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| Report | Question ID | Question | Discussion (Ascending) | Answer |
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| 20031146 | EOD-Size of Primary Tumor--Breast: How do we code this field when there is a difference between the size of the tumor mentioned in the gross (i.e., macroscopic description) and the comment sections of a pathology report? See Description. | Path Macro Summary states size as 1.5 cm. The path comment states "largest area of tumor seen is 1.5 cm. However, 8 of the nearly contiguous sections are involved with an estimated 2.4 cm area of involvement." | For cases diagnosed 1998-2003: Code the size of the largest area of tumor from the path macro summary. For the example provided, code the size as 015 [1.5 cm]. In this case, the additional sections of tumor described in the path comment do not seem to represent pieces of one larger tumor. The 2.4 cm estimated area of involvement was determined by adding together noncontiguous tumor sections. According to the CAP protocol for breast, Note J "When 2 or more distinct invasive tumors are present, each is separately measured...they are not combined into a single larger size." | |
| 20000556 | Surgery of Primary Site--Cervix: How is this field coded for a cervix primary when a biopsy removes the entire tumor? See discussion. | Path from biopsy shows "severe dysplasia--CIN III" and the report from an endocervical curettage (ECC) is "chronic cervicitis"? | For cases diagnosed 1998 and later: Code the Surgery of Primary Site field to 25 [Dilatation and curettage; endocervical curettage (for in situ only)]. | |
| 20130171 | Reportability--Heme & Lymphoid Neoplasms: Is "plasma cell neoplasm" a synonym for multiple myeloma and is it reportable? See Discussion. | Path report in the comment section states "plasma cell neoplasm such as monoclonal gammopathy of undetermined significance (MGUS)." | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Appendix F, plasma cell neoplasm is not a synonym for multiple myeloma. Plasma cell neoplasm is a disorder that has an abnormal number of plasma cells. MGUS is such a disorder, but it is not reportable.
According to WHO, 'Plasma cell neoplasms' is the umbrella term that includes MGUS, plasma cell myeloma, solitary plasmacytoma of bone, immunoglobulin deposition diseases, extraosseous plasmacytoma, and osteosclerotic myeloma. Of these, only plasma cell myeloma, solitary plasmacytoma of bone, and extraosseous plasmacytoma are reportable.
Note: This terminology was added to the 2012 Hematopoietic Manual and Database for 1/1/2012. This should not have been added. If the only diagnosis is "plasma cell neoplasm," this is not reportable. If the diagnosis is "plasma cell neoplasm c/w multiple myeloma (or another reportable disease)," then it would be a reportable disease.
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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| 20031140 | Primary site--Unknown & ill-defined site/Kidney: How should this field be coded when humeral metastases are compatible with renal cell carcinoma pathologically, no kidney lesion is found clinically and the physician's signout diagnosis is "no primary found, as of now unknown"? See Description. | Path states "biopsy of humerus, mets sarcomatoid carcinoma consistent with renal cell carcinoma." Material was sent to Mayo Clinic for consult & they state "with focus of clear cells, agree that a likely primary is renal cell carcinoma." Abdominal CT showed no abnormality in kidneys. When the registrar abstracted the case she spoke to the managing physician who told her that "no specific site was found and it was, as of now, unknown." This was stated about three months after dx. Can we code as a renal primary based on pathologic information or should we code unknown based on CT and physician's statement? | Code this case to C64.9 [Kidney, NOS]. ICD-O-3 rule H states that the topography code attached to a morphology term may be used when the topographic site is not given in the diagnosis. Topography code C64.9 is attached to morphology code 8312/3 [Renal cell carcinoma] in ICD-O-3. |
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| 20031162 | Multiple Primaries/Histology--Hematopoietic, NOS/Lymphoma: How many primaries are represented and what are the histologies for "B-cell lymphoma with immunophenotypic findings consistent with hairy cell leukemia" found on a bone marrow biopsy? See Description. | Pathologist completed AJCC lymphoma staging form indicating this case should be abstracted as a lymphoma. | For cases diagnosed prior to 1/1/2010:Abstract as one primary, 9591/3 [B-cell lymphoma, NOS]. The bone marrow diagnosis indicates that the main/definite diagnosis is B-cell lymphoma, with a lesser indication of hairy cell leukemia. Both of these are mature B-cell neoplasms according to the WHO histological classification. 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. |
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| 20000277 | Ambiguous Terminology: Should SEER's lists of ambiguous terminology be modified to reflect how pathologists and radiologists actually use these terms? See discussion. | Pathologists and radiologists say the term "suggestive" is used to describe a lesion that may be malignant, and the term "suspicious" is not used to describe lesions that may be malignant. According to the physician director of our Breast Center the FDA governs the use of terminology, and the term "highly suggestive" instead of "highly suspicious" must be used if there is a greater chance that a mass is malignant. | We recognize that the way clinicians and registrars speak is often different, and that the differences vary from region to region.
Our Medical Advisory Board reviewed the lists of ambiguous terminology before they were included in the third edition of the SEER EOD and the SEER Program Coding and Staging Manual 2004. Since that time, specific terminology has been mandated for describing mammography results. We know some of these terms are discrepant with our ambiguous terminology list.
As of 2007, the standard setters (CoC, NPCR, SEER and CCCR) all use the same ambiguous terminology list. Changes to the list must be approved by the NAACCR Uniform Data Standards Committee. |
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| 20130137 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for follicular lymphoma, low grade? See Discussion. | Pathologists seem to be moving away from identifying follicular B-cell lymphomas as grade 1, grade 2, etc. Instead, the term follicular lymphoma, low grade is being used. Should the histology be coded as follicular lymphoma, NOS even though the Heme DB indicates this code is usually used for death certificate cases? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9690/3 [follicular lymphoma, NOS].
Low grade for follicular lymphoma are not listed in the Heme DB or Manual. Because low grade can mean grade 1 or grade 2, default to follicular lymphoma, NOS [9690/3].
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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| 20091102 | MP/H Rules/Histology--Thyroid: How should histology be coded for a diagnosis of "papillary sclerosing carcinoma" with an additional description of the tumor being "nonencapsulated"? See Discussion. | Pathology report reads, "Papillary sclerosing carcinoma." In one case, the results are in CAP protocol format and next to 'Encapsulation of tumor' it says 'No.' In the other case, it is not in CAP format, but the microscopic description says, 'encapsulation of tumor - no.' Is the correct code 8350? | For cases diagnosed 2007 or later, code 8350 [Nonencapsulated sclerosing carcinoma] per MP/H Other Sites Rule H11. The definition for 8350 in the Morphology section of ICD-O-3 includes nonencapsulated as well as diffuse sclerosing papillary carcinoma. When the pathologist states 'No' for encapsulated, that means nonencapsulated. | |
| 20061006 | Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Testis: If an orchiectomy specimen contains non-seminomatous mixed germ cell tumor and a separate satellite of seminoma, how many tumors should be abstracted and how should the histology field(s) be coded? | Pathology: R Orchiectomy: 2.1 cm non-seminomatous mixed germ cell tumor (50% teratoma primarily mature, 50% embryonal CA and yolk sac tumor). Located 3cm from the main tumor is a 2mm satellite pure seminoma. | For tumors diagnosed prior to 2007:
This is a single primary because the first three digits of the ICD-O-3 histology codes are the same, according to Rule 3a on page 11 of the 2004 SEER manual. Code the histology 9065 [Germ cell tumor, nonseminomatous]. Code 9065 is preferred over the less-specific code of 9061 [Seminoma, NOS].
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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| 20110134 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted, and what rule applies, when the patient has a 1999 diagnosis of Burkitt high grade B-cell lymphoma and was diagnosed in 2011 with diffuse large B-cell lymphoma? See Discussion | Patient diagnosed in 1999 with Burkitt high-grade B cell lymphoma of the thyroid gland and cervical nodes. The patient was treated with a thyroidectomy and chemotherapy. A 2011 biopsy of the parotid gland is positive for diffuse large B cell lymphoma. The pathologist reviewed the 1999 and 2011 pathology reports and stated this is one primary. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as two primaries per Rule M15. Rule M15 instructs one to use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14. Code the histology for the 1999 primary to 9687/3 [Burkitt high grade B cell lymphoma] and code primary site to C739 [thyroid.] Code the second primary to 9680/3 [diffuse large B-cell lymphoma] with primary site coded to C079 [parotid gland] per Rule PH24 which instructs one to code the to the when lymphoma is present only in an .
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. |
