Question: 20200045

Status


Final

Category


#1:   Diagnostic confirmation
#2:   Heme & Lymphoid Neoplasms
#3:  


References


Source 1:   Heme and Lymphoid Manual and Database
pgs:  
Notes:   Effective with cases diagnosed 1/1/2010 and forward
Source 2:  
pgs:  
Notes:  


Question


Diagnostic confirmation--Heme & Lymphoid Neoplasms: Is Diagnostic Confirmation coded to 5 or 8 based on a patient diagnosed as multiple myeloma by a physician based on a bone marrow biopsy stating plasma cell neoplasm? See Discussion.



Discussion


Bone marrow, right iliac crest (aspirate smear, touch preparation, clot section and core biopsy): Hypercellular marrow (40-50%) with plasma cell neoplasm (see Comment): – No evidence of metastatic carcinoma. – Adequate iron storage.

Comment: CBC data shows normocytic anemia. Flow cytometric analysis of bone marrow detects a kappa restricted plasma cell population that expresses CD138 and CD38. CD56 is positive. CD19 and CD20 are negative. T lymphocytes are immunophenotypically unremarkable. Polyclonal B lymphocytes are detected. Blast gate is not significantly increased. Immunohistochemical stains are performed on the biopsy core and clot section for greater sensitivity and further architectural assessment with adequate controls. CD138 positive plasma cells comprise > 70% of the total cellularity. AE1/AE3 is negative. Taken together, the morphologic and immunophenotypic findings are consistent with a diagnosis of plasma cell neoplasm. Trilineage hematopoietic activity as are seen.



Answer


This would be a Diagnostic Confirmation of 8 based on the physician's diagnosis.

The Pathology report mentions plasma cell neoplasm only. By itself, plasma cell neoplasm is not reportable because it includes a variety of diseases, some that are not reportable, and some that are (See Hematopoietic Database under Plasma Cell Neoplasm.)

The physician probably has other information, including imaging, which may show lytic lesions. He/she is probably using clinical findings, plus findings from the bone marrow, and diagnosing this patient with multiple myeloma.



History




Last Updated


08/26/2020

Date Finalized


10/30/2020