Report | Question ID | Question | Discussion | Answer | Year |
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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 |
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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 | |
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20120032 | MP/H Rules/Histology--Melanoma: How is the histology coded for an invasive melanoma stated to have a "superficial spreading growth pattern"? See Discussion. |
Some facilities in our reporting region submit pathology reports that document invasive melanoma cases with a subtype stated to be a "growth pattern." The MP/H rules state that we are not to use the term "pattern" to code the histology of invasive tumors. However, applying this rule means the more specific histology will not be recorded for any of these cases. Can the term "growth pattern" be a more specific histologic type for invasive melanomas when no other information is available? |
Code the histology as superficial spreading melanoma [8743/3]. For cases diagnosed 2007-2014, 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 within the applicable Module. Code the most specific histologic term when the diagnosis is melanoma, NOS [8720] with a single specific type, superficial spreading in this case. The subtype of this invasive melanoma is "superficial spreading." A change will be made to Rule 9 in next update to indicate "growth pattern" can be used to describe an invasive histology. |
2012 |
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20120070 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a bone marrow biopsy shows myelodysplastic syndrome - refractory anemia with excess blasts type 2 (RAEB-2) and myelofibrosis? See Discussion. | Should the myelofibrosis be accessioned as a second primary? Or is it a descriptor of the MDS/RAEB-2? The multiple primaries calculator shows 9983/3 and 9961/3 represent two primaries. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession a single primary per Rule M2 which indicates you are to abstract a single primary when there is a single histology. Code the histology to 9983/3 [refractory anemia with excess blasts type 2 (RAEB-2)].
Per Appendix F, myelofibrosis, NOS, is NOT a synonym for primary myelofibrosis. Myelofibrosis, NOS, if not specified to be myelofibrosis, therefore, is not reportable.
Per PH29, code the specific histology when the diagnosis is one non-specific (NOS) histology (MDS) and one specific histology (RAEB-2) AND the Multiple Primary Calculator confirms the specific histology and NOS histology are the same primary (which it does).
Myelodysplastic syndrome, NOS is a generic disease description. In most cases, NOS histology is only the provisional diagnosis; the physician will run further diagnostic procedures and look for various clinical presentations to identify a more specific disease. The more specific myelodysplastic syndromes are: refractory anemia; refractory neutropenia; refractory thrombocytopenia; refractory anemia with ring sideroblasts; refractory cytopenia with multilineage dysplasia; refractory anemia with excess blasts; and refractory cytopenia of childhood. 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.
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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20120092 | MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence? See Discussion. | 7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.
3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and "there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence."
Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a "recurrence" of the 7/12/2007 diagnosis after reviewing the slides? |
For cases diagnosed 2007 or later, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007.
The steps used to arrive at this decision are:
Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.
General Information Rule 7 states "Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary."
Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary. |
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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20120088 | MP/H Rules/Multiple primaries--Head & Neck: How many primaries are accessioned and what rule applies if a patient has an extensive tumor in the left ethmoid sinus and a separate tumor in the right maxillary sinus? See Discussion. |
MRI and CT Neck Impression: Extensive tumor mass which likely originated within the left ethmoid sinus and extends intracranially via the cribriform plate into the anterior cranial fossa. There is involvement of the left orbit and extension into the superior aspect of the left maxillary sinuses as well as the nose. Second enhancing lesion within the right maxillary sinus measures almost 2 cm. The second mass within the floor of the right maxillary sinus, with similar imaging characteristics, is consistent with malignant involvement. The patient has an extensive ethmoid sinus tumor, biopsy showed squamous cell carcinoma. The ethmoid sinus is not a paired organ. The patient also has a small maxillary tumor with no histologic confirmation, Hem/Oncology chart notes state the right maxillary sinus mass is carcinoma. The maxillary sinus is a paired organ. Per the AJCC Manual (AJCC Manual for Staging, 7th edition, page 70), both the ethmoid and maxillary sinuses are further identified by their laterality (left and right). Why aren't the ethmoid sinuses a paired organ for the MP/H Rules? What MP rule applies to this case? |
For cases diagnosed 2007 or later, accession a single primary. 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 Head and Neck MP rules after determining the histology of each tumor - (8070/3 [squamous cell carcinoma] and 8010/3 [carcinoma, NOS]) because site specific rules have been developed for this primary. Start at the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within a module. Abstract a single when one tumor is carcinoma, NOS [8010] and another tumor is a specific carcinoma, squamous cell carcinoma [8070] because the ethmoid sinus (site of origin) is not a paired site per the MP/H rules. We will review the list of paired organs for the next edition of the MP/H Rules. |
2012 |
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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 |
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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 |
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20120079 | Reportability: Is positive urine cytology (ex: malignant cells interpreted as carcinoma) by itself reportable? If so, is the case coded to bladder by default or is is coded to C689, urinary system, NOS? | Urine cytology positive for malignancy is reportable. Code the primary site to C689 in the absence of any other information.
However, if a subsequent biopsy of a urinary site is negative, do not report the case.
For 2013 diagnoses and forward, report these cases when they are encountered. Do not implement new/additional casefinding methods to capture these cases. As always, do not report cytology cases with ambiguous terminology. |
2012 |