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Report Produced: 08/29/2025 12:56 PM

Report Question ID Question Discussion Answer Year
20130115 Histology--Heme & Lymphoid Neoplasms: How is histology coded when the biopsy final diagnosis is "low grade B-cell lymphoma of unclear subtype (splenic marginal zone lymphoma?)" and the hematologist clinically diagnoses this as splenic marginal zone lymphoma? See Discussion.

This patient has massive splenomegaly. The biopsy final diagnosis was "low grade B lymphoma of unclear subtype (splenic marginal zone lymphoma?)." The pathologist's comment states, "Because of the clinical context (lymphocytosis and splenomegaly) a splenic marginal zone lymphoma is a possibility." There are no other histologic diagnoses. All the flow cytometry reports are as unclear as the biopsy.

The hematologist, after seeing the pathology report, states, "The bone marrow biopsy shows a significant infiltration by mature lymphocytes; their markers strongly suggest a marginal zone lymphoma, probably of splenic origin The final diagnosis is a splenic marginal zone lymphoma."

Should the clinical diagnosis of splenic marginal zone lymphoma [9689/3] be coded when a clinical diagnosis is not listed as a definitive diagnostic method for this neoplasm? Or should the histology be coded as low grade B-cell lymphoma [9591/3]? The clinicians will expect the case to be coded as a splenic marginal zone lymphoma when there's no doubt about the diagnosis.

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

Code the histology to 9689/3 [splenic marginal zone lymphoma] per Rule PH29 and Case Reportability Instruction #6 in the Heme Manual. Case Reportability Instruction #6 indicates, "Report the case when there is a (physician's statement) of reportable hematopoietic or lymphoid neoplasm."

The pathology gave an NOS diagnosis, low grade B-cell lymphoma [9591/3]. The physician clinically stated this was a splenic marginal zone lymphoma [9689/3]. Rule PH 29 states to code the specific histology when the diagnosis is one non-specific histology AND one specific histology AND the Heme DB MP Calculator indicates they are the same primary. Per the Multiple Primaries Calculator, these two histologies indicate the same primary.

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.

2013
20130114 Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the bone marrow biopsy shows acute myeloid leukemia, but the physician states this is therapy-related AML secondary to prior radiation treatment? See Discussion. Physician states this patient has radiation therapy-related AML due to radiation received as treatment for a prior prostate cancer. The bone marrow and other immunophenotyping do not state this is therapy-related AML. Should the histology be coded AML, NOS [9861/3] or therapy-related AML [9920/3]?

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

Code the histology as therapy-related acute myeloid leukemia, NOS [9920/3] when the physician states this is a therapy-related AML.

The therapy-related diagnosis may be either clinically or pathologically stated to code the histology to 9920/3. In this case, the physician is aware of the previous chemotherapy, hormone therapy or radiation and adds that knowledge to the histologic findings of AML. The pathology report did not include this clinical, historical information as part of the final diagnosis. However, one can code therapy-related acute myeloid leukemia because clinically it was stated.

We recommend that you clearly document in the abstract that you are coding a clinical 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.

2013
20130113

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient diagnosed and treated for multiple myeloma is subsequently diagnosed with multiple large plasmacytomas involving the scalp and thorax? See Discussion

The patient was diagnosed with multiple myeloma, underwent treatment and subsequently was in remission. The patient later presented with lesions on the scalp and thorax lesions. The final diagnosis on the pathology report for the scalp lesion was multiple myeloma with plasmablastic transformation (high grade). The physician states this is an aggressive, recurrent multiple myeloma with multiple large plasmacytomas involving the scalp and thorax.

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

Accession a single primary, multiple myeloma [9732/3] per Rule M2.

The multiple myeloma is in an advanced stage when plasma cells are being deposited on the scalp and thorax. Clinically, those plasma cells are rightly called plasmacytomas by the physician. However, the patient has a late-stage multiple myeloma causing the plasma cells/plasmacytomas. Note that under the myeloma Recurrence and Metastases section of the Heme DB it indicates that extramedullary involvement (e.g., the scalp and thorax involvement) usually indicates advanced disease. Therefore, this scenario represents a case of a single histology that is accessioned as a single primary per Rule M2.

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.

 2013
20130112 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of post-transplant lymphoproliferative disorder (PTLD) diagnosed on an inguinal lymph node biopsy with CT scan evidence of lymphadenopathy in the chest, abdomen and pelvis if the bone marrow is also involved?

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

Code the primary site to multiple lymph node regions, NOS [C778] per Rule PH21 when multiple lymph node regions, as defined by the ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated

In the Abstractor Notes section in the Heme DB for PTLD it states PTLD commonly involves lymph nodes, GI tract, lungs and the liver. This patient has extensive lymph node involvement. Rule PH26 states to code the primary site to the bone marrow when ONLY the bone marrow is involved; however, that does not apply in this case.

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.

2013
20130111 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2008 diagnosis of extralymphatic follicular lymphoma in the breast is subsequently diagnosed in 2011 with ocular follicular lymphoma? See Discussion.

The patient was diagnosed with follicular lymphoma in the breast in 2008. Per notes, there was no evidence of disease again until 2011 when the patient presented with ocular lymphoma. The physician stated this was part of the same disease process as the prior breast diagnosis. The bone marrow was not involved in either case.

Is this a single primary (recurrence) of follicular lymphoma? Or are these multiple primaries because they arise in different extralymphatic sites?

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

Accession a single primary, follicular lymphoma [9690/3] of the breast diagnosed in 2008 per Rule M2.

Accession a single primary when there is a single histology. This is a recurrence of the patient's 2008 follicular lymphoma.

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.

2013
20130110 Reportability--Heme & Lymphoid Neoplasms: Is a diagnosis of "coagulable state" reportable?

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

The term "coagulable state" is not reportable. This is not a a neoplasm. The term means capable of coagulating or capable of becoming thick. There are neoplasms, such as polycythemia vera, in which the blood becomes thick; however, you must have an actual reportable diagnosis in order to accession the case.

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.

2013
20130109

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2004 diagnosis of acute myeloid leukemia is followed by a 2013 diagnosis of myeloid sarcoma? See Discussion.

Patient was diagnosed in 2004 with acute myeloid leukemia [9861/3] and treated with chemotherapy and transplant. Now the patient has a biopsy of an umbilical mass that is positive for myeloid sarcoma (granulocytic sarcoma) [9930/3].

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

Accession a single primary, acute myeloid leukemia [9861/3] diagnosed in 2004 per Rule M3.

When there is a myeloid sarcoma diagnosed simultaneously or after a leukemia of the same lineage, it is a single primary. The myeloid sarcoma is actually caused by the AML progressing. The myeloid cells in the bone marrow or blood literally "seep out" and implant in the tissue.

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.

2013
20130107 Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a diagnosis of polycythemia vera with myeloproliferative syndrome?

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

Code the histology to 9950/3 [polycythemia vera], the more specific histology, per Rule PH29. Myeloproliferative syndrome is a non-specific (NOS) histology and polycythemia vera is a specific type of myeloproliferative disease.

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.

2013
20130106 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2009 diagnosed Hodgkin lymphoma, nodular sclerosis type is treated and subsequently presents in 2010 with the same diagnosis? See Discussion.

2009 diagnosis of Hodgkin lymphoma, nodular sclerosis type involved the superior mediastinal nodes, AP window nodes, bilateral axillary nodes and pulmonary nodules. The patient received chemotherapy and went into remission.

Patient presents in 2010 with Hodgkin lymphoma, nodular sclerosing type in the superior mediastinum.

Does timing play any part in determining if this reported as one or two primaries? There is no timing rule in the Heme Manual.

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

Accession a single primary, Hodgkin lymphoma, nodular sclerosis type [9663/3] diagnosed in 2009 per Rule M2.

Accession a single primary when there is a single histology. Note 2 for Rule M2 indicates timing is not relevant. This is disease progression or recurrence and not a new primary.

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.

2013
20130105

Primary Site--Heme & Lymphoid Neoplasms: How is the primary site coded for a B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma when a biopsy of the paraspinal muscle and epidural tissue is positive, but there is no indication of lymph node involvement in the chart?

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

Code the primary site to soft tissue of the back, NOS [C496] per Rule PH24 and the Abstractor Notes in the Heme DB for B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma.

Code the primary site to the organ when lymphoma is present only in an organ. The lesion is described as epidural (tissue surrounding the dura) and involving paraspinal muscle, NOS. Both are connective or other soft tissues of the trunk, NOS [C496].

B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is a synonym for DLBCL 9680/3. When there is no primary site listed in the Heme DB, go to the Abstractor Notes. In the Abstractor Notes section it states that patients present with lymphadenopathy OR mass lesions in extranodal sites.

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.

 2013