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
code 21 [Direct extension to adjacent
organs or tissues].

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
captured in a CS site specific factor in
the future.

11/27/09