Report | Question ID | Question | Discussion | Answer | Year |
---|---|---|---|---|---|
|
20130150 | MP/H Rules/Histology--Bladder: What is the histology code histology code for a bladder TUR that demonstrates mixed invasive urothelial and small cell carcinoma? See Discussion. |
SINQ 20041104 (prior to 2007 MP/H rules) states to code histology to 8045. The MP/H rules do not address this combination of urothelial and small cell carcinoma. The current MP/H rule that applies is Rule H8, code the higher histology (8120/3). However, if the histology is coded to 8120/3, the fact that small cell carcinoma exists will be lost. If the small cell carcinoma drives the treatment plan/prognosis, shouldn't this situation be reflected in the rules for coding histology? |
Code the histology to 8045/3 [mixed small cell carcinoma]. The presence of small cell carcinoma drives the treatment decisions for this case.
This issue will be addressed in the next revision of the MP/H rules. |
2013 |
|
20130190 | Reportability: Is a thymoma, type B3 malignant and, therefore, reportable? See Discussion. |
Recent information received from a registrar/pathologist states the WHO classifies well-differentiated thymic carcinoma [8585/3] as a synonym for type B3 thymoma. |
For cases diagnosed prior to 2021 Thymoma, type B3 [8585/1] is not reportable. Well-differentiated thymic carcinoma [8585/3] is reportable. WHO lists well-differentiated thymic carcinoma as a synonym for type B3 thymoma, but indicates the behavior code differs as indicated above. See the applicable SEER manual for cases diagnosed 2021 and later. |
2013 |
|
20130005 | Reportability--Brain and CNS: Are spinal schwannomas and neurofibromas reportable or non-reportable? | The most accurate and most current instruction is to report these spinal tumors when they arise within the spinal dura or spinal nerve roots, or when they are stated to be "intradural" or "of the nerve root." Do not report these tumors when they arise in the peripheral nerves. The peripheral nerves are the portion of nerve extending beyond the spinal dura. | 2013 | |
|
20130221 | MP/H Rules/Multiple primaries--Prostate: How many primaries are accessioned for a diagnosis of metastatic small cell neuroendocrine carcinoma of the prostate following a previous diagnosis of adenocarcinoma of the prostate? See Discussion. | Would a second prostate primary with histology coded to 8041/3 [small cell carcinoma] be accessioned for the following examples? Or are these metastases despite the different histologies?
Example 1: Prostate adenocarcinoma diagnosed in 2001, no treatment given. Metastatic small cell neuroendocrine carcinoma diagnosed 03/2012 on liver biopsy with a physician's statement in 4/2012 that the prostate is likely the cause of the metastasis to the liver.
Example 2: Prostate adenocarcinoma diagnosed in 2006, treated with TURP. Bone marrow biopsy in 5/2012 shows involvement by metastatic small cell carcinoma with morphologic and immunophenotypic features that argue against prostatic adenocarcinoma. The oncologist assessment states, "The patient has Stage 4 small cell carcinoma of the prostate and the bone marrow biopsy path shows metastatic small cell carcinoma (likely prostate in origin)." |
Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619], followed by small cell (neuroendocrine) carcinoma [8041/3] of the prostate [C619] for each of the examples given per Rule M10.
In each case, the second histology (because it is not adenocarcinoma) is a new prostate primary. Small cell carcinoma and small cell neuroendocrine carcinoma are not adenocarcinomas. As a result they are not covered by Rule M3. |
2013 |
|
20130206 | Primary site--Heme & Lymphoid Neoplasms: What rule applies to code a primary site for a peripheral blood diagnosis of marginal zone lymphoma that has a positive flow cytometry/FISH analysis when no biopsies are performed, scans show no evidence of disease, exam indicates no lymph nodes are palpable and the physician's clinical diagnosis "marginal zone lymphoma, unspecified site, stage 1"? See Discussion. | PE: No palpable lymph nodes.
PET scan: No spleen or lymph node uptake; no uptake anywhere in the body.
Peripheral blood and flow cytometry/FISH analysis diagnosis: Marginal zone lymphoma.
No bone marrow or biopsy of any lymph nodes done. Doctor states "marginal zone lymphoma, unspecified site, stage 1." |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule PH27, code the primary site to C809 [unknown primary]. According to Rule PH27 one is to code the primary site to unknown primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR multiple organ involvement without any nodal involvement.
If further workup is done and a primary site is determined, update the primary site for this case.
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. |
2013 |
|
20130105 | Primary Site--Heme & Lymphoid Neoplasms: How is the primary site coded for a B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma when a biopsy of the paraspinal muscle and epidural tissue is positive, but there is no indication of lymph node involvement in the chart? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Code the primary site to soft tissue of the back, NOS [C496] per Rule PH24 and the Abstractor Notes in the Heme DB for B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma. Code the primary site to the organ when lymphoma is present only in an organ. The lesion is described as epidural (tissue surrounding the dura) and involving paraspinal muscle, NOS. Both are connective or other soft tissues of the trunk, NOS [C496]. B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is a synonym for DLBCL 9680/3. When there is no primary site listed in the Heme DB, go to the Abstractor Notes. In the Abstractor Notes section it states that patients present with lymphadenopathy OR mass lesions in extranodal sites. 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. |
2013 | |
|
20130007 | MP/H Rules/Histology--Colon: What rule applies and how is histology coded if a colon tumor is composed of moderately differentiated adenocarcinoma and neuroendocrine tumor, grade 1 (G1)? See Discussion. |
Intestine, large -- moderately differentiated adenocarcinoma
Pathological stage: IIIA (T2 N1a Mx) -- Neuroendocrine tumor, G1
Addendum comment: The results of the immunochemical study are compatible with a neuroendocrine tumor, G1. |
For cases diagnosed 2007 or later, the correct histology code is 8244/3 [composite carcinoid]. The steps used to arrive at this decision are:
Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Colon Histology rules because site specific rules have been developed for this primary.
Step 2: Start at the SINGLE TUMOR module, rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H9. Code the histology as 8244/3 [composite carcinoid] when the diagnosis is adenocarcinoma and carcinoid tumor.
Neuroendocrine tumor, grade 1 (G1) is synonymous with carcinoid tumor [8240/3] for the purpose of rule H9. |
2013 |
|
20130041 | Reportability--Heme & Lymphoid Neoplasms: Is a flow cytometry immunophenotyping of peripheral blood that demonstrates a chronic lymphocytic leukemia (CLL) phenotype reportable as CLL? See Discussion. | Final Diagnosis: "Peripheral blood, flow cytometry immunophenotyping: Monoclonal B-cell lymphocytosis with Chronic Lymphocytic Leukemia (CLL) phenotype; Negative for Zap 70; No abnormal T-cell population identified; CD34-positive blasts are not increased. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is reportable. Code the histology to 9823/3 [chronic lymphocytic leukemia (CLL)]. Per Rule PH5, Note 1, CLL will always have peripheral blood involvement. Based on the provided information, this patient's peripheral blood is positive for CLL.
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. |
2013 |
|
20130033 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a low grade B-cell lymphoma with plasmacytic differentiation? |
This answer has been corrected. Previous answer is shown below under "History." Assign 9591/3 for this case. See also SINQ 20190070. |
2013 | |
|
20130027 | Reportability--Are well-differentiated neuroendocrine tumors and grade 1 neuroendocrine tumors of the appendix now reportable? See Discussion. |
The terminology for carcinoid tumors has changed. The current terminology used is "neuroendocrine tumor." Are well-differentiated neuroendocrine tumors of the appendix non-reportable because carcinoid, NOS of the appendix has a borderline behavior code [8240/1]? When the histology/behavior codes for the term "well-differentiated neuroendocrine tumor" became 8240/3, did SEER intend this change to also apply to appendix primaries? If so, for which diagnosis year did this change go into effect? |
Well-differentiated neuroendocrine tumors and grade 1 neuroendocrine tumors of the appendix are reportable because these tumors have a morphology code 8240/3 per the WHO Classification of Tumors of the Digestive System. However, per the ICD-O-3, carcinoid tumors of the appendix have a behavior code of /1 [borderline]. The terminology of neuroendocrine tumors is evolving and current thinking at the international level is that carcinoid/WD NET of appendix is reportable. However, reportability in the United States is based on ICD-O-3. The histology code for "Carcinoid of appendix" is 8240/1; the histology code for a carcinoids of all other primary sites is 8240/3. Until the United States adopts the proposed changes for ICD-O-3, reportability of appendix cases is as follows:
|
2013 |