Concept: Neoplasia
Definition: A process representing unregulated cellular growth that can arise in tissue type of the body.
General Approach: It is suggested that neoplasms be represented by post-coordination of the diagnosed neoplasia. This post-coordination approach involves the use of the high level SNOMED disorder concept 'Neoplasm Disease' in combination with the appropriate associated morphology concept for the specific neoplasm and its finding site relevant to the case.
Where possible grand children or great grand children of 'Neoplasm (morphologic abnormality)' should be used to specify the morphology of the neoplasm. These concepts (grand and great grand children) represent the specific morphology of the neoplasia being defined in as great of detail as possible. The direct child concepts of 'Neoplasm (morphologic abnormality)' represent a general classification scheme for the types of specific neoplasm morphologies. Exception to this recommendation will occur when a needed specific morphology does not exist necessitating the selection of a more general morphology as represented by the direct children concepts of 'Neoplasm (morphologic abnormality)'.
- The assigned associated morphologic finding concept will convey the biologic behavior as to malignancy, benign, uncertain behavior or unclassified via inheritance through the morphology hierarchy.
- The selected finding site value should be as refined as possible to convey as much anatomic specificity as possible concerning the neoplasia. Additional finding site value pairs may be added if desired in order to represent tumors in multiple locations.
- Additional information can optionally be added to the representation of the neoplasm by attaching the additional attributes 'with laterality' and 'associated etiology' if the user desires.
- Veterinary concepts regarding stages and histological grade are not currently represented in SNOMED, even though a concept representing stages and grade can be found in the nomenclature. It is not recommended that these Modifier codes be added to the neoplasm concept until grading and staging systems appropriate to veterinary medicine are added to the nomenclature.
Root Concepts:
Attributes:
- Associated morphology 116676008
Values = "is-a" descendants of Neoplasm (morphologic abnormality) 108369006 (1123 types of neoplasms)
- Finding site (attribute) 363698007
Values = "is-a" descendants of Anatomical structure (body structure) 91723000.
- With laterality 78615007
Values = "is-a" descendents of "Side" 182353008
- Causative agent 246075003
Values = "is-a" descendents of:
Substance 105590001
Infectious agent (living organism) 36272005
Physical object 260787004
Physical force 78621006
Comments:
- This approach was taken for two reasons:
- Neoplasms cannot be managed without SOME post-coordination. This guideline suggests moving UP the hierarchy to "Neoplasm", rather than "Neoplasms by body site". It will take less time to locate the "root concept", and more to post-coordinate topography
- It may be very difficult to infer the degree of malignancy from the information provided to record abstracting personnel. If an institution decides that malignant versus benign MUST be captured AND provides a suitable mechanism to convey that information to the medical record system, the root concept(s) Benign neoplastic disease 20376005, Disorder: Malignant neoplastic disease (primary) 38807002 etc. can be substituted for "Neoplasm"
- SNOMED needs these concepts:
- Infiltrative Lipoma
- Large Granular Lymphosarcoma
- Cutaneous Histiocytosis
- Systemic Histiocytosis
- Mast Cell (needs a child specific morphology concept to one in example)
.
Examples:
Case 1: "Subcutaneous Lipoma, on the chest wall"
Neoplastic Disease 55342001
- Associated morphology 116676008
- Lipomatous neoplasm (morphologic abnormality) 115227001
- Finding site (attribute) 363698007
- Subcutaneous tissue structure of chest (body structure) 58087007
Case 2: "Basal Cell Tumor, skin of head"
Neoplastic Disease 55342001
Case 3: Mast Cell Tumor, skin of rear leg
Neoplastic Disease 55342001
- Associated morphology 116676008
- Mast cell neoplasm (morphologic abnormality) 127581004
- Finding site (attribute) 363698007
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- Skin structure of lower extremity (body structure) 28053004
Case 4: "Lymphoma/Lymphosarcoma, thymic location"
Neoplastic Disease 55342001
Case 5: "Warts/Papillomas, lip"
Neoplastic Disease 55342001
Case 6: Equine Sarcoid, left neck
Neoplastic Disease 55342001
Case 7: Granulocytic Leukemia, marrow and circulating blood
Neoplastic Disease 55342001
- Associated morphology 116676008
Myeloid leukemia, morphology (morphologic abnormality) 37810007
- Finding site (attribute) 363698007
- Hematopoietic system (body structure) 57171008
Case 8: Malignant Histiocytoses
8a Malignant Histiocytosis, spleen
Neoplastic Disease 55342001
8b: Systemic Histiocytosis, chest lymph nodes
Neoplastic Disease 55342001
- Associated morphology 116676008
- Histiocytic neoplasm (morphologic abnormality) 128622001
- Finding site (attribute) 363698007
- Structure of Lymph node of thorax (body structure) 47109002
8c: Cutaneous Histiocytosis, multiple skin sites
Neoplastic Disease 55342001
8d: Cutaneous Histiocytoma, left front limb
Neoplastic Disease 55342001
- Associated morphology 116676008
- Canine cutaneous histiocytoma (morphologic abnormality) 90190005
- Finding site (attribute) 363698007
- Left upper extremity structure (body structure) 80768000
8e: Malignant Fibrous Histiocytoma, right rear limb
Neoplastic Disease 55342001
- Associated morphology 116676008
- Fibrous histiocytoma, malignant (morphologic abnormality) 34360000
- Finding site (attribute) 363698007
- Right lower extremity structure (body structure) 62175007
Case 9: Masses on skin of abdomen
9a: Mass on skin of abdomen
No microscopic confirmation - clinically tumor (finding) 59635003
9b: Mass on skin of abdomen, clinical impression, benign tumor
No microscopic confirmation - clinically benign tumor (finding) 65712000
9c: Mass on skin of abdomen, clinical impression, malignant tumor
No microscopic confirmation - clinically malignant tumor (cancer) (finding) 74599000
9d: Mass on skin of abdomen, clinical impression, metastatic tumor
No microscopic confirmation - clinically metastatic tumor (cancer) (finding) 52691008
Case 10: Schwannoma, right axilla region
Neoplastic Disease 55342001
- Associated morphology 116676008
- Nerve sheath tumor (morphologic abnormality) 115242003
- Finding site (attribute) 363698007
- Subcutaneous tissue structure of axilla (body structure) 57930003
Case 11: Cutaneous Melanoma, skin neck
Neoplastic Disease 55342001
- Associated morphology 116676008
- Nevus AND/OR melanoma (morphologic abnormality) 115223002
- Finding site (attribute) 363698007
Case 12: Melanoma, Eye
Neoplastic Disease 55342001