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20130001 | Reportability--Brain and CNS: Are hemangioma, NOS (9120/0), cavernous hemangioma (9121/0) or venous hemangioma (9122/0) reportable when they arise in the brain or CNS?
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Hemangioma, NOS (9120/0) and cavernous hemangioma (9121/0) arising in the dura and parenchyma of the brain/CNS are reportable.
Venous angiomas (9122/0) are not reportable wherever they arise. The primary site for venous hemangioma arising in the brain is blood vessel (C490). The combination of 9122/0 and C490 is not reportable. This is a venous abnormality. Previously called venous angiomas, these are currently referred to as a developmental venous anomalies (DVA). |
2013 | |
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20130045 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if subsequent to a bone marrow biopsy diagnosis of acute myeloid leukemia there is an oncology consult note that indicates the pathology finding is suggestive of an underlying myelodysplastic syndrome? See Discussion | 5/14/12 Bone marrow biopsy: Acute myeloid leukemia (AML).
5/21/12 Oncology consult: AML with 30-40% blasts and evidence of del(20q) and del(5q), is suggestive of an underlying myelodysplastic syndrome (MDS). Hence the patient has secondary AML.
If these are two primaries, how are the diagnosis dates coded? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case is accessioned as a single primary diagnosed on 5/14/12 as acute myeloid leukemia with myelodysplasia-related (e.g., del(5q)) changes [9895/3] per Rule M2. The patient was diagnosed with a single histology, acute myeloid leukemia with myelodysplasia-related changes per the submitted information.
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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20130191 | Systemic/Surgery Sequence--Bladder: How is the systemic treatment/surgery sequence field coded for a 2013 case if the patient has a TURBT followed by multi-agent chemotherapy, and then a cystoprostatectomy followed by post-operative multi-agent chemotherapy? | For cases diagnosed in 2012 and later, code 7 (surgery both before and after systemic therapy) seems like the most appropriate answer. However, previous SINQ entries 20091055 and 20071102 have conflicting answers regarding surgery before and after systemic therapy. Do these SINQ entries apply to a 2013 diagnosis? Would the systemic treatment/surgery sequence be coded 7 because this patient had surgery then chemotherapy followed by more surgery? Should the post-operative systemic treatment be ignored in coding the sequence in this case? | Code the Systemic/Surgery Sequence to 7 [surgery both before and after systemic therapy] for this case.
The answers to SINQ 20091055 and 20071102 do not apply to a case diagnosed in 2013. These answers were posted prior to code 7 becoming effective in 2012. |
2013 |
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20130022 | Reportability--Melanoma: Is "early" melanoma reportable? See Discussion. |
Because "evolving" melanoma was never reportable, this issue only relates to "early" melanoma. |
For cases diagnosed 2018 to 2020, early or evolving melanoma is not reportable. Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. The tumors may be described as "proliferation of atypical melanocytes confined to epidermal and adnexal epithelium," "atypical intraepidermal melanocytic proliferation, "atypical intraepidermal melanocytic hyperplasia"; or "severe melanocytic dysplasia." Not reportable. Melanoma Solid Tumor Rules, 2018, page 3, https://seer.cancer.gov/tools/solidtumor/Melanoma_STM.pdf |
2013 |
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20130043 | Reportability--Heme & Lymphoid Neoplasms: Is reactive plasmacytosis a reportable diagnosis that is equivalent to plasmacytoma? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Reactive plasmacytosis is not reportable unless there is another indication of a reportable neoplastic disease. Reactive plasmacytosis is "a well known pathological process described as occurring in a variety of situations including infections, autoimmune disease, diabetes mellitus, sideropenia, liver cirrhosis and neoplastic conditions including leukemia. This process, by definition, is assumed to be a reaction of the immune system to an unknown or poorly defined stimulus." Based on this definition, reactive plasmacytosis is not the same as a plasmacytoma, although it may indicate the presence of a neoplastic process, such as 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. |
2013 | |
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20130055 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a lymphoma with multifocal bone and epidural involvement but no lymph node involvement if the physician does not clearly state the primary site? See Discussion. | MRI Lumbar spine: Bony metastatic disease most evident at L5, L3 and T10. There is marrow tumor in the posterior elements of T12 and T10. The 14 mm epidural mass represents epidural tumor, likely metastatic, extending into the left intervertebral foramen at T12-L1.
PET scan: Hypermetabolic activity corresponding to epidural mass at the level of T12 and L1 concerning for malignancy. Other small areas of hypermetabolic activity in the left mandible and both femoral necks. There is no hypermetabolic activity corresponding to the areas of abnormal marrow edema in the vertebral bodies which enhanced on MRI scan in the lumbar and lower thoracic spine. No lymph nodes mentioned.
Biopsy epidural mass: Diffuse large B-cell lymphoma with a background of follicular lymphoma, consistent with a large cell transformation. Flow cytometry confirms a mixed large and small cell population of lymphoma (55% large cells).
T12/L1 Bone Biopsy: Bone and marrow with atypical paratrabecular lymphoid infiltrates, suspicious for involvement by follicular lymphoma. Negative for large cell lymphoma. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site of the diffuse large B-cell lymphoma [9680/3] to C809 [unknown primary site] per Rule PH27. The patient has involvement of multiple bones and an epidural mass with no evidence of nodal involvement. Code the primary site to unknown [C809] when multiple organs are involved without any lymph node involvement, even when there is no statement from the physician regarding primary site.
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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20130167 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported if a 2013 diagnosis of right leg skin nodules, consistent with plasmacytoma/plasma cell myeloma, follows a 3/20/07 biopsy diagnosis of multiple myeloma? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Abstract this case as a single primary. Code the histology to 9732/2 [multiple myeloma]. Review the Abstractor Notes section in the Heme DB for multiple myeloma. It states that in multiple myeloma there is generalized bone marrow involvement and that extramedullary involvement is diagnostic of advanced disease. This is a case of advanced multiple myeloma. |
2013 | |
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20130139 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the original slides are reviewed at a later date and the revised diagnosis changes the histology? See Discussion. | Diffuse large B-cell lymphoma [9680/3] diagnosed in 5/2010 and treated with chemotherapy. In 11/2012 a bone marrow biopsy revealed small lymphocytic lymphoma (CLL/SLL) [9823/3].
The 2010 slides were reviewed and showed, "a large cell lymphoid proliferation, many of the cells which appear to be prolymphocytes. There are background smaller lymphocytes that are consistent with CLL/SLL. In retrospect, the lymph node most likely represented a prolymphocytic conversion in SLL."
The medical oncologist is calling this a recurrent lymphoma. Should the original 5/2010 diagnosis be changed to 9823/3 [CLL/SLL]? Is this documented in the Heme Manual? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Change the histology of the original 2010 diagnosis to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma] based on the review of the 2010 slides. The 2010 diagnosis was revised based on the review of slides and the histology should be changed accordingly. The closest example of this is located in the SEER Manual, Changing Information on the Abstract, instruction 3, example 4.
Histology code 9670/3 [SLL] is obsolete for cases diagnosed 2010 and later. All diagnoses of CLL/SLL, CLL, and SLL are now coded to histology code 9823/3 [CLL/SLL].
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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20130056 | Primary site/Histology--Heme & Lymphoid Neoplasms: How are the site and histology fields coded if a bone marrow biopsy shows, "B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma," but the patient has no palpable lymphadenopathy and no scans were done? See Discussion. | Should the primary site be C779 or C421? Is the correct histology 9684/3 [malignant lymphoma, large B-cell, diffuse, immunoblastic, NOS]? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C421 [bone marrow] and the histology to 9680/3 [diffuse large B-cell lymphoma] per Rule PH26. B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is listed under Alternative Names section of the Heme BD for DLBCL [9680/3]. This patient has bone marrow involvement only. The Note for Rule PH26 instructs one to code the primary site to the bone marrow when all physical exams or work-up were negative for lymph node, tissue, or organ involvement OR no other work-up was done.
The histology is not coded 9684/3 [malignant lymphoma, large B-cell, diffuse, immunoblastic, NOS]. This histology code became obsolete in 1/1/2010. Diffuse large B-cell lymphoma, immunoblastic variant is also listed under Alternative Names section of the Heme BD for DLBCL.
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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