Report | Question ID | Question | Discussion | Answer | Year |
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20130014 | Reportability--Heme & Lymphoid Neoplasms: Is Castleman disease reportable when diagnosed 2010 and later? | When checking Castleman disease in the Hematopoietic Database, the result is a reportable histology code 9738/3. However, per an online search, Castleman disease is a very rare disorder characterized by non-cancerous growths (tumors). | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Castleman disease, NOS, is not reportable for cases diagnosed 2010 and later. However, when Castleman disease is diagnosed in connection with large B-cell lymphoma [9738/3], it is reportable.
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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20130091 | Treatment, NOS--Heme & Lymphoid Neoplasms: Which guidelines are used to code treatment for hematopoietic diseases diagnosed prior to 2010? | For cases diagnosed 1/1/2010 and later, use the Hematopoietic & Lymphoid Neoplasm Manual for instructions on coding aspirin, blood thinners/anti-clotting medications, and transfusions in the field "Other Treatment."
For cases diagnosed 5/1/2002 12/31/2009, use the instructions in the SEER Manual and the instructions in "Abstracting and Coding Guide for the Hematopoietic Diseases" to code aspirin, blood thinners/anti-clotting medications, and transfusions in the field "Other Treatment."
For cases diagnosed 1/1/2001 04/30/2002 use the instructions in the SEER Manual for collection of aspirin, blood thinners/anti-clotting medications, and transfusions in the field "Other Treatment."
Prior to 1/1/2001, these treatment modalities were not collected. |
2013 | |
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20130093 | MP/H Rules/Histology--Lung: What histology code is used for an adenocarcinoma in situ/bronchioloalveolar carcinoma (BAC) of the lung? See Discussion. | Classification of lung malignancies has undergone a change. The bronchioloalveolar carcinoma histology is being replaced by adenocarcinoma in situ and minimally invasive adenocarcinoma, using an evaluation of lepidic growth pattern in the tumor.
The final diagnosis is "adenocarcinoma in situ/BAC" and the comment states, "The findings in the current biopsy are most compatible with low grade malignant lesions which, in this sample, shows features of adenocarcinoma in situ (former bronchioloalveolar adenocarcinoma), given the proliferation of pneumocytes is limited to the alveolar lining with no evidence of invasion. However, classification of the lesion depends, per reference guidelines (Travis et al. J THOR ONCOL 2011 6,(2):244-275), on its size and its overall histologic features, to rule out the presence of an invasive component and therefore can only be performed upon examination of it in its entirety, upon resection." The radiation oncologist staged this T1N0M0, stage 1 BAC. |
Code the histology to 8140/2 [adenocarcinoma in situ, NOS].
The comment for this case is consistent with information from the CAP protocol, which says, "The diagnosis of bronchioloalveolar carcinoma requires exclusion of stromal, vascular, and pleural invasiona requirement that demands the tumor be evaluated histologically in its entirety. It is therefore recommended that a definitive diagnosis of bronchioloalveolar adenocarcinoma not be made on specimens in which the tumor is incompletely represented."
This tumor was not completely resected. Therefore, code to adenocarcinoma in situ based on the information provided. |
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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20130040 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what rule applies when a patient has a history of chronic myeloid leukemia diagnosed in 1993 followed by a diagnosis of acute myeloid leukemia arising in chronic myelogenous leukemia, blast phase? See Discussion. |
12/1993 Bone marrow biopsy: Chronic myeloid leukemia t(9;22) (q34;q11).
09/2011 Bone marrow biopsy: Abnormal cytogenetic & FISH support persistent involvement by chronic myelogenous leukemia.
12/2011 Peripheral blood, flow cytometry: Involvement by acute myeloid leukemia arising in chronic myelogenous leukemia (CML, blast phase, 30% blasts by manual diff.).
Is the 12/2011 diagnosis a new primary? If not, why don't Rules M8-M13 apply when the Heme DB Abstractor Notes section for CML indicates that when there is a chronic, accelerated and blast phase that develops later in the course of the disease, change the histology code to the more specific diagnosis?
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For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as a multiple primary: chronic myelogenous leukemia t(9;22) (q34;q11) [9863/3] diagnosed in 1993 and acute myeloid leukemia [9861/3] diagnosed in 2011 per Rule M15.
Use the diagnosis date to determine the appropriate manual and rules to follow to determine the histologies for this case. To determine the histology of the 1993 diagnosis, use the ICD-O-2. The Heme Manual & DB will be used to determine the number of primaries and the histology of the 2011 diagnosis of AML.
Rules M8-M13 in the Heme Manual cannot be applied to this case because no transformation occurred. CML does not transform to another neoplasm.
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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20130165 | MP/H Rules/Multiple primaries--Thyroid: How many primaries are reported and what is histology for the papillary carcinomas if a Classical cytomorphology with a follicular architecture is on the right and a Columnar cell cytomorphology with a follicular and papillary architecture is on the left? See Discussion. |
The answer seems to hinge on whether or not the two tumors differ at the third digit of histology. Can we code the histology based on the terms listed for variant or architecture? |
This is a single thyroid primary. The tumors are both papillary carcinoma with follicular architecture for the most part. Apply Rule M6 and abstract a single primary. | 2013 |
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20130147 | Primary site--Heme & Lymphoid Neoplasms: What the primary site for a diagnosis of Langerhans cell histiocytosis with multifocal multisystem involvement of the skin, chest, CNS and thyroid, but no evidence of involvement on a bone scan? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the primary site to C809 [unknown].
Langerhans Cell Histiocytosis (LCH) includes three major groups:
When the disease is both multifocal and multisystem, code the primary site to unknown [C809] because there is no way to identify the origin of the neoplasm in this situation.
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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20130009 | Grade--Pancreas: Can the grade be coded when a biopsy is taken from the part of a primary tumor that has contiguously extended into an adjacent organ or structure? See Discussion. | The grade rule states to code grade from tissue removed from the primary tumor only, never from a metastatic site or a site of recurrence. There is no mention of whether the grade can be coded if only the contiguous site of involvement is biopsied when a single tumor directly extends to an adjacent tissue or organ. For example, is grade coded to 2 when a pancreatic tumor extends into the duodenum, and the duodenal biopsy confirms moderately differentiated adenocarcinoma consistent with a pancreatic primary? Or does the primary organ/site have to be biopsied in order to be able to code grade? | For one tumor involving a contiguous site, when there is no tissue specimen available from the primary site, you may code the grade based on the tissue from the tumor in the contiguous site.
This instruction is included in the upcoming grade instruction document. |
2013 |
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20130211 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported if a bone marrow shows low grade mature B cell lymphoma with IgM paraprotein - macroglobulinemia? See Discussion. | Physician note: Bone marrow shows 10% involvement with low grade lymphoma. Assessment: Low grade mature B cell lymphoma with IgM paraprotein - macroglobulinemia.
The multiple primaries calculator indicates two primaries are to be reported. However, the physician stated that Waldenstrom's macroglobulinemia is another name for this patient's lymphoma.
There were no enlarged lymph nodes seen on the CT scan. The proposed treatment for this patient is Rituxan for the macroglobulinemia. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M2, this is a single primary because there is a single histology. The bone marrow initially showed a non-specific B-cell lymphoma. WM is a type of B-cell neoplasm. After immunophenotyping, a more specific histologic diagnosis of WM was made. In this case a single histology (WM) is diagnosed by the definitive diagnostic method (serum paraprotein demonstrating IgM), so it accessioned as a single primary.
Per PH16, code the histology to 9761/3 [Waldenstrom Macroglobulinemia (WM)] and the primary site to C420 [blood].
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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20130088 | Grade--Heme & Lymphoid Neoplasms: Should Grade be coded to 5 [T-cell] or 9 [cell type not determined, not stated, not applicable] for anaplastic large cell lymphoma, NOS [9714/3]? See Discussion. | Under the Grade section in the Heme DB for anaplastic large cell lymphoma, NOS it indicates the following:
"Grade - Code grade specified by pathologist. If no grade specified, code 9."
There is no reference in the Grade section that we should look at the Abstractor Notes or a specific Module in the Heme DB for additional information. However, in the Abstractor Notes section it states, "Grade is T-cell (5) unless pathologist specifically designates as a B-cell (see G2 rule)." These two statements are conflicting. Which is the correct grade? |
Assign code 5 [T-cell] for anaplastic large cell lymphoma [9714/3] unless the pathologist specifies that the histology is a B-cell disease process. See Grade rule G2, Note 2.
In the Heme DB, there is a default value in the Grade field for histologies that do not have a grade specified. However, this particular histology does not default to code 9. There was an error in the Grade section of the 2010 and 2012 versions of Heme DB that has now been corrected in the latest release. |
2013 |