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Report Produced: 10/26/2025 00:14 AM

Report Question ID Question Discussion Answer Year
20130040

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what rule applies when a patient has a history of chronic myeloid leukemia diagnosed in 1993 followed by a diagnosis of acute myeloid leukemia arising in chronic myelogenous leukemia, blast phase? See Discussion.

12/1993 Bone marrow biopsy: Chronic myeloid leukemia t(9;22) (q34;q11).

09/2011 Bone marrow biopsy: Abnormal cytogenetic & FISH support persistent involvement by chronic myelogenous leukemia.

12/2011 Peripheral blood, flow cytometry: Involvement by acute myeloid leukemia arising in chronic myelogenous leukemia (CML, blast phase, 30% blasts by manual diff.).

Is the 12/2011 diagnosis a new primary? If not, why don't Rules M8-M13 apply when the Heme DB Abstractor Notes section for CML indicates that when there is a chronic, accelerated and blast phase that develops later in the course of the disease, change the histology code to the more specific diagnosis?

 

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

This case should be accessioned as a multiple primary: chronic myelogenous leukemia t(9;22) (q34;q11) [9863/3] diagnosed in 1993 and acute myeloid leukemia [9861/3] diagnosed in 2011 per Rule M15.

Use the diagnosis date to determine the appropriate manual and rules to follow to determine the histologies for this case. To determine the histology of the 1993 diagnosis, use the ICD-O-2. The Heme Manual & DB will be used to determine the number of primaries and the histology of the 2011 diagnosis of AML.

Rules M8-M13 in the Heme Manual cannot be applied to this case because no transformation occurred. CML does not transform to another neoplasm.

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
20130012

MP/H Rules/Multiple primaries--Urinary: If topography codes C681-C689 are not included in Urinary Multiple Primary Rule M8, would a subsequent renal pelvis papillary transitional cell carcinoma be a new primary? See Discussion.

The patient had a papillary transitional cell carcinoma of the bladder and ureter diagnosed in 2010. The primary site was coded to C689 [urinary system, NOS]. The patient was diagnosed with a transitional cell carcinoma of the renal pelvis [C659] in 2012. In applying the MP/H rules to the 2012 diagnosis, rule M8 would be ignored because the primary site of the 2010 primary was coded to C689. The result is that M9 or M10 would be applied which indicates a new primary for the 2012 diagnosis. Should the 2012 renal pelvis carcinoma be a new primary?

For cases diagnosed 2007 or later, accession a single primary, papillary transitional cell carcinoma of the bladder and ureter [C689, urinary system, NOS] diagnosed in 2010. The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Urinary MP Rules because site specific rules exist for this primary.

Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. This patient has urothelial tumors in two or more of the listed sites (bladder, ureter and renal pelvis) diagnosed within 3 years.

When C689 is assigned because tumors of the bladder and tumors of the ureter were determined to be a single primary and the site of origin is not known (as in this example), rule M8 is applied when a subsequent tumor is diagnosed in one of the listed sites. However, if site C689 [urinary system, NOS] was assigned for other unknown urinary primary site situations, rule M8 would not be used.

Rule M8 was written specifically for urothelial tumors in the renal pelvis, ureter, bladder and urethra. Paraurethral gland [C681] and overlapping lesions of urinary organs [C688] do not belong in rule M8.

We will add this issue to the list of possible revisions for the next edition of the MP/H Rules.

 2013
20130207 Multiple primaries--Heme & Lymphoid Neoplasms: Is a new primary reported for the diagnosis of plasmacytoma associated with a pathological fracture if it follows a diagnosis five years ago of multiple myeloma? See Discussion.

Multiple myeloma was diagnosed more than 5 years prior to admission. The patient underwent multimodality treatment.

Currently, the patient suffered a fracture. The pathology report diagnosis was "plasmacytoma." The discharge summary states, "multiple myeloma advanced with multiple lytic lesions".

Does this scenario represent a single primary dating back to the original diagnosis? Or does the diagnosis of plasmacytoma on the recent biopsy indicate a new primary because it was originally diagnosed as acute and reverts to a chronic neoplasm after treatment more than 21 days later?

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

Per the Abstractor Notes section, this case represents a single primary. Histology is coded to 9732/2 [multiple myeloma], which is now advanced.

Review the Abstractor Notes section in the Heme DB for multiple myeloma. It states that in multiple myeloma there is generalize bone marrow involvement. It further states that lytic bone lesions and bone tumor masses of plasma cells (plasmacytomas) are signs of advanced disease. According to the Discharge Summary, this patient had multiple lytic lesions and plasmacytoma which indicates advanced 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
20130043

Reportability--Heme & Lymphoid Neoplasms: Is reactive plasmacytosis a reportable diagnosis that is equivalent to plasmacytoma?

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

Reactive plasmacytosis is not reportable unless there is another indication of a reportable neoplastic disease. Reactive plasmacytosis is "a well known pathological process described as occurring in a variety of situations including infections, autoimmune disease, diabetes mellitus, sideropenia, liver cirrhosis and neoplastic conditions including leukemia. This process, by definition, is assumed to be a reaction of the immune system to an unknown or poorly defined stimulus." Based on this definition, reactive plasmacytosis is not the same as a plasmacytoma, although it may indicate the presence of a neoplastic process, such as leukemia.

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
20130003

MP/H Rules/Histology--Head & Neck: How is the histology coded for a mammary analogue secretory carcinoma (MASC) of the parotid gland? See Discussion.

There is no histology listed in the ICD-O-3 for a mammary analogue secretory carcinoma. The pathologist stated that, "MASC is a recently described salivary gland tumor type which, as the name implies, resembles secretory carcinoma of the breast." Should the histology be coded 8550/3 [acinar carcinoma] or 8502/3 [secretory carcinoma of breast]?

Assign code 8502/3 [secretory carcinoma of breast].

Acinar carcinoma [8550/3] describes a very typical type of salivary gland tumor only. This histology code does not adequately capture the histology in this case which describes a secretory carcinoma that is similar to mammary cancer. Both of these elements are reflected in the histology code 8502/3 [secretory carcinoma of breast].

 2013
20130083 Ambiguous terminology/Histology--Heme & Lymphoid Neoplasms: How is the histology coded if an FNA reveals high grade B-cell lymphoma, compatible with diffuse large B-cell lymphoma, and the treating physician states this is diffuse large B-cell lymphoma? See Discussion.

The FNA showed high grade B-cell lymphoma, morphologically compatible with diffuse large B cell lymphoma. Special studies state: Tumor cells are positive for Vimentin, CD45, and CD20, focally weakly positive for CD43; negative for Myeloperoxidase, CD99, AE1/AE3, CK7, CK20, S100, CD3, cyclin D1, CD34, CD5 and TTF1. The cellular findings and immunophenotype are compatible with large B-cell lymphoma.

The treating physician refers to this disease process and is treating the patient for diffuse large B-cell lymphoma. Should the histology be coded as B-cell lymphoma, NOS (9591/3) because both the FNA and the immunophenotyping use ambiguous terminology? Does the physician reference to the disease process as diffuse large B-cell lymphoma, Stage II-AE impact the histology used?

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

Code the histology to diffuse large B-cell lymphoma [9680/3] because the physician states this is a DLBCL and is treating the patient accordingly. Although the pathology report was only compatible with DLBCL, there was a subsequent clinical diagnosis that confirmed a diagnosis of DLBCL. In addition, the patient was treated for DLBCL.

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
20130125 Reportability--Heme & Lymphoid Neoplasms: Is self-healing Langerhans cell histiocytosis (LCH) of the skin reportable?

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

This is a reportable primary. Langerhans cell histiocytosis (LCH) [9751/3] is a reportable neoplasm.

The term "self-healing" means that the neoplasm regressed without treatment. This is a known phenomenon.

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
20130137 Histology--Heme & Lymphoid Neoplasms: How is the histology coded for follicular lymphoma, low grade? See Discussion. Pathologists seem to be moving away from identifying follicular B-cell lymphomas as grade 1, grade 2, etc. Instead, the term follicular lymphoma, low grade is being used. Should the histology be coded as follicular lymphoma, NOS even though the Heme DB indicates this code is usually used for death certificate cases?

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

Code the histology to 9690/3 [follicular lymphoma, NOS].

Low grade for follicular lymphoma are not listed in the Heme DB or Manual. Because low grade can mean grade 1 or grade 2, default to follicular lymphoma, NOS [9690/3].

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
20130170

MP/H Rules/Histology--Breast: What is the histology code for "invasive carcinoma of the breast, no special type" as the final diagnosis on a pathology report? See Discussion.

Recently pathology reports for breast primaries are no longer listing invasive ductal carcinoma as the histology on many cases if the treating physician calls the cancer an invasive ductal carcinoma. The pathology report (final diagnosis and synopsis) state this is invasive carcinoma, no special type.

Upon inquiry to the pathology department, the response received stated, In 2012, the WHO got rid of ductal carcinoma as a specific type. So what would have been called Invasive ductal carcinoma, Not Otherwise Specified (NOS), is now being called Invasive carcinoma, No Special Type (NST). In the new WHO classification, lobular, tubular, cribriform, mucinous, etc. are the special types. But ductal is gone.

Is this a change in terminology? Should these cases be coded as 8500/3 [ductal carcinoma, NOS] or 8010/3 [carcinoma, NOS]?

Code the histology to ductal carcinoma, NOS [8500/3] for a pathology report with a final diagnosis of "invasive carcinoma, no special type." Do not code the histology to carcinoma, NOS [8010/3].

The 4th Edition of the WHO Classification of Tumors of the Breast refers to invasive ductal carcinoma as invasive carcinoma, no special type. The ICD-O-3 code remains the same as invasive duct carcinoma [8500/3]. The next revision to the MP/H Solid Tumor Rules will clarify this issue.

2013
20130189

Reportability--Brain and CNS: Are the terms 'mass' and 'lesion' reportable terms for accessioning brain and CNS primaries? See Discussion.

With respect to reportability, the SEER Manual mentions 'tumor' and 'neoplasm,' but not 'mass' or 'lesion.' The SEER MP/H Manual states tumor, mass, lesion and neoplasm are equivalent terms for determining multiple primaries, but does this apply to reportability? If not, what is the distinction?

'Mass' and 'lesion' are not reportable terms for benign/borderline brain and CNS tumors.

Reportable terms for benign/borderline brain and CNS primaries are 'tumor' and 'neoplasm.' These terms appear in the ICD-O-3. 'Lesion' and 'mass' do not appear in the ICD-O-3. Do not use the MP/H Manual to determine reportability; page 2 of the SEER Manual is the correct source for reportability instructions.

 2013