Report | Question ID | Question | Discussion | Answer | Year |
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20130010 | MP/H Rules/Histology--Skin: How is the histology coded for "infiltrative carcinoma with ductal alterations compatible with squamoid eccrine ductal carcinoma" of the skin? | Code the histology to 8413/3 [eccrine adenocarcinoma]. This is the most specific code available for this diagnosis.
According to our expert pathologist advisor, "The adnexal glands in the skin, sweat (eccrine) glands and apocrine glands, all have ducts which connect the business portion of each gland to the skin surface. Some of the adnexal tumors have features of differentiation which appear to be duct-like, hence the designation 'ductal.'"
In addition, "The 'squamoid' simply indicates some degree of squamous differentiation, but doesn't alter the usefulness of [code 8413/3] because we have no way of coding anything more specific in this case anyway." |
2013 | |
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20130146 | Histology--Heme & Lymphoid Neoplasms: What is the histology code for a diagnosis of myeloproliferative neoplasm/myelodysplastic syndrome overlap? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable]. Per the Definition section in the Heme DB, this neoplasm has the, "Clinical laboratory and morphological features of myeloproliferative neoplasm but fails to meet the criteria for a specific myeloproliferative neoplasm; or presents with features that overlap two or more MPN neoplasms."
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 | |
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20130137 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for follicular lymphoma, low grade? See Discussion. | Pathologists seem to be moving away from identifying follicular B-cell lymphomas as grade 1, grade 2, etc. Instead, the term follicular lymphoma, low grade is being used. Should the histology be coded as follicular lymphoma, NOS even though the Heme DB indicates this code is usually used for death certificate cases? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9690/3 [follicular lymphoma, NOS].
Low grade for follicular lymphoma are not listed in the Heme DB or Manual. Because low grade can mean grade 1 or grade 2, default to follicular lymphoma, NOS [9690/3].
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. |
2013 |
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20130134 | Reportability--Heme & Lymphoid Neoplasms: According to the hematopoietic database, systemic mastocytosis is reportable; does that include INDOLENT systemic mastocytosis (which is not listed in the list of alternative names)? |
For cases diagnosed 2018 and forward, indolent systemic mastocytosis is not reportable (9741/1). Smoldering systemic mastocytosis is reportable (9741/3). |
2013 | |
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20130114 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the bone marrow biopsy shows acute myeloid leukemia, but the physician states this is therapy-related AML secondary to prior radiation treatment? See Discussion. | Physician states this patient has radiation therapy-related AML due to radiation received as treatment for a prior prostate cancer. The bone marrow and other immunophenotyping do not state this is therapy-related AML. Should the histology be coded AML, NOS [9861/3] or therapy-related AML [9920/3]? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology as therapy-related acute myeloid leukemia, NOS [9920/3] when the physician states this is a therapy-related AML.
The therapy-related diagnosis may be either clinically or pathologically stated to code the histology to 9920/3. In this case, the physician is aware of the previous chemotherapy, hormone therapy or radiation and adds that knowledge to the histologic findings of AML. The pathology report did not include this clinical, historical information as part of the final diagnosis. However, one can code therapy-related acute myeloid leukemia because clinically it was stated.
We recommend that you clearly document in the abstract that you are coding a clinical histology.
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 |
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20130185 | Reportability/Behavior: Is HGSIL (high grade squamous intraepithelial lesion) of the vulva or vagina reportable and is it a synonym for histology code 8077/2 [squamous intraepithelial neoplasia, grade III]? |
For cases diagnosed 2018 and later HGSIL of the vulva or vagina is reportable. HGSIL is a synonym for squamous intraepithelial neoplasia, grade III. |
2013 | |
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20130070 | Reportability--Is "intraductal papillary mucinous neoplasm with low grade dysplasia" (also called IPMN adenoma) reportable? See Discussion. |
According to the ICD-O-3, the histology for IPMN adenoma is 8453/0 is non-reportable. However, per SINQ 20021099, this is reportable. |
Intraductal papillary mucinous neoplasm (IPMN) of the pancreas with low grade dysplasia, also referred to as IPMN adenoma, is not reportable. IPMN of the pancreas is reportable when stated as "IPMN with high-grade dysplasia," or "IPMN with an associated invasive carcinoma," or "IPMN with an associated in situ carcinoma." The case in SINQ 20021099 is stated to have "multifocal high grade dysplasia (so-called borderline tumor and carcinoma in-situ)" and is reportable because there is an explicit statement of carcinoma in situ, not because of the reference to the presence of high grade dysplasia. It is coded 8453/2 [Intraductal papillary-mucinous carcinoma, non-invasive]. |
2013 |
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20130157 | Primary Site--Heme & Lymphoid Neoplasms: What primary site code should be assigned and what rule justifies that code?
Scenario: Pleural effusion, underwent thoracentesis. Pleural fluid unexpectedly showed Large B-Cell Lymphoma. Extensive workup including CT & PET was done and all findings were within normal limits. No evidence of lymphoma was seen and no palpable adenopathy was found. The only indication of lymphoma was the malignant pleural effusion. |
Code to pleura, C384.
Per the Hematopoietic database, Diffuse Large B-Cell Lymphoma can originate in the pleural cavity. |
2013 | |
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20130215 | Reportability--Heme & Lymphoid Neoplasms: Is hemophagocytic lymphohistiocytosis synonymous with an EBV-associated lymphoproliferative disorder in children reportable? See Discussion. |
Pathology report states: Prominent T-cell infiltrate with frequent immunoblast-like cells. COMMENT: Findings consistent with an acute EBV-associated hemophagocytic process. In addition, there is a prominent CD8 + T-cell infiltrate with many large, activated forms. This T-cell process may represent an EBV-associated lymphoproliferative disorder in children. EBV-associated lymphoproliferative disorder in children is listed in the Heme database. However, throughout multiple admissions, the oncologist states the diagnosis as "hemophagocytic lymphohistiocytosis". Are the two the same condition? The patient is being treated with Etoposide. |
Per Appendix F, do not report this case based on the information provided. The oncologist likely used the pathology report and clinical factors to determine the diagnosis of hemophagocytic lymphohistiocytosis, which is not reportable. Hemophagocytic lymphohistiocytosis is caused by an over stimulated immune system (infection, etc.). This clinical syndrome is associated with a variety of underlying conditions. To be reportable, it must state "fulminant hemophagocytic syndrome" (in a child) to be reportable (9724/3). The pathology report for this case is not definitive. It states that the process "may" represent the EBV-associated lymphoproliferative disorder in children. Follow back on this case to confirm reportability if possible. |
2013 |
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20130113 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient diagnosed and treated for multiple myeloma is subsequently diagnosed with multiple large plasmacytomas involving the scalp and thorax? See Discussion |
The patient was diagnosed with multiple myeloma, underwent treatment and subsequently was in remission. The patient later presented with lesions on the scalp and thorax lesions. The final diagnosis on the pathology report for the scalp lesion was multiple myeloma with plasmablastic transformation (high grade). The physician states this is an aggressive, recurrent multiple myeloma with multiple large plasmacytomas involving the scalp and thorax. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Accession a single primary, multiple myeloma [9732/3] per Rule M2. The multiple myeloma is in an advanced stage when plasma cells are being deposited on the scalp and thorax. Clinically, those plasma cells are rightly called plasmacytomas by the physician. However, the patient has a late-stage multiple myeloma causing the plasma cells/plasmacytomas. Note that under the myeloma Recurrence and Metastases section of the Heme DB it indicates that extramedullary involvement (e.g., the scalp and thorax involvement) usually indicates advanced disease. Therefore, this scenario represents a case of a single histology that is accessioned as a single primary per Rule M2. 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 |