Multiple primaries--Heme & Lymphoid Neoplasms: Is this one primary or two? Follicular lymphoma grade 1 (9695/3) on 8/23/12 from an abdominal lymph node. On 1/6/14 an abdominal lymph node biopsy showed diffuse large b cell lymphoma arising from high grade follicle center cell lymphoma. Patient has been on observation.
1st primary, 8/23/12: Follicular lymphoma, grade 1 2nd primary, 1/6/14: Diffuse Large B Cell Lymphoma
Apply the multiple primary rules twice for this case. The 2012 diagnosis is follicular lymphoma. There are two histologies in 2014: diffuse large b cell lymphoma and follicle center cell lymphoma diagnosed at the same time in the same location. This is one primary per rule M4.
Then compare the 2012 diagnosis to the 2014 diagnosis.
Per the Hematopoietic Database, follicular lymphoma (all types) transforms to DLBCL. Per Rule M10, the DLBCL would be a second primary.
MP/H Rules/Multiple primaries--Thyroid: How many primaries should be reported when a complete thyroidectomy specimen shows two tumors: 1.8 cm papillary carcinoma with tall cell features (8344/3) and a 0.4 cm papillary thyroid carcinoma (8260/3)? See discussion.
Is papillary thyroid carcinoma an NOS histology qualifying for rule M16, thus leading to a single primary, or would M17 apply (multiple primaries) because the histology codes are different at the second digit (8260 and 8344)? While rule M16 doesn't include papillary thyroid carcinoma in the listed histologies, it seems like it may be an NOS histology for the thyroid. In addition, code 8260/3 is listed as NOS in the ICD-O-3.
Apply rule M16 and abstract a single primary. These two thyroid tumors, one papillary carcinoma with tall cell features (8344/3) and one papillary thyroid carcinoma, fit the criteria for rule M16, although not explicity listed there. We will clarify this in the next version of the rules.
Reportability--Ovary: Can you clarify when widely metastatic borderline histologies of the ovary and various other sites are reportable? See discussion.
SINQ 20130176 states that an adult granulosa cell tumor of the ovary with metastases is malignant. However, SINQ 20091087 states that a borderline tumor of the appendix with metastasis is not reportable.
The first statement of 20130176 “though granulosa cell tumor is coded 8620/1, the presence of peritoneal or lymph node metastases indicate the tumor is malignant and coded as /3” does not coincide with the second statement of “the behavior of borderline/LMP ovarian epithelial tumors is determined by the ovarian primary, even though there may be peritoneal implants or metastatic disease in the lymph nodes”. If the ovarian metastases do make this a reportable malignancy, can this line of thinking be used to determine reportability for borderline histologies for other sites such as the appendix?
The case in 20130176 is adult granulosa cell tumor. The answer points out an important difference in the way "metastases" from this histology should be interpreted versus low malignant potential ovarian epithelial tumors. Metastases from adult granulosa cell tumor of the ovary indicates a malignant primary. So-called metastases from a LMP epithelial tumor do not indicate a malignant primary when the metastatic deposits are also LMP/borderline in behavior.
Do not apply instructions for ovarian cases to other primary sites including appendix.
Reportability/Histology--Heme & Lymphoid Neoplasms: Is primary erythrocytosis equivalent to primary polycythemia and thus reportable? See discussion.
Per the Heme Manual, Appendix F - Non-Reportable list for Heme Diseases, under Polycythemia, the Comment states that polycythemia is also known as erythrocytosis. Because polycythemia is equivalent to erythrocytosis, can we assume that "primary erythrocytosis" is equivalent to "primary polycythemia" and thus reportable as 9950/3 per the Heme DB? Or is the case nonreportable because the exact term of "primary erythrocytosis" is not listed as an alternate name for polycythemia vera, only "primary polycythemia" is listed?
Primary erythrocytosis is not equivalent to primary polycythemia and is not reportable. This will be clarified in a future revision. Thank you for point it out to us.
Reportability--Pancreas: Is a solid pseudopapillary neoplasm of the pancreas reportable?
Solid pseudopapillary neoplasm of the pancreas is reportable. According to the WHO classification, it is a "low-grade malignant neoplasm…[which] frequently undergoes hemorrhagic-cystic degeneration and occurs predominantly in young women."
Assign topography code C25 with the appropriate 4th digit. Code the histology as 8452/3.
Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion.
The SEER Coding and Staging Manual instructs one to code the primary site to the location where the tumor originated, in this case the liver. However, there is no CS Extension code for in situ tumors found in the CS Manual Liver Schema.
Based on the information provided, the primary site is liver. Submit the CS question to the CoC CAnswer Forum, http://cancerbulletin.facs.org/forums/content.php
First course treatment/Surgery of Primary Site--Anus: Would infrared coagulation be coded as treatment for AIN III of the anus/anal canal? See discussion.
SINQ 20051064 indicates infrared coagulation is not treatment for cancer. Internet search explains that infrared coagulation delivers heat to destroy the tissue so it can be removed. In our region it is currently used to treat internal and external anal low grade squamous intraepithelial lesions (LSIL) and high grade squamous intraepithelial lesions (HSIL). While it is understandable that this wouldn't be coded as treatment for an invasive anal primary, could it be treatment for an in situ tumor? If it is treatment, should it be coded under Surgery code 15
The answer to SINQ 20050164 still applies. Do not code infrared coagulation as cancer treatment. It is used to coagulate blood vessels and not to destroy cancer tissue.
MP/H Rules/Histology-Urinary: 1) What is the correct ICD-O-3 morphology code for conventional renal cell carcinoma? Is this clear cell carcinoma or does conventional refer to the general diagnosis?
2) If a patient was diagnosed with invasive papillary urothelial carcinoma of the bladder in May 2011 and returns in February 2013 with invasive urothelial carcinoma of the bladder, what is the correct ICD-O-3 morphology code?
1) Clear cell renal carcinoma, code 8310, is often called conventional renal cell carcinoma. It is specific compared to renal cell carcinoma, NOS, code 8312, a general morphology term for the majority of kidney cancers. See kidney rules H5 and H12 and Table 1 on page 57 of the Kidney Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
2) Do not change the ICD-O-3 code assigned for the 2011 diagnosis. As you know, the 2013 diagnosis is not a new primary per rule M6.
MP/H Rules/Histology--Sarcoma: What would be the morphology code for a low grade myofibroblastic sarcoma of the left distal forearm? I tried several different combinations but the closest I could come up with is myosarcoma.
Assign code 8825/3. Apply the ICD-O-3 Matrix Concept, Rule F, page 29 of the hardcover ICD-O-3. The WHO Classification of Soft tissue and Bone, page 85, lists low grade myofibroblastic sarcoma, also called myofibrosarcoma, 8825/3.
MP/H Rules/Histology--Bladder: What is the correct histology code for a diagnosis of urothelial plasmacytoma carcinoma of the bladder per pathology report?
Assign code 8120/3, urothelial carcinoma, NOS, to urothelial plasmacytoma carcinoma of the bladder. The WHO classification describes plasmacytoid variants of urothelial carcinoma. There is no specific ICD-O-3 code for these variants; however, and 8120/3 must be used.
An official website of the United States government
Home