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Carcinoid heart disease is not reportable but this diagnosis indicates that the patient likely has a carcinoid tumor which may be reportable. Obtain further information.

Code high grade urothelial carcinoma described as having "extensive sarcomatoid dedifferentiation" to sarcomatoid transitional cell carcinoma (8122/3).

According to a consensus answer of the technical advisory group, a small group of representatives from each standard setter that meets periodically, microwave tumor ablation should be coded as surgery.  For liver, assign code 16 (Heat-Radio-Frequency ablation (RFA); for kidney, assign code 15 (Thermal ablation).

Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.

See also SINQ 200120078 and 20110069.

Hematopoietic neoplasms that transform generally don't have 'chronic' or 'acute' as part of their preferred name. The 'chronic' and 'acute' designations are determined by the usual course of the neoplasm. Chronic neoplasms are generally slow growing while acute neoplasms grow fast and are more widespread. Not all Hematopoietic neoplasms transform. Each neoplasm that has the ability to transform has the transformations listed under the 'Transformations to' and/or 'Transformation from' sections in the Hematopoietic database.

For example, Diffuse large B-cell lymphoma (histology code 9680/3) has no histologies/neoplasms listed under 'transformations to.' This means that this neoplasm does not transform to any other neoplasm. There are multiple histologies/neoplasms listed under 'Transformations from' indicating the neoplasms listed under the Transformations from are the chronic neoplasms, and DLBCL is the acute neoplasm. If DLBCL (9680/3) occurs at the same time, within 21 days, or greater than 21 days of any of the histologies listed under 'Transformations From,' rules M8-M13 apply. If DLBCL (9680/3) occurred at the same time as a neoplasm not listed in the Transformations sections, the acute and chronic rules do not apply.

Apply rule M6 and report a single primary.

Hurthle cell carcinoma is a snynonym for follicular carcinoma of the thyroid.

Code histology to combined carcinoid and adenocarcinoma (8244/3). The tumor is a mix of adenocarcinoma and carcinoid.

Basal cell carcinoma with neuroendocrine differentiation of the skin is not reportable to SEER.

In this case, the pathologist discussed several possible options, and determined that the final diagnosis is basal cell ca with neuroendocrine diff based at least partially on the immunostains.

Assign 8574/3 according to Other Sites rule H17 for basaloid carcinoma with squamous and neuroendocrine differentiation.

There is no combination code that includes basal cell, squamous, and neuroendocrine. We can combine basal cell with squamous, 8094/3, or carcinoma with neuoendocrine differentiation, 8574/3. Rule H17 directs us to assign the higher code, 8574/3.

Sirolimus is used to treat GVHD (graft versus host disease) and is not coded as treatment. Even though the sub-category is mTOR inhibitor it does not automatically mean it is a chemotherapeutic agent. Sirolimus affects cells differently than Temsirolimus.  The chemical compounds differ between these drugs. In order to code rapamycin, the drug given must be stated to be either the analog or ester compound.  The SEER*RX database has been corrected and NSCLC/glioblastoma are no longer listed for sirolimus.

 We researched clinical trials and found several that include sirolimus with other chemotherapy drugs for patients who either have received or will be receiving bone marrow transplants for hematologic diseases. In this case it is not coded. There are a few trials that are looking at sirolimus as a treatment for bladder, prostate, nerve sheath tumors, MDS, and AML. For these cases it would be coded in Other (code 2).