| ID | Question | Discussion | Answer | Last Updated |
| 20091107 |
CS Extension--Lymphoma: Does peripheral blood involvement affect the stage for lymphoma? See discussion. |
2009 Diagnostic Year
Lymph node bx is positive for Mantle Cell lymphoma. Flow cytometry on lymph node tissue shows CD+ pos B cell lymphoproliferative disorder. IHC findings support Mantle Cell lymphoma. Flow cytometry on peripheral blood shows CD+ B cell lymphoproliferative disorder. Because the lymph node is positive for Mantle Cell lymphoma and the flow cytometry findings are the same on the lymph node tissue and peripheral blood, is the peripheral blood considered to be involved (Stage IV disease)? |
No. Peripheral blood is not the same as bone marrow involvement which is what would be required for stage IV. Lymphomas can arise in lymph nodes which are connected by lymphatic vessels. Both lymphatic vessels and blood vessels travel through lymph nodes and malignant cells can travel between the vessels. Cells in peripheral blood do not prove Stage IV. |
11/27/09 |
| 20091106 |
MP/H Rules--Urinary:
8/9/07 invasive transitional cell ca of right ureter; 7/9/08 non-invasive urothelial ca of bladder; 11/18/08 non invasive urothelial ca of left ureter; 6/20/09 invasive urothelial ca of left ureter. How many primaries using which multiple primary rules? |
One primary. This is a good example of how the field effect occurs in the urinary system. From 2007 to 2008, Rule M8 says bladder and ureter tumors are not new primaries and would be documented as a recurrences. Because other urinary sites are involved by 11/08 and by 06/09, do not make second primary of left ureter (Rule M4 does not apply). |
11/27/09 | |
| 20091105 |
Multiple Primaries--Hematopoietic: For the following hematopoietic case how many primaries (and histologies) should be coded? It's not clear using the current rules. See discussion. |
2005 dxd with CLL/SLL M-9670 (lymph node involvement) treated with FCR 2006 clinically dxd with MDS secondary to chemo (M-9987) CLL/SLL in remission 2008 bx reveals AML (M-9861) Per Seer Hematopoietic Table, M-9987 & M-9861 are a single primary 06/2008 patient receives bone marrow transplant 2009 status post BMT, BM bx reveals RAEB-1 (M-9983) How do we handle this? Is this still considered the same disease process or a new primary (since status post BMT)? |
Two primaries should be abstracted. Using the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, compare 9670 (SLL) in 2005 and 9987 (MDS secondary to chemo) in 2006. This is two primaries. MDS can transform to AML. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9861 (AML) are a single primary. The AML would be documented in follow-up. (While 9670/SLL and 9861/AML are two different primaries, the SLL has already been reported.) RAEB is a form of MDS. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9983 (RAEB) are a single primary. The RAEB would be documented in follow-up. (While 9670/SLL and 9983/RAEB are two different primaries, the SLL has already been reported.) |
11/27/09 |
| 20091101 |
CS Reg LN Pos/Exam--Melanoma: How is regional lymph nodes positive/examined coded for the following example if CS LN Code 80? Pt has an unknown primary site melanoma with liver involvement and positive axillary lymph node. Please see discussion. |
Refer to SINQ 20061045 and SINQ 20071019 |
Code regional lymph nodes positive 01 [one positive lymph node] and regional lymph nodes examined 01 [one lymph node examined] (assuming the positive node was the only node examined). If the only lymph node involvement is the positive axillary lymph node, it is reasonable to conclude that this is a regional lymph node. When only one chain of lymph nodes is involved with metastatic melanoma, the metastatic cells had to come from skin with direct drainage to those lymph nodes. |
11/27/09 |
| 20091091 |
Primary site/CS Extension--Lymphoma: What is the site and CS Extension for a malignant lymphoma with spleen involvement, inguinal and iliac adenopathy, T12 lesion with bony destruction, and a paraspinal mass in lower lumbar region with extension into iliac fossa involving left psoas muscle and causing bony destruction? |
Code the primary site C496 [Connective, subcutaneous and other soft tissue of trunk]. When lymphoma is present in an extranodal organ/site and in that organ/site's regional lymph nodes, code the extranodal organ/site as the primary site. In this case, there is a soft tissue paraspinal mass at T12 extending into iliac fossa, left psoas muscle and bone. Lymph nodes are also involved.
Assign CS extension |
11/27/09 | |
| 20091073 |
Grade: SINQ 20020059 says not to use FIGO grade to code differentiation. It also says SEER is evaluating whether the ICD-O-3 6th digit differentiation codes accurately represent the FIGO grade. For the time being, do not code FIGO grade. What is the result of the evaluation? Any new information regarding FIGO grade? |
Do not code FIGO grade in the grade field. The conversion from a three-grade system to a four-grade system does not work for FIGO grade three. Since FIGO G3 includes both Poorly differentiated and undifferentiated, it cannot be converted.
FIGO grade may be |
11/27/09 |