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Report Produced: 05/21/2026 15:40 PM

Report Question ID Question Discussion Answer Year
20091020 MP/H Rules/Histology--Breast: How do you code histology for a breast tumor when the comment section of the pathology report compares the current resected specimen with a previous needle biopsy? See Discussion. A single tumor is described on the breast needle biopsy as "infiltrating lobular carcinoma and ductal carcinoma in situ" and on the lumpectomy specimen as "infiltrating duct carcinoma." Per the COMMENT section on the pathology report: "Tumor resection was compared to previous needle biopsy. The appropriate designation is probably a terminal duct/lobular lesion." For cases diagnosed 2007 or later, assign code 8522 [Infiltrating duct and lobular carcinoma] according to Breast MP/H rule H16. The comment on the lumpectomy pathology report takes both the lumpectomy information and the biopsy information into consideration. "Probable" is an ambiguous term used to code histology. 2009
20120075 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for chronic lymphocytic leukemia/small lymphocytic lymphoma when a lymph node biopsy was positive for CLL/SLL but no bone marrow biopsy was performed? See Discussion. A right neck lymph node biopsy and flow cytometry proved CLL/SLL. The PET scan showed multiple involved lymph nodes in the right cervical, mediastinal and para-aortic areas. No bone marrow biopsy was done. Per the Hematopoietic DB, Module 3, the histology should be coded 9823/3 [CLL/SLL], but how is primary site coded? The manual states to code the primary site to the involved lymph node region when there is no bone marrow involvement, but it does not specifically address how to code the primary site when no bone marrow biopsy or peripheral blood smear was done.

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

Code the primary site to C77.8 [multiple lymph node regions, NOS].

Per Rule PH6, code the primary site to the involved lymph node region(s) when there is no bone marrow involvement or when it is unknown whether the bone marrow is involved. To determine the more specific lymph node subsite to code, use Rule PH21. It indicates one is to code the primary site to C778 [multiple lymph node regions, NOS] when multiple lymph node regions, as defined by the ICD-O-3 (see Table C1: Lymph Node/Lymph Node Chain Reference Table in Appendix C), are involved and it is not possible to identify the lymph node region where the lymphoma originated.

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
20110056 Primary site--Heme & Lymphoid Neoplasms: What is the primary site for a post-transplant lymphoproliferative disorder (PTLD) diagnosed on a brain biopsy? See Discussion. A patient was diagnosed in 6/2010 with PTLD by a brain biopsy. PTLD typically involves lymph nodes. Can the primary site for PTLD be coded to the brain?

Updated May 2026

Per the Heme DB, PTLD commonly involves lymph nodes, GI tract, lungs, and liver. Although CNS involvement is rare, in solid organ recipients the CNS may be the only site of involvement or may be associated with multi-organ involvement. Code the primary site to C719 [brain, NOS] and the histology to 9971/3 [post-transplant lymphoproliferative disorder (PTLD)]

2011
20031092

Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: How is the histology of invasive small cell carcinoma of lobular histogenesis coded?

Could high grade ductal carcinoma in situ, comedo type be a recurrence of ductal carcinoma diagnosed 18 years earlier?

Is "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" one or two primaries? See Description.

 A patient was diagnosed in 1984 with 1st breast primary, histology was ductal carcinoma, T1N0, LIQ left breast. In 2002 a mass was found on mammogram, MRM with axillary sampling performed. Histology was invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type, nuclear grade 3/3, T2N1, UOQ left breast. Is the ductal carcinoma in situ recurrent disease from the 1st primary? Does it go with the lobular histogenesis, i.e., lobular carcinoma and DCIS histology code 8522/3 or is the ductal in situ a 3rd primary?

For tumors diagnosed prior to 2007:

According to our pathologist consultant:

Invasive small cell carcinoma of lobular histogenesis appears to be an unusual histology for a breast primary. Code it as such 8041 [Small cell carcinoma, NOS].

The 2002 lesion is most likely a new primary since the previous lesion was 18 years ago, in a different quadrant, and invasive. A comedo DCIS would probably not be asymtomatic for 18 years; an unlikely "recurrence" of an earlier ducal carcinoma.

Code "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" as two primaries. Code the small cell as a separate primary (8041/3), and the DCIS separately (8501/2).

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.

 2003
20140011 MP/H Rules/Multiple primaries--Breast: Is the diagnosis of Paget disease two years after a diagnosis of infiltrating duct carcinoma of the same breast a new primary? See discussion. A patient was diagnosed and treated in 2010 for infiltrating duct carcinoma of the left breast. There was no mention of Paget disease. Then in 2012, the same patient was diagnosed with Paget disease of the nipple of the left breast. Rule M9 seems to apply; so this is the same primary, correct? And the information about the Paget disease is simply never captured, correct? Yes, Rule M9 makes this a single primary. You could revise the original histology code to 8541/3 on the assumption that Paget was present at the original diagnosis, but not yet identified. 2014
20100082 Ambiguous terminology/Reportability--Heme & Lymphoid Neoplasms: Should a case be accessioned as MDS, NOS when a consult uses ambiguous terminology (e.g., probable MDS) to describe the disease process and the bone marrow does not confirm the consult diagnosis? See Discussion. A patient is stated to have "probable MDS" by a hematology oncologist consult during an admission. A bone marrow biopsy was also performed during this admission, the final diagnosis on the pathology report is, "anemia and thrombocytopenia." The patient was not seen again by a hematology oncologist; however the patient's cardiology states, "BM biopsy was not clear whether this is MDS or another etiology."

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

This is not reportable. In effect, the original diagnosis was a rule/out MDS diagnosis. The bone marrow biopsy performed as part of the initial workup, proved that rule/out diagnosis was not valid. The subsequent statement confirms the diagnosis is not clear.

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.

2010
20110077 MP/H Rules/Multiple primaries--Breast: How many primaries are to be reported if different recurrence scores are found on the Oncotype Dx studies performed for multiple tumors in the same breast if the clinician states the patient has two primaries but the pathologist does not address the issue? See Discussion. A patient has two separate lesions in the same quadrant with the same histology. According to the MP/H rules this is a single primary. However, Oncotype Dx studies were performed on both tumors and the DX recurrence was different for each tumor. The medical oncologist states the patient has two primaries. The pathologist does not indicate the number of primaries.

This is a single primary. The only rules used to determine the number of primaries are the MP/H rules for cases diagnosed 2007 or later. Do not use other information such as Oncotype Dx to determine the number of primaries for a patient. Oncotype is used to determine whether the cancer is likely to recur AND whether the cancer would benefit from chemotherapy.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Breast MP rules under one of the three formats (i.e., flowchart, matrix or text).

Start with the MULTIPLE TUMORS module, Rule M4. The rules are intended to be reviewed in consecutive order within the module from Rule M4 to Rule M13. You stop at the first rule that applies to the case you are processing.

The patient has two tumors in the same breast with the same histology. Abstract a single primary for this patient.

2011
20100022 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: Is a 2010 diagnosis of ALK+ anaplastic T cell lymphoma following a 2008 diagnosis of follicular B cell lymphoma, grade 1 a new primary? If so, how is the histology coded? See Discussion. A patient has a history of Stage 4 follicular B cell lymphoma, grade 1 [9695/3] diagnosed in 2008. The patient was treated with Adriamycin, Cytoxan, Rituxan, and Prednisone. In 2010, the medical oncologist states the patient has progression/recurrence of lymphoma with pathology that has changed to anaplastic T cell lymphoma ALK+. There was immunophenotyping, but there was no more specific diagnosis made. The patient died within 3 months.

Updated May 2026

Rule M15 applies to this case which instructs you to use the Multiple Primaries Calculator. The result for 9695/3 and 9714/3 is "New Primary."

Abstract the anaplastic T cell lymphoma as a new primary. Code the histology to 9714/3 [Anaplastic large cell lymphoma, ALK-positive].

2010
20041065 Date Therapy Initiated/First-Course of Cancer-Directed Therapy Fields/Summary Stage 2000--Prostate: How do you code these fields for a case that received preventative chemo before a definitive cancer diagnosis? A patient has a "suspicious but not diagnostic" biopsy of the prostate in 09/2002. Doctor said it was not cancer and put the patient on a preventative chemo drug study (GTX-211). The patient returned for a repeat biopsy on 04/2003. Biopsy returned positive for adenocarcinoma. The patient had not been diagnosed when chemo was administered. Can the case be staged using the post-chemo information?

Stage this case the same as all other cases. Use only the information subsequent to the date of diagnosis to code stage and treatment.

The diagnosis date in the example is 04/2003. Do not use information prior to 04/2003 to code stage or treatment. Do not code the preventative chemo as treatment.

 2004
20071077 MP/H Rules/Multiple Primaries/Histology--Colon: How many primaries should be reported and how is the histology field(s) coded if the left colon contains two adenocarcinomas and one mucinous adenocarcinoma arising in a villous adenoma and each has a different level of invasion? See Discussion. A patient had three tumors in the left colon including an 1) invasive well differentiated mucinous adenocarcinoma arising in tubulovillous adenoma with pericolonic subserosal fat invasion 8.5cm, 2) An infiltrative moderately differentiated colonic adenocarcinoma with invasion of muscularis propria 4cm and 3) an invasive moderately differentiated adenocarcinoma with invasion of muscularis propria, 1/69 nodes positive. The case was coded using rule M8 for one primary, but M10 contradicts; and H13 coding rule for histology 8263/3.

For cases diagnosed 2007 or later:

Assuming that all tumors are in the left colon, there are three tumors:

  • Mucinous adenocarcinoma arising in a villous adenoma

  • Colonic adenocarcinoma

  • Colonic adenocarcinoma

    • Multiple Primary Determination

    In the colon MP rules go to the multiple tumors module. Start with M3. Stop at M7 and abstract as a single primary.

    Histology Code

    Go to the histology coding rules, multiple tumors module, and start with H15. Stop at H20 which tells you to code the most invasive tumor. Tumor 1 is the most invasive according to the definition of most invasive in the 2007 SEER Manual, page C-271. Code 8263/3 [Adenocarcinoma in tubulovillous adenoma].

    		 2007