Reportability--Leukemia: Is the diagnosis "a minority abnormal T-cell population (2-3%) with phenotypic features of large granular lymphocyte leukemia cells" reportable if it is from a flow cytometry procedure performed on a non-diagnostic bone marrow biopsy specimen? See Discussion.
Pt had only a bone marrow Bx done at the hospital.
Bone marrow biopsy and aspirate:
Peripheral blood showing mild relative lymphocytosis and mild relative neutropenia.
Normocellular bone marrow (50%) with mild eosinophilia. No conclusive morphologic evidence of a neoplastic process.
Flow cytometry of the marrow shows a minority abnormal T-cell population (2-3%) with phenotypic features of large granular lymphocyte leukemia cells. PCR is positive for a clonal T-cell population. The significance of these findings is unclear.
COMMENT: Flow cytometry, PCR and morphologic correlation were performed at [names removed]. The significance of a minimal, clonal, large granulocyte leukemia population absent absolute lymphocytosis is unclear. Positive results for a T-cell receptor PCR study in the setting of mild leukopenia alone is reportedly relatively common and usually regarded as nonspecific. In essence, this could be characterized as a small, monoclonal T-cell proliferation of uncertain significance associated with mild leukopenia. Appropriate follow up is suggested.
For cases diagnosed prior to 1/1/2010:Do not report this type of case until there is a definitive reportable diagnosis. Based on the information provided, this case is not yet reportable. It could develop into a reportable case in the future.
For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
Histology/Polyp--Colon: Which histology code is used when a colon biopsy states adenocarcinoma arising in a polyp, but the resection path states only adenocarcinoma, and does not mention arising in a polyp. See Discussion.
This scenario occurs frequently and our QC staff is divided on which code to use.
03-24-06 Rectal Polyp: Adenocarcinoma, moderately differentiated. 6-29-06 Rectum: Adenoca, MD, invades into the submucosa. No malignancy (0/15) LNs.
Use the polyp information from the biopsy and code adenocarcinoma arising in a polyp (8210, 8261 or 8263 as appropriate).
CS Extension--Pancreas, Head: When a tumor is described as having "vascular encasement of the celiac artery", is extension coded to 68 [tumor is inseparable from the celiac axis]?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Code vascular encasement of the celiac artery to CS extension code 68 [tumor is inseparable from the celiac axis].
This celiac axis is a small (1cm) area of branching arteries. The celiac artery branches into hepatic, gastric, and splenic at the axis. Dissecting tumor out from around the celiac axis is very tricky and usually encasement by tumor is a sign of inoperability.
CS Lymph Nodes--Lung: Do modifying terms such as "borderline" affect whether lymph nodes are coded as involved when they are used in conjunction with the descriptors listed in Note 2 (i.e., mass, adenopathy or enlargement) for lung primaries? See Discussion.
Lung primary: CT states "borderline" enlarged hilar lymph nodes. Note 2 in the Lung schema under CS Lymph Nodes does not address qualifiers.
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
Do not code the hilar lymph nodes as involved in this case. "Borderline" enlarged hilar lymph nodes do not meet the clinical criteria for enlargement.
CS Extension--Lymphoma: If bilateral tonsils are involved with lymphoma, is it one or two regions of involvement and how is extension coded?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.For cases diagnosed 1-1-08 and later: Assign CS extension code 10 [involvement of a single lymph node region]. Bilateral tonsils are one organ/site.
See Note 1 under CS Extension. Tonsil is coded the same as a lymph node region.
Neoadjuvant Treatment/Date Therapy Initiated--Breast: If Tamoxifen has been used since 2000 for the treatment of hyperplasia, should it be coded as neoadjuvant treatment for a 2004 diagnosis of breast cancer?
Do not code tamoxifen given for hyperplasia as treatment for breast cancer. In this case, tamoxifen started four years before the breast cancer diagnosis -- not treatment for breast cancer.
Histology (Pre-2007): Is an intra-abdominal mass with the histology of "squamous cell carcinoma arising in a dermoid cyst" coded to 8070/3 [Squamous cell carcinoma] or 9084/3 [Dermoid cyst with malignant transformation]?
For tumors diagnosed prior to 2007:
Code histology to 9084/3 [Dermoid cyst with malignant transformation] per the ICD-O-3. Dermoid cysts may contain a malignant component of a type typically encountered in other organs and tissues.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
CS Site Specific Factor--Prostate: Can autopsy results also be used when coding SSF3, pathologic extension, given that the instructions only address the use of prostatectomy findings when coding this field?
This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.
If the prostate cancer was diagnosed on autopsy, or the autopsy was performed within the staging timeframe (See 2004 SEER Manual, page 112), code SSF3 using the autopsy information.
Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are to be abstracted and how is the histology field(s) coded when a nipple biopsy demonstrates Paget disease and a separate biopsy in the same breast demonstrates inflammatory breast carcinoma? See Discussion.
Should Paget disease be coded as the histology because it has a higher histology code than inflammatory carcinoma?
For tumors diagnosed prior to 2007:
Abstract the inflammatory carcinoma as one primary and the Paget disease as a separate primary. The first three digits of the histology codes for these histologies are different (8530 and 8540). Therefore, these are separate primaries.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
Histology (Pre-2007)--Bladder: How is a "carcinoma with squamous, mucinous, and signet ring cell features" coded?
For tumors diagnosed prior to 2007:
Code histology to 8490 [Signet ring cell carcinoma]. Rule 7 on page 87 of the 2004 SEER Manual applies to this case.
Rule 7: Code the numerically higher ICD-O-3 code. This is the rule with the lowest priority and should be used infrequently.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.
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