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Report Produced: 05/21/2026 04:26 AM

Report Question ID Question Discussion Answer Year
20130047 Date of diagnosis--Heme & Lymphoid Neoplasms: What is the diagnosis date for a patient with a mild thrombocytosis diagnosed in 2008, that was subsequently treated with Anagrelide in 11/2010 following an increase in platelet count, and later in 3/2011 was found to have positive JAK2 study physician refers to as essential thrombocythemia? See Discussion. In 2008, patient diagnosed with mild thrombocytosis. The patient opted to be followed clinically with observation. In November 2010, a CBC showed an increased platelet count to 600,000. Anagrelide was started. The patient would never agree to a bone marrow biopsy. However, in 3/2011 a JAK2 study was performed and read as positive. Following the positive Jak2 study, physician stated the diagnosis was essential thrombocytosis and started the patient on a different drug.

Code the diagnosis date to 3/2011. It wasn't until 3/2011 that the physician documented a reportable diagnosis of essential thrombocytosis [9962/3].

Mild thrombocytosis is not reportable. Therefore, the case was not reportable in 2008. Although the patient was treated in 2010, there was no documentation of a reportable diagnosis.

2013
20071066 Grade, Differentiation--Bladder: Can grade be coded from the pathology report for a recurrent bladder cancer specimen? See Discussion. In 2006 a TURB was done for bladder carcinoma diagnosed 10 years ago. Is grade always coded 9 on class 3 cases unless the original slides were reviewed?

Code grade from the original tumor; do not code grade from recurrence.

If the grade of the original primary tumor is specified, code it, regardless of class of case.

 2007
20120074 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient is diagnosed in 2004 with extranodal diffuse large B-cell lymphoma (DLBCL) of the stomach followed by a 2011 diagnosis of DLBCL involving abdominal lymph nodes? See Discussion. In 2004 a patient's extranodal DLBCL was treated with a partial gastrectomy at another facility. A recurrence of DLBCL was diagnosed in 2011 by a fine needle aspiration of abdominal lymph nodes. The patient presented to this facility for chemotherapy.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

This case is accessioned as a single primary. Code the histology to 9680/3 [diffuse large B-cell lymphoma] and diagnosis date to 2004. Per Rule M2, abstract as a single primary when there is a single histology.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2012
20031202 Surgery of Primary Site--Head & Neck: How is this field coded for a surgery titled "Parotidectomy with facial nerve dissection"? See Description. If the operative report is not titled "total parotidectomy," can we assume that less than total parotidectomy was done? Can we assume that "facial nerve dissection" and "facial nerve monitoring" are other ways of stating "facial nerve spared"?

Use the best information available to determine whether or not all of the parotid has been removed. It is important to read the entire operative report and review the content of the pathology report. The Op report will usually include wording about how much was removed, and this can be confirmed by the path report. Do not make assumptions about the extent of the surgery based solely on the title used on the operative report.

For cases diagnosed 1998-2003: Code 30 [less than total parotidectomy] can be used when the parotid is not totally removed, but the exact type of partial parotidectomy cannot be determined. "Facial nerve monitoring" and "Facial nerve dissection" are synonymous with "facial nerve sparing."

 2003
20010156 Multiple Primaries (Pre-2007)--Breast: Patient diagnosed with two lumps in same breast, different quadrants at same time. One was ductal carcinoma, cribriform type; the other was ductal carcinoma. How many primaries do we code? See discussion. If the breast cancer had been diagnosed in 2000 we would have coded this case as one primary, code to higher ductal ca. For a 2001 or later diagnosis, should this be coded as two primaries?

For cases diagnosed 1998-2003:

Code this case as two primaries if the tumors are separate. Separate tumors have clear (negative) margins. If the tumors are not separate, code as one primary.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2001
20110006 Reportability--Heme & Lymphoid Neoplasms: Are all stages of CLL reportable? See Discussion. If a physician notes the patient has Stage 0 CLL (increasing leukocytosis), is this reportable? CLL Stage is not mentioned in the Hematopoietic Manual or Database, but internet research reveals CLL has five stages (Stage 0, I, II, III, and IV).

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Yes. All stages of CLL are reportable. CLL has a unique staging system. The Heme DB and Manual do not address the issue of stage. Therefore, stage information is not reported in the Abstractor Notes section of the Heme DB.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2011
20020002 Date Therapy Initiated: What date should be entered in Date Therapy Initiated when treatment follows a surgical procedure that is not coded under Surgery of Primary Site? See discussion. If a patient has a surgical procedure that is not coded in the Surgery of Primary Site field and then the patient undergoes additional first course of treatment, such as radiation therapy, how should the Date Therapy Initiated field be coded? In this example, code the Date Therapy Initiated field to the date of the first surgical procedure. If a SEER edit is triggered, please notify us. 2002
20000851 Primary Site: What site code is used to classify a femur biopsy with pathologic diagnosis of "Ewing sarcoma/primitive neuroectodermal tumor (PNET)"? See discussion. ICD-O-3 lists PNET as being site specific to C71._. The pathology report states "some authors consider both Ewing sarcoma and PNET to be the same histologic entity given that they share the same translocation between chromosomes 11 and 23." Code the Primary Site field to C40.2 [femur] based on Rule H in the ICD-O-3 that states, "Use the topography code provided when a topographic site is not listed in the diagnosis. This topography code should be disregarded if the tumor is known to arise at another site." 2000
20091085 MP/H Rules/Histology--Breast: How is histology coded for a breast primary with a final diagnosis of "infiltrating duct carcinoma with apocrine features"? See Discussion. I & R has conflicting answers: #25719 (dated 3/17/2008) says per rule H12 this is 8401/3 but #23347 (dated 8/12/07) says per rule H16, this is 8523/3.

For cases diagnosed 2007 or later, assign histology code 8401/3 [apocrine adenocarcinoma] according to rule H12. Apocrine is a type of duct carcinoma, see table 1. Code 8401 should be listed in Rule H12. Apocrine should be removed from table 3.

These corrections will appear in the revised version of the rules.

 2009
20081099 MPH Rules/Behavior--Breast: Would a positive right axillary node following DCIS of the right breast indicate the presence of a new primary? See Discussion. How would you abstract the information from 2007? A patient with a strong family history of breast cancer had bilateral simple mastectomies in 2000, after a suspicious mammogram. Results showed DCIS in the rt breast; no malignancy in the left breast. Now in 2007, the patient has a right axillary lymph node removed - positive for carcinoma of breast origin. Comment says, "recurrent breast carcinoma in rt axillary node from patient's known history of DCIS." Is this a new primary? Is this a diagnosis date in 2007? Is the site C509 and laterality right side?

For cases diagnosed 2007 or later:

A metastasis was diagnosed in 2007. The 2007 MP/H rules do not apply to metastases.

Change the behavior code of the 2000 diagnosis. The breast cancer diagnosed in 2000 must have been invasive based on the metastasis in 2007.

 2008