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20130216 | Primary site--Heme & Lymphoid Neoplasms: Need help determining primary site for Diffuse Large B-Cell Lymphoma 9680/3 confirmed pathologically in right ovary and soft tissue left adnexa. No lymph nodes examined pathologically. Patient treated outside and no access to notes. See discussion. |
CT A/P massively enlarged uterus with no distention between the vagina, cervix or proximal to mid uterus identified. Highly concerning for malignancy though distinct etiology not clear. Ovarian not favored though not excluded given lack of clearly defined fat planes between uterus and either ovary. Extensive bilateral iliac chain and periaortic/pericaval lymphadenopathy.
Trying to work through Module 7 in the Hem DB. According to the ovary site, regional lymph nodes include the iliac and the para-aortic lymph nodes. This makes me think I should use Rule PH35 (organ and regional nodes). However, using Appendix C in the Hem DB, the iliac lymph nodes are part of the pelvic C775 while the para-aortic (periaortic) are intra-abdominal C772. This makes me wonder if I should go with rule PH36 present in organ and nodes that are not regional. |
Use Rule PH25 and code primary site to C569.
First determine if the iliac and para-aortic lymph nodes are regional for Ovary. Use AJCC TNM or Collaborative Stage. Per AJCC 7th edition, regional lymph nodes for ovary include iliac and para-aortic (pg. 419). Therefore, this case involves an organ and its regional lymph nodes. Use appendix C to determine how to code a lymph node primary. It should not be used to determine whether lymph nodes are regional for a specific organ. |
2013 |
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20130077 | Reportability--Heme & Lymphoid Neoplasm: What is the histology code if a myeloproliferative disorder is reportable should a physician suspect this diagnosis and treats the patient? See Discussion. | Physician suspects patient has a myeloproliferative disorder and treats her with a phlebotomy and Hydrea. Patient receives Hydrea during an inpatient stay, but does not see the Heme/Onc again. The patient is subsequently only seen by a Palliative Medicine physician who also states she has an underlying myeloproliferative disorder. The patient died while an inpatient. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].
The term is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4). Also, the patient was treated for a myeloproliferative disorder, making this a reportable clinical diagnosis per the SEER Manual (Reportability, Pg 4, Exception 1).
Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.
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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20130094 | MP/H Rules/Multiple primaries--Lung: How many primaries are accessioned and which M rule applies for a 2010 diagnosis of clear cell adenocarcinoma of the left upper lobe lung followed by a 2012 diagnosis of adenosquamous carcinoma of lung origin without evidence of a primary lung tumor? See Discussion. | Patient was diagnosed with T1 N0 M0 adenocarcinoma with prominent clear cell features [8310/3] in the LUL on 08/05/2010. The patient underwent a lobectomy only.
On 10/09/2012 the patient underwent an iliac bone biopsy showing non-small cell carcinoma with glandular and squamous features [8560/3]. Clinically, the physician is calling this stage IV adenosquamous carcinoma of lung origin involving lymph nodes, spleen and bones. There were no FDG avid pulmonary nodules found. There was no pathologic comparison to the prior lung tumor.
Should the 2012 diagnosis be a new primary because the histology is different from the 2010 diagnosis? Or should this be one primary because there appears to be only metastatic disease with no new primary lung tumor identified in 2012? The choice of one primary seems supported by the fact that the 2012 tumor showed glandular and squamous features, and the 2010 tumor also showed glandular and clear cell (NOS) features. The clear cell could have been a clear cell squamous cell carcinoma. The original tumor was not re-examined. |
Accession a single primary, clear cell adenocarcinoma [8310/3] of the left upper lobe lung [C341] diagnosed on 08/05/2010.
The MP/H Rules do not apply to the 2012 diagnosis because only metastatic sites were examined and there was no re-examination of the original 2010 tumor. Therefore, the disease process in 2012 is assumed to be metastatic from the lung primary diagnosed in 2010. |
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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20130152 | Primary site/Histology--Brain and CNS: How is the primary site and histology coded for a 2013 diagnosis of squamous cell carcinoma arising in a dermoid cyst of the third ventricle? See Discussion. | Patient has a dermoid cyst of the third ventricle of the brain diagnosed in 1998. In 2013 the cyst was removed and was diagnosed as squamous cell carcinoma. An internet search revealed a journal article in the Journal or Neuro-Oncology that states, "Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis." The combination of site C715 [third ventricle, NOS] and histology 8070/3 [squamous cell carcinoma] fails SEER Edit IF 38_3: Primary site and Morphology Impossible. | According to the literature, intracranial squamous cell carcinoma is very rare with most cases arising from a preexisting benign epidermoid cyst. The combination of C71_ and 8070/3 should be allowed. We will submit a request to have this edit revised. | 2013 |
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20130148 | Reportability--Brain and CNS: Are "spinal" schwannomas reportable if stated to be extradural, vertebral nerve sheath, or of specific vertebrae? See Discussion. | Are any of the following cases reportable?
Example 1: Clinical Diagnosis: Extradural spinal cord tumor compatible with schwannoma. What assumptions should be made about reportability if the tumor is described as being extradural? The extradural spinal cord includes epidural fat surrounding the thecal sac and exiting nerve roots. Does this mean there are not nerve roots in the extradural spinal cord?
Example 2: Final Pathologic Diagnosis: Designated "C3-4 nerve sheath tumor" excision: Morphologic and immunohistochemical findings consistent with cellular schwannoma. When stated to be a "nerve sheath tumor" does that mean peripheral nerve (C47_) involvement or nerve root (C72_) involvement?
Example 3: Final Pathologic Diagnosis: T-8 vertebral tumor resection: Schwannoma with degenerative changes (calcification, cyst formation) - ganglion and nerve are identified. There is no mention clinically or pathologically whether this tumor is "intradural" or "of the nerve root." In the absence of information about whether the location of the tumor is intradural or involving the nerve root, is it assumed that it does involve this part of the spinal cord when a specific vertebrae is removed? |
Extradural schwannomas are not reportable. Neither vertebral nerve sheath nor a location of/on a specific vertebrae confirm the origin as being either extradural or intradural. Do not report a schwannoma if it cannot be determined to be "intradural" or "of the nerve root." | 2013 |
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20130140 | Reportability/Ambiguous terminology--Heme & Lymphoid Neoplasms: Is a peripheral blood sample with an immunophenotype that is "characteristic of B-cell chronic lymphocytic leukemia" reportable? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is a reportable diagnosis of chronic lymphocytic leukemia [9823/3]. The physician is using the terms "characteristic of" in the same manner as he/she would use the terms "diagnostic of."
This case fits with the usual diagnosis of CLL. The peripheral blood is diagnostic for leukemias. There was a specific leukemia noted, B-cell chronic lymphocytic leukemia. CLL (B-cell is the phenotype) is usually diagnosed incidentally by a peripheral smear because it is asymptomatic. However, we recommend looking for further work-up, such as a bone marrow 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. |
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20130168 | Date of diagnosis--Heme and Lymphoid Neoplasms: Is the date of diagnosis coded to the date a bone marrow biopsy revealed "plasma cell neoplasm; plasma cells are < 10%" or the date a diagnosis of myeloma was noted in the Discharge Summary? See Discussion. | Bone marrow biopsy pathology states: Plasma Cell Neoplasm. The plasma cells are < 10%.
Subsequent to the bone marrow biopsy, the Discharge Summary indicated the patient has a diagnosis of myeloma, hypercalcemia and negative bone marrow surveys.
What date is used for the date of diagnosis? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Use the date of the Discharge Summary as the date of diagnosis. In this case, the date of diagnosis is the date the physician confirmed the diagnosis of myeloma using all information available.
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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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 |
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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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