Report | Question ID | Question | Discussion | Answer | Year |
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20130067 | Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathology report final diagnosis of diffuse large B-cell lymphoma (50%) and follicular lymphoma, 3A (50%)? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to diffuse large B-cell lymphoma [9680/3] per Rule PH11.
Code the histology to 9680/3 [diffuse large B-cell lymphoma] when DLBCL and any other non-Hodgkin lymphoma (follicular lymphoma, grade 3 in this case) are present in the same anatomic location. DLBCL is coded because it is the more aggressive histology.
NOTE: This answer assumes these two histologies are present simultaneously in the same anatomic location. Per Rule M4, this is a single primary.
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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20130066 | Multiple primaries--Heme & Lymphoid Neoplasms (Lymphoma): How many primaries are accessioned when a patient is diagnosed in 2003 with diffuse large B-cell lymphoma on an inguinal lymph node biopsy followed by a 2012 diagnosis of diffuse large B-cell lymphoma on a cervical lymph node biopsy? See Discussion. |
The only documentation in the record is that there is a history of DLBCL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Accession a single primary, diffuse large B-cell lymphoma [9680/3] diagnosed in 2003 per Rule M2. Abstract a single primary when there is a single histology. Per Rule M2, Note 2, a recurrence of the same histology is always a single primary (timing is not relevant). 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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20130065 | Histology--Heme & Lymphoid Neoplasms: Should the higher histology code associated with grade 1 follicular lymphoma [9695/3] be used rather than grade 2 follicular lymphoma [9691/3] in cases of follicular lymphoma grade 1-2? | Code histology to 9691/3 [follicular lymphoma, grade 2], histology. For follicular lymphoma, when there is a grade such as 1-2 indicated, take the histology associated with the higher grade disease process, even though the lower grade histology code is higher. | 2013 | |
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20130064 | Primary site--Heme & Lymphoid Neoplasms: Are hematopoietic primaries coded to C421 [bone marrow] or C420 [blood]? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Refer to the Hematopoietic Database and Manual to determine the primary site.
Leukemias are coded to C421 [bone marrow]. The ONLY neoplasm that is coded to C420 [blood] is Waldenstrom's macroglobulinemia [9761/3].
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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20130062 | Date of diagnosis--Heme & Lymphoid Neoplasms: Should the diagnosis date be coded to the date of the flow cytometry on the peripheral blood or the date of the bone marrow biopsy for a diagnosis of chronic lymphocytic leukemia/low grade B-cell lymphoma? See Discussion. | Is a flow cytometry on peripheral blood alone diagnostic of a hematopoietic malignancy (CLL)? If not, when the diagnosis is verified by a subsequent histologic diagnosis (bone marrow biopsy) would the diagnosis date be the date of the peripheral blood flow cytometry or the date of the bone marrow biopsy? The Class of Case depends on this diagnosis date. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the diagnosis date to the date of the peripheral blood flow cytometry because this is a procedure used to diagnose CLL. Per both the Abstractor Notes and the Definitive Diagnostic Methods sections in the Heme DB, CLL is diagnosed by flow cytometry (immunophenotyping).
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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20130061 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded for "post-transplant lymphoproliferative disorder (diffuse large B-cell lymphoma)"? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to diffuse large B-cell lymphoma [9680/3] per Rule PH1. Code the histology as 9680/3 [DLBCL], the histology of the accompanying lymphoma, when the diagnosis is PTLD and any B-cell lymphoma.
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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20130060 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a diagnosis of bilateral extranodal orbital lymphoma when the same histology is present in both orbits? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as a single primary lymphoma of bilateral orbits per Rule M2. Abstract a single primary when there is a single histology. Both orbits showed the same histology. Note 1 for Rule M2 states bilateral involvement of lymph nodes and/or organs is a single primary.
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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20130059 | Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded if a patient with a history of chemotherapy treated "groin" lymphoma, subsequently has bone biopsies that demonstrate diffuse large B-cell lymphoma? See Discussion. |
3/2012: Patient states he has a past history of lymphoma of the "groin." A bone biopsy of the right tibia done at this facility showed diffuse large B-cell lymphoma. There was no palpable lymphadenopathy on 03/2012. There is no other information available regarding the initial diagnosis except that the patient was treated with only chemotherapy. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Code the primary site to C774 [inguinal lymph nodes] per Rule PH18. Code the primary site to inguinal lymph nodes [C774] when the site of lymphoma is described only as an inguinal mass. Groin lymph nodes are inguinal lymph nodes. The diffuse large B-cell lymphoma diagnosed by right tibia biopsy is not a new primary per rule M7 because the histology of the history only case would be coded as 9590/3 [lymphoma, NOS]. No more specific histology is known for the initial diagnosis. Accession a single primary when a more specific histology [DLBCL] is diagnosed after the NOS ONLY histology when the Heme DB Multiple Primaries Calculator confirms the NOS and the more specific histology are the same primary. The right tibial involvement is not used to code the primary site because the patient had chemotherapy for this groin lymphoma prior to diagnosis of DLBCL. 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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20130058 | Reportability--Heme & Lymphoid Neoplasms: Is EBV-positive hemophagocytic lymphohistiocytosis (HLH) reportable when diagnosed in a 5 year old child and resulted in death in less than two months? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Hemophagocytic lymphohistiocytosis (HLH) is not a reportable disease because it is not listed in the Heme DB.
Per our expert pathologist consultant, "HLH is a lymphocyte driven hemophagocytic syndrome which may be either genetically based or caused by over-activated lymphoid cells, often in response to a viral infection. It is an abnormal immune response and is not considered a malignant disease, and is, therefore, not reportable. It is not synonymous with EBV-positive T-cell lymphoproliferative disease of childhood (9724/3)."
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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20130057 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded if the bone marrow biopsy favors lymphoplasmacytoid lymphoma and the physician states the diagnosis is lymphoplasmacytic lymphoma-Waldenstrom's macroglobulinemia? See Discussion. | Bone marrow biopsy: Focal bone marrow involvement with B-cell lymphoproliferative disorder. Comment: This patient has 2 monoclonal proteins in serum, IgM kappa and IgG kappa clones. The marrow does have focal involvement with a small cell lymphoproliferative disorder. A lymphoplasmacytoid lymphoma is favored.
Flow Cytometry: Bone marrow reveals a low level, kappa-bearing-B-lymphoproliferative population that has an immunophenotype compatible with mantle cell lymphoma or related small, mature non-Hodgkin lymphoproliferative disorder.
Physician statement: lymphoplasmacytic lymphoma-Waldenstrom's macroglobulinemia.
Per the Heme DB, the criteria to diagnosis WM is the serum paraprotein IgM. This patient's IgM was 6020 mg/dL. It was described as elevated per the physician. The physician also states the patient's IgG is elevated. According to the Heme DB, when both IgG and IgM are elevated it is indicative of LPL. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9671/3 [lymphoplasmactyic lymphoma (LPL)] per the Heme DB Abstractor Notes and Rule PH17. When IgG and IgM are elevated, code to lymphoplasmacytic lymphoma. Waldenstrom's macroglobulinemia is caused by increased lymphocytes which causes an increase in IgM. LPL has mixed abnormalities, both the lymphocytes and plasma cells are increased which results in an abnormally high IgM and IgG.
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 |