non-Hodgkin lymphoma. Bone marrow biopsy is negative. Mediastinoscopy with mediastinal and pretracheal nodes biopsy is positive for follicular lymphoma grade 1 of 2. The patient has a PET demonstrating positive extensive metastatic disease with nodes in neck, chest, abdomen/pelvis and bone involvement. Should the histology be coded 9591/3 [NHL, NOS] or 9695/3 [FL, grade 1]? Which rule applies?
The table of contents for the Hematopoietic Manual indicates Module 8 for these histologies, however, Module 8 rules do not seem to apply. Continuing on to Module 9, the first rule that applies is PH30. PH30 states use the Heme DB to determine primary site/histology. The Heme DB indicates these are separate primaries, but both histologies are B-cell lymphomas. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9695/3 [follicular lymphoma, grade 1] per PH29.
Under the Alternate Names section of the Heme DB, B-cell non-Hodgkin lymphoma is synonym for non-Hodgkin lymphoma, NOS and B-cell lymphoma, NOS.
Per PH29, one codes the histology when there is one non-specific histology (NHL, NOS) and one specific histology (FL, grade 1). You are also required to confirm the specific and the non-specific (NOS) histology represent the same primary using the Multiple Primaries Calculator. The calculator indicates these are the same 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. |
2012 |
|
20120011 | Multiple primaries/Histology--Heme & Lymphoid Neoplasms: Is there a timing rule used to recode histology should a more specific diagnosis of refractory anemia with excess blasts (RAEB) be confirmed after an initial diagnosis of myelodysplastic syndrome (MDS)? How many primaries are abstracted if RAEB subsequently evolves toward an acute myeloid leukemia? See Discussion. |
Facility A: 4/8/2010 Bone Marrow biopsy: Features most compatible with MDS. (No treatment administered.) 7/2/2010 Peripherial Blood: Transforming Myelodysplastic Syndrome (MDS). COMMENT: Clonal abnormality compatible with MDS/acute myeloid leukemia (AML) in all metaphases examined. (Still no treatment administered.) Facility B: 10/6/2010 Patient now presents for evaluation and treatment. Patient started on Vidaza. 10/07/10 Bone Marrow biopsy: Refractory anemia with excess blasts (RAEB-2) COMMENT: Evolution towards AML with myelodysplasia related changes considered; cytogenetic analysis reveals abnormalities most compatible with MDS and/or AML. Based on the Heme Manual and DB, the 4/8/2010 diagnosis of MDS, NOS (9989/3) is the first primary. Should the 7/2/2010 diagnosis of transforming MDS to AML (9861/3) be a new, second primary? Based on the Abstractor Note for MDS in the Heme DB for MDS, "If the characteristics of a specific subtype of MDS develop later in the course of the disease, change the histology code to the more specific diagnosis." Based on this note, should the MDS histology code [9989/3] be changed to refractory anemia with excess blasts (RAEB-2) [9983/3] from the biopsy taken on 10/7/2010 (one day after treatment began) that revealed RAEB-2 with evolution towards AML? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. There is no time limit set to update histology to a more specific disease process if a patient has an initial NOS histology identified. Unlike solid tumors, hematopoietic and lymphoid neoplasms may take a year or more to manifest the specific disease. This is simply a part of the "disease characteristics." Abstract a single primary per M2, a single histology represents a single primary. Code the histology to 9983/3 [MDS/RAEB-2.] The Heme DB guidelines were interpreted correctly. MDS/RAEB can transform to AML and would be two separate primaries there had also been a reportable diagnosis of AML. The 7/2/2010 peripheral blood showed MDS and a clonal abnormality that was "compatible with MDS/AML." The 10/7/2010 bone marrow biopsy showed only RAEB-2 with "evolution towards AML with myelodysplasia related changes." Ambiguous terminology is only used to help determine reportability; it not used to code a more specific histology. In this case, there was only ambiguous terminology used to describe the AML. It is important to understand the implication of incorrectly assigning histology codes for hematopoietic and lymphoid neoplasm using ambiguous terminology. Using this case as an example, the patient was not treated until three months after the 7/2/2010 peripheral blood diagnosis of MDS compatible with MDS/AML. The medical literature indicates that AML, if left untreated, is usually fatal within 1-3 months. The treatment given 10/6/2010, 3 months after the "compatible with" diagnosis, was a drug used to treat MDS and not AML. The other issue with this case is that the bone marrow examination, which is more reliable than peripheral blood, showed only "evolution towards AML." This means that the bone marrow is exhibiting the changes seen in the final stages of MDS prior to progression to AML. Wait for a definitive diagnosis of AML and/or treatment for AML before abstracting the second 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. |
2012 |
|
20120095 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a patient is diagnosed with inflammatory carcinoma of the left breast, (ductal with apocrine features type on biopsy), and an incidental lobular carcinoma in the right breast? See Discussion. | A 1.2 cm lobular carcinoma was incidentally discovered during the work-up of the patient's left breast that was inflammatory carcinoma. The lobular carcinoma on the right was localized without any skin involvement. Rule M6 indicates inflammatory breast carcinoma in either breast is a single primary. Does rule M6 apply when the patient has inflammatory carcinoma in one breast and a separate lobular carcinoma in the other? | For cases diagnosed 2007 or later, accession two primaries, ductal with apocrine features in the left breast and lobular carcinoma in the right breast.
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). Go to the Breast MP rules because site specific rules exist for this primary.
Start at the MULTIPLE TUMORS module, rule M4. The rules are intended to be reviewed in consecutive order within a module. The patient has tumors in both the right and left breasts.
Rule M6 does not apply because inflammatory carcinoma involves only the left breast and the patient has a different histology in the right breast and there is no mention of inflammatory carcinoma in that breast. In this situation continue to the next applicable rule. |
2012 |
|
20120071 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded and what rule applies if the patient has involvement of multiple organs and one lymph node chain with diffuse large B-cell lymphoma? See Discussion. |
In 2011 the patient was diagnosed with a 15 cm mass involving the terminal ileum, cecum and adjacent mesentery. The pathology was positive for diffuse large B-cell lymphoma. A staging PET/CT revealed a mass at the base of tongue and a left cervical lymph node. The biopsy of the base of tongue also showed DLBCL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Apply rule PH22 to code the primary site to C779 [lymph nodes, NOS]. While the pathology does not indicate that this particular case represents a B-cell lymphoma, unclassifiable with features intermediate between DLBCL and Burkitt variant, in the Abstractor Notes section of the Heme DB for diffuse large B-cell lymphoma it does indicate that its presentation, "may have lesions in ileocecal region or jaws. Bone marrow and peripheral blood may be involved. Patients present with lymphadenopathy or mass lesions in extranodal site." This patient does have involvement of two extranodal sites and involvement of regional lymph nodes for only one of those sites. PH22 indicates one is to code the primary site to C77.9 [lymph nodes, NOS] when lymphoma is present in multiple organs and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. There are two extranodal sites of involvement and only one chain of lymph nodes is regional to one of those sites so this rule applies. 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 |