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Report Produced: 02/01/2023 06:50 AM

Report Question ID Question Discussion (Ascending) Answer
20110054 First course treatment/Other therapy--Heme & Lymphoid Neoplasms: Is a transfusion coded as first course treatment for multiple myeloma? See Discussion. Per the SEER Manual, First Course for Leukemia and Hematopoietic Diseases definitions, Other Hematopoietic states that transfusions are coded as "other" in the Other Treatment fields. Does this mean that a transfusion for chemotherapy-related anemia is coded as treatment for patients with multiple myeloma? Do not code transfusions as treatment. According to hematopoietic specialty physicians, transfusions are given for such a variety of reasons (anemia, etc.) and should not be coded as other treatment.
20120056 First course treatment--Corpus Uteri: Should Arimidex be coded as hormone therapy for an endometrioid adenocarcinoma? See Discussion. Per the SEER Manual, endometrial cancers may be treated with progesterone which is coded as hormone therapy for these primaries. As endometrioid adenocarcinomas are hormonally-dependent carcinomas, should an aromatase inhibitor or anti-estrogen agent also be coded as hormone therapy?

Arimidex has not been approved to treat endometrial cancer. It is not prescribed for pre-menopausal women. Clarify with the physician why the drug was being used. If the physician states Arimidex was given to reduce tumor burden, code as hormone therapy.

See the SEER*Rx interactive database, http://seer.cancer.gov/seertools/seerrx/

20120076 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what histology codes are used for a 2005 diagnosis of nodular histiocytic lymphoma followed by a 2012 diagnosis of B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma? See Discussion. Per the history and physical, patient was diagnosed in 2005 with nodular histiocytic lymphoma and had chemo at that time. Now the patient presents with enlarged right axillary lymph nodes. A lymph node core biopsy confirmed B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia. Flow cytometry was most consistent with B-cell chronic lymphocytic leukemia.

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. Code the histology for the first primary to 9698/3 [nodular histiocytic lymphoma. Per the Alternate Names section in the Heme DB, this histology is synonymous with follicular lymphoma, grade 3. Code the histology for the second primary to 9823/3 [B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma].

Nodular histiocytic lymphoma does not transform into CLL/SLL (Transformations to), nor does CLL/SLL transform to nodular histiocytic lymphoma (Transformations from). Rule M15 indicates we are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries in this case because none of the rules from 1-14 apply. Per the calculator, the CLL/SLL is a new 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.

20081044 MP/H Rules/Behavior--Melanoma of Skin: How are histology and behavior coded for a "malignant melanoma in situ with regression"? See Discussion. Per the microscopic portion of the path report, there is a zone of regression within the confines of the lesion, such that the possibility of antecedent invasive disease at the site cannot be ruled out with certainty.

For cases diagnosed 2007 or later:

Code malignant melanoma in situ with regression to 8720/2 [Melanoma in situ].

Code the histology according to the histologic type specified in the pathology report final diagnosis. Code the behavior as specified in the pathology report. Regression does not affect the coding of histology or behavior. See Melanoma Histology Coding rule H5. See 2007 SEER manual instructions for coding behavior, page 84.

20130204 MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tubulocystic renal cell carcinoma? See Discussion. Per the resected specimen final diagnosis COMMENT in the pathology report: Tubulocystic renal cell carcinoma is a relatively new renal epithelial neoplasm that has been added to an updated WHO classification of renal tumors. (Srigley et al. The International Society of Urologic Pathology Vancouver Classification of Renal Neoplasia Am J Surg Pathol. 2013;37:1469-1489). The majority of tubulocystic renal cell carcinomas reported in the literature (greater than 90%) have behaved in an indolent manner. Code the histology to 8312/3 [renal cell carcinoma, NOS] per Rule H3. The term "tubulocystic" is not a specific renal cell histology according to our kidney pathology expert.
20100027 Reportability: Is AIN III reportable if it arises in the perianal skin? See Discussion. Physical exam states patient has a suspicious area of anal skin. Operative findings show a raised, suspicious lesion in the right perianal region. Our interpretation of the primary site would be skin and therefore not reportable. However, the final diagnosis on the pathology report indicates "AIN III/squamous cell carcinoma with focal areas suspicious for microinvasion. "SINQ #20041056 states that AIN III is reportable. AIN III of the anus or anal canal (C210-C211) is reportable. AIN III (8077) arising in perianal skin (C445) is not reportable.
20021028 EOD-Clinical Extension--Prostate: If the tumor arises in the prostatic apex, does that take priority over coding clinical extension based on the stage of cT1c? See discussion. Physician states prostate primary is a cT1c. Pathology states adenocarcinoma, Gleason 3+3, right apex. All other biopsies were negative. Because the primary appears to be in the prostatic apex, do we code 33 or 15 for clinical extension? Which is more important for SEER? Do you want to capture the "apex" information or the "cT1c" information?

For cases diagnosed 1998-2003:

Code the EOD-Clinical Extension field to 33 [arising in prostatic apex]. Apex information takes priority. The only statement we have is cT1c by the urologist, and we don't know how that stage was determined.

20130114 Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the bone marrow biopsy shows acute myeloid leukemia, but the physician states this is therapy-related AML secondary to prior radiation treatment? See Discussion. Physician states this patient has radiation therapy-related AML due to radiation received as treatment for a prior prostate cancer. The bone marrow and other immunophenotyping do not state this is therapy-related AML. Should the histology be coded AML, NOS [9861/3] or therapy-related AML [9920/3]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the histology as therapy-related acute myeloid leukemia, NOS [9920/3] when the physician states this is a therapy-related AML.

The therapy-related diagnosis may be either clinically or pathologically stated to code the histology to 9920/3. In this case, the physician is aware of the previous chemotherapy, hormone therapy or radiation and adds that knowledge to the histologic findings of AML. The pathology report did not include this clinical, historical information as part of the final diagnosis. However, one can code therapy-related acute myeloid leukemia because clinically it was stated.

We recommend that you clearly document in the abstract that you are coding a clinical histology.

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.

20130077 Reportability--Heme & Lymphoid Neoplasm: What is the histology code if a myeloproliferative disorder is reportable should a physician suspect this diagnosis and treats the patient? See Discussion. Physician suspects patient has a myeloproliferative disorder and treats her with a phlebotomy and Hydrea. Patient receives Hydrea during an inpatient stay, but does not see the Heme/Onc again. The patient is subsequently only seen by a Palliative Medicine physician who also states she has an underlying myeloproliferative disorder. The patient died while an inpatient.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].

The term is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4). Also, the patient was treated for a myeloproliferative disorder, making this a reportable clinical diagnosis per the SEER Manual (Reportability, Pg 4, Exception 1).

Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.

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.

20031199 CS Extension/Polyp--Colon: How is CS extension coded for tumor invasion described as "Haggitt level 4"? See Description. Polypectomy specimen revealed adenocarcinoma of the rectum in a tubulovillous adenoma. Per path extent of invasion was Haggitt level 4. The micro description of the tumor stated that there was malignant epithelial neoplasm in colonic mucosa.

In a 1985 Gastroenterology journal article, Haggitt described five levels of polyp invasion:

Level 0-confined to mucosa

Level 1-head

Level 2-Neck

Level 3-Stalk

Level 4-Submucosa of underlying colonic wall.

For cases diagnosed 2004 and forward:

Use the best information available to code CS extension. The following conversion may be used when the only information available is the Haggitt level.

Level 0 - Extension 10

Level 1 - Extension 13

Level 2 - Extension 15

Level 3 - Extension 14

Level 4 - Extension 16