Question Reportability: Is VIN II-III reportable? Answer VIN II-III is not reportable.
When "VIN II-III" is stated, it is interpreted as meaning that the pathologist is not certain whether this is VIN II or VIN III. Do not report the case until/unless VIN III or carcinoma in situ is confirmed. Last Updated 10/22/12 Question: 20120080
Question MP/H Rules/Multiple primaries--Kidney, renal pelvis, bladder, ureter: How many primaries should be abstracted for the following scenario? See discussion. Discussion Patient had TCC in situ of the renal pelvis in Oct. 2006. Then he had TCC in situ of the bladder in July, 2008. Per MP/H rule M8, this is a single primary. Then the patient has TCC in situ of the ureter diagnosed in Nov. 2009. Is this a new primary, since sequence 1 was diagnosed in Oct. 2006 (M7)? Or does the 3 year time frame start from the last recurrence (i.e., July, 2008) making this all part of the first primary? Answer Abstract one primary for this scenario. The three-year time-frame starts from the date of the last diagnosis, which in this case was the July 2008 diagnosis. Last Updated 10/22/12 Question: 20120078
Question Reportability--Melanoma: Upon review of SINQ 20020019 and 20041034 the terms "early" or "evolving" in situ melanoma are not reportable. Does the addition of a "Clarks Level I " change reportability? See discussion. Discussion 7/21: c/w evolving lentigo maligna
7/29: path review of bx specimen: Comment: “pattern c/w lentigo maligna”. Diagnosis: c/w evolving lentigo maligna.
10/20:Re-Exc: Recent bx site & atypical lentiginous melanocytic proliferation c/w persistent early malignant melanoma in situ, lentiginous type, Clark’s level I, margins free. The results of the previous outside pathology report were reviewed.
I know that “early” and “evolving” melanoma are not reportable, but when they give a Clark’s level, does the case then become reportable?
FINALIZED SEER SINQ QUESTIONS
Answer Early and evolving melanoma are not reportable. Mention of Clark Level 1 does not make the diagnosis reportable. Evolving melanomas are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. The tumors may be described as "proliferation of atypical melanocytes confined to epidermal and adnexal epithelium," "atypical intraepidermal melanocytic proliferation, "atypical intraepidermal melanocytic hyperplasia"; or “severe melanocytic dysplasia.” See the equivalent terms and definitions for cutaneous melanoma in the 2007 MP/H rules. http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf See also SINQ 20110069. Last Updated 10/22/12 Question: 20120077
Question Primary site/Histology--Heme & Lymphoid Neoplasms: Please advise regarding a situation with inconsistency between the EDITS based on the SEER Site/Type Table and the Heme/Lymph Rules and DB. See discussion. Discussion According to the Heme/Lymph Rules and DB - CLL/SLL (chronic lymphocytic leukemia/small lymphocytic lymphoma) is to be coded 9823/3 – regardless of site of origin. The code 9670/3 which used to be used for SLL has been made “Obsolete”.
The DB and rules instruct the registrar to use the code 9823/3 for these cases whether presenting in lymph nodes or bone marrow.
Unfortunately, the SEER Site/Type Table only lists C420, C421 or C424 as allowable codes for Primary Site when histology = 9823/3. And an EDIT is triggered when entering a lymph node or other site with histology code 9823/3. The registrar cannot “fix” the “error” without ignoring the new rules or coding the site to C420, C421, or C424.
Yes, the edit can be overridden and will be in the interim.but, this is frustrating and confusing to registrars when they are following the rules but still getting an EDIT that they cannot correct without ignoring the new rules.
Do we know when the Site/Type Tables will be updated to bring them up-to-date with new rules and coding guidelines and the Heme/Lymph DB and soon-to-be Solid Tumor MP/H DB? Answer The Site/Type Table is currently under review and a new version will be released with the next edition of the MP/H rules.
Continue to override the edit for now. We are coordinating with NAACCR to update relevant SEER and NAACCR edits. Last Updated 09/21/12 FINALIZED SEER SINQ QUESTIONS Question: 20120076
Question Histology--Heme & Lymphoid Neoplasms: What histology code should I use? See discussion. Discussion Not sure if I code this as a new primary from the NHL in 2005?
Quoted directly from history and physical: NHL (Nodular Histiocytic Lymphoma) in 2005 status post chemo. Now enlarged right axillary lymph nodes with path lymph node core biopsy confirmed B-cell Small Lymphocytic Lymphoma/Chronic Lymphocytic Leukemia flow cytometric most consistent with B-cell Chronic Lymphocytic Leukemia. Answer This is a new primary.
Use ICD-O-3 to find the histology code for the 2005 diagnosis. The histology code for nodular histiocytic lymphoma is 9698/3. Use the 2012 heme database to find the histology code for B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia, 9823/3.
Next, go to the M rules. M13 applies and you are instructed to go to the hematopoietic database. Comparing 9898/3 and 9823/3 using the multiple primaries calculator shows the small lymphocytic lymphoma/chronic lymphocytic leukemia, 9823/3, is a new primary. Last Updated 09/21/12 Question: 20120075
Question Primary site--Heme & Lymphoid Neoplasms: How should primary site be coded when a bone marrow biopsy is not done? See discussion. Discussion Biopsy of a right neck lymph nodes was positive for lymphoma. Flow cytometry was positive for Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma. A bone marrow biopsy was not done. PET showed multiple involved lymph node areas of right cervical, mediastinal nodes and para-aortic area.
Per Module 3 in the Hematopoietic DB I see that I should code the histology to 9823/3 but my question is what the primary site should be. It says to code the primary site to the involved lymph node regions when there is No bone marrow involvement so I think that I should code the primary site to C778 but the instructions don't specifically address if there was no bone marrow or peripheral smear done. What are we supposed to do if there is no bone marrow done? Answer Code primary site to C778 using rules PH8 and PH30.
Since there was no bone marrow done, use the information available, which is the involvement of multiple lymph node chains. We will add this clarification to the next version of the manual. Last Updated FINALIZED SEER SINQ QUESTIONS Question: 20120074
Question Multiple primaries--Heme & Lymphoid Neoplasms: Is this a recurrence or a new primary? See discussion. Discussion Patient with an extranodal diffuse large B-cell lymphoma (DLBCL)treated with a partial gastrectomy at another facility in 2004. Recurrence of DLBCL in 2011, diagnosed by fine needle aspiration to abdominal lymph nodes, no further information as to where. The pt presents to my facility for a VAD insertion as well as chemo. I cannot find the rule that would help me if this is a recurrence or a new primary. Can you help me? Answer The 2011 diagnosis is a recurrence of the original diagnosis of DLBCL. Do not abstract a new primary. Use the 2010 Hematopoietic Manual for this case. Rule M2 states to abstract as a single primary when there is a single histology. Last Updated 09/21/12 Question: 20120067
Question Histology--Thyroid: What is the histology code for: poorly differentiated thyroid carcinoma with rhabdoid phenotype arising in a papillary carcinoma? Answer Code as papillary carcinoma, poorly differentiated, 8260/33. The WHO classification lists grade III papillary carcinoma as one of the synonyms for poorly differentiated thyroid carcinoma.
"Rhabdoid phenotype" does not affect the histology code. Last Updated 10/22/12 Question: 20120063
Question Reportability--Pancreas: Are neuroendocrine tumors reportable? Are they the same as neuroendocrine carcinoma? See discussion. Discussion Example: Pancreatic mass that PROB represents a neuroendocrine tumor. Staged as cT2N0M0. Answer The World Health Organization (WHO) designates pancreatic neuroendocrine tumors (NET) as malignant. Therefore, they are reportable. For pancreas primaries, code NET, G1 (well differentiated) as 8240/3; NET G2 (moderately differentiated) as 8249/3; and nonfunctional NET, GI or G2 as 8150/3.
Neuroendocrine carcinoma (NEC) is coded 8246/3, or 8013/3 for large cell NEC, or 8041/3 for small cell NEC.
FINALIZED SEER SINQ QUESTIONS Last Updated 10/22/12 Question: 20120061
Question MP/H Rules/Multiple Primaries--Ovary: How many primaries are to be abstracted and which multiple primary rule applies for a patient diagnosed with a carcinosarcoma of the left ovary and a serous carcinoma of the right ovary? See discussion. Discussion The patient underwent a debulking surgery showing a 20.5 cm carcinosarcoma with focal areas of high grade serous carcinoma and extensive high grade stromal sarcoma in the left ovary. The right ovary showed only a high grade serous carcinoma with extensive involvement of the ovarian parenchyma but no sarcomatous elements. While carcinosarcoma is composed of both epithelial and non-epithelial elements, does the presence of a purely epithelial tumor in the contralateral ovary indicate these are separate primaries per rule M8? Answer Abstract two primaries per rule M8.
Carcinosarcoma (8980) is not an epithelial tumor of the ovary within the range of 8000-8799, so rule M7 does not apply. Last Updated 09/11/12 Question: 20120060
Question Primary Site/Reportability: What is the primary site and reportability status of a “pancreatic endocrine neoplasm” that arises in the heterotopic pancreas of the splenic hilum that is stated to be a “well-differentiated endocrine tumor, uncertain behavior per the WHO classification”? See discussion. Discussion SINQ 20120035 states that well differentiated pancreatic endocrine neoplasms should be reported with histology code 8240/3. However, the pathology report provides the WHO Classification which states “uncertain behavior.” Should this still be reported as 8240/3? If reportable, what is the best code for primary site? The tumor arose in heterotopic pancreas (in the splenic hilum), which is pancreatic tissue found outside the usual anatomical location of the pancreas. Per the path, the tumor did not invade the spleen. We thought C481 (mesentery) would be most appropriate primary site. Because the patient is female, the coding schema for “Peritoneum for Females” would apply to the case. However, none of the CS extension codes seem to apply to this localized case. Answer Report this case as a pancreatic primary with histology code 8240/3. This neoplasm arose in pancreatic tissue and will behave accordingly, even though this pancreatic tissue is not located in the usual place.
Pancreatic endocrine and neuroendocrine neoplasms are essentially the same thing. However, they are described in two different WHO classifications; the endocrine classification and the digestive system classification. The digestive system classification is more recent, and is preferred by our expert pathologist consultant. The term "neuroendocrine" is to be used now, rather than "endocrine." In the pancreas, "well differentiated endocrine tumor" is synonymous with "neuroendocrine tumor (NET) Grade 1" and coded 8240/3.
FINALIZED SEER SINQ QUESTIONS
Last Updated 10/22/12 Question: 20120059
Question Primary site/Reportability--Breast: Is a “right nipple skin” biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See discussion. Discussion The 2011 SEER Manual Reportability Examples (example 3) states a “biopsy-proven squamous cell carcinoma of the nipple” is reportable when the subsequent resection shows “no evidence of residual malignancy in the nipple epidermis.” However this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500. Answer Since the site is specifically stated to be "skin" of nipple, this case is not reportable.
If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain full-thickness of skin and subcutaneous breast (nipple) tissue, and this tumor would likely be a reportable squamous cell ca of nipple (C500). If, however, this was a punch biopsy, it is more likely a non- reportable skin cancer. Last Updated 09/11/12 Question: 20120058
Question Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when the patient is diagnosed with an acute neoplasm (DLBCL) per a pathology report and is subsequently diagnosed clinically with a chronic neoplasm (CLL/SLL) less than 21 days later? See discussion. Discussion The patient was diagnosed with an extranodal diffuse large B-Cell lymphoma and a bone marrow biopsy performed 16 days later showed no DLBCL, but demonstrated an abnormal CD5-positive B-cell population that was subsequently referred to as a CLL/SLL by a physician. The peripheral blood was negative and showed only moderate thrombocytopenia.
Does rule M9 apply for this case which indicates this is a single primary (DLBCL) because there was only one pathology specimen (a stomach biopsy) proving DLBCL and the bone marrow did not definitively identify CLL/SLL? Answer Abstract two primaries. Rule M13 applies to this situation. The pathology report for the DLBCL and the bone marrow for the CLL/SLL were less than 21 days apart. The physisican used the bone marrow biopsy information to diagnose CLL/SLL. Last Updated 09/11/12 FINALIZED SEER SINQ QUESTIONS Question: 20120057
Question Reportability--Appendix: Is a low grade mucinous neoplasm of uncertain malignant potential of the appendix with an in situ mucinous cystadenoma component reportable? See discussion. Discussion The patient was diagnosed with pseudomyxoma peritonei and the pathology report final diagnosis stated, “Low grade mucinous neoplasm, of uncertain malignant potential, involving a dilated appendix (5cm) with the following features: In situ mucinous cystadenoma component is identified, with low-grade cytology of neoplastic epithelium.” Does the presence of an in situ component make this mucinous cystadenoma of the appendix reportable based on the ICD-O-3 matrix rule? Answer No, this diagnosis is not reportable. Cystadenoma is not reportable. The "in situ" description in this case does not make cystadenoma reportable.
According to our expert pathologist consultant, this is "a non-invasive, low grade, epithelial proliferation in an often cystic appendiceal tumor, 8480/1. If this has leaked or ruptured it can seed the peritoneal cavity causing pseudomyxoma peritonei." Last Updated 10/22/12 Question: 20120056
Question First course treatment--Corpus Uteri: Should Arimidex be coded as hormone therapy for an endometrioid adenocarcinoma? See discussion. 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? Answer Arimidex has not been approved to treat endometrial cancer. It is not prescribed for pre-menopausal women. Please clarify the reason the drug was being given with the physician. If the physician states Arimidex was given to reduce tumor burden, code as hormone therapy. See the SEER*Rx interactive database, http://www.seer.cancer.gov/seertools/seerrx/ Last Updated 09/11/12 FINALIZED SEER SINQ QUESTIONS Question: 20120055
Question Surgery of Primary Site--Kidney, renal pelvis: How is this field coded when a laparoscopic renal mass core biopsy is followed by cryoablation of the tumor? See discussion. Discussion The note under the local tumor destruction codes states “No specimen sent to pathology from this surgical event 10-15.” The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted? Answer The correct code for surgery of primary site in this case is 13, cryosurgery. The core biopsy provided a path specimen, but it is not coded as surgery of primary site. Last Updated 09/21/12 Question: 20120053
Question Diagnostic Confirmation--Heme & Lymphoid Neoplasms: For cases diagnosed 2010-2011, can this field be coded to 3 [Positive histology PLUS positive immunophenotyping and/or positive genetic studies] for a small lymphocytic lymphoma [9670/3] when the histology and flow cytometry (immunophenotypic) are diagnostic for SLL? See discussion. Discussion The patient has SLL involving multiple lymph node regions below the diaphragm, and no peripheral blood involvement. The primary site and histology were coded as C778 [multiple lymph node regions] and 9670/3 [SLL] per rule PH10. The Heme Database for SLL states the definitive diagnostic methods include histologic confirmation and immunohistochemistry. The DB lists disease genetics data, but no disease immunophenotyping. The DB does state that the definitive diagnostic methods for CLL include flow cytometry and lists disease immunophenotyping data. These immunophenotypic features are the same as seen in the flow cytometry studies performed for this patient’s SLL. If SLL and CLL are essentially the same disease at “separate ends of continuous spectrum” shouldn’t these immunophenotypic findings be used to code the diagnostic confirmation as 3? Were SLL’s immunophenotypic features unintentionally left out of the DB? Or is a diagnosis of SLL truly diagnosed by histology and clinical findings only? Answer Yes. Assign diagnostic confirmation code 3 in this situation.
This has been corrected in the heme database for 2012 and later cases. Last Updated FINALIZED SEER SINQ QUESTIONS
NORTH HOUSTON CENTER FOR REPRODUCTIVE MEDICINE FEMALE PATIENT HISTORY IDENTIFYING INFORMATION Date____________________ Name_______________________________________________Partner’s Name_____________________________________________________ Address______________________________________________________________________________________________________________ Telephone: Home_____
MEDICATIONS AND TOURETTE’S DISORDER: COMBINED PHARMACOTHERAPY AND DRUG INTERACTIONS Barbara Coffey, M.D., Cheston Berlin, M.D., Alan Naarden, M.D. Introduction Tourette Syndrome (TS) or Tourette’s Disorder (DSM IV) is a complex neuropsychiatricdisorder characterized by a changing pattern of motor and vocal tics that begin in childhood. Many individuals with Tourette Syndrome have a