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Report Produced: 04/21/2026 14:21 PM

Report Question ID Question Discussion Answer Year
20110016 Behavior--Brain and CNS: Can hemangioblastomas occurring in the CNS be coded as /3 (malignant) based on a radiologic or clinical diagnosis by the physician? See Discussion. Hemangioblastomas are borderline (/1) according to ICD-O. The standard matrix rule in ICD-O directs registrars to change the behavior code to malignant when a malignant (/3) behavior is stated by a physician for a morphology code that appears in ICD-O with a non-malignant behavior code. The "malignant" hemangioblastomas we see are not pathologically confirmed; they are radiological or clinical diagnoses confirmed when renal cell carcinoma is a disease process listed in the malignant differential diagnoses.

The behavior code for hemangioblastoma can be coded to /3 when a pathologist indicates that the behavior is malignant. The behavior code should be based on a pathologist's opinion. It is usually not possible for a radiologist or patient care physician to make this determination clinically.

The histologic appearance of hemangioblastoma may resemble metastatic renal cell carcinoma; therefore, one will often see renal cell carcinoma listed as a possible diagnosis. This does not indicate that the hemangioblastoma is malignant. Do not code the behavior as /3 based on a differential diagnosis of renal cell carcinoma.

2011
20110019 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when bilateral testes are involved with lymphoma?

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

This is a single primary per Rule M2 which indicates to abstract a single primary when there is a single histology. Code the histology to 9590/3 [lymphoma] and the primary site to C629 [testes. Unless your software has edits that prevent coding laterality for lymphomas, code the laterality as bilateral. Up to half of extranodal lymphomas occur in multiple sites, particularly in paired 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.

2011
20110102

Reportability--Heme & Lymphoid Neoplasms: For cases diagnosed 2010 and later, are idiopathic thrombocytopenia and autoimmune thrombocytopenia reportable?

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

Idiopathic and autoimmune types of thrombocytopenia are not reportable. Thrombocytopenia and thrombocythemia are not synonyms. Cytopenia and cythemia have different definitions. See Appendix F: Non-Reportable List for Hematopoietic Diseases.

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
20110014 MP/H Rules/Histology--Corpus Uteri: Which MP/H rule applies in coding histology for a "high grade endometrioid adenocarcinoma with squamous differentiation (adenosquamous carcinoma)"? See Discussion. Is the pathology describing a specific histology, adenosquamous carcinoma [8560/3]? Or is this a combination/mixed histology code per rule H16? The Rule H16 instruction is to code a mixed histology code, 8323/3 [mixed cell adenocarcinoma] from Table 2 when two or more of the histologies are present (i.e., endometrioid and squamous in this case).

For cases diagnosed 2007 or later:

Endometrioid adenocarcinoma with squamous differentiation is coded to 8570 [Adenocarcinoma with squamous metaplasia].

The following row needs to be added to Table 2 in order to be able to correctly use the MP/H rules to reach this conclusion.

Column 1:   Endometrioid adenocarcinoma

Column 2:   Squamous metaplasia

                    Squamous differentiation

Column 3:   Adenocarcinoma with squamous metaplasia

Column 4:   8570

The change will be made in the next revision of the rules.

2011
20110013

MP/H Rules/Histology--Testis: Which MP/H rule applies in coding the histology described as a "malignant mixed germ cell tumor with the following features: Histologic type: embryonal carcinoma (97%) and yolk sac tumor (3%)"? See Discussion.

Per MP/H rule H16, code the appropriate combination/mixed code (Table 2) when there are multiple specific histologies or when there is a non-specific histology with multiple specific histologies. The combination embryonal carcinoma and yolk sac tumor is not listed in Table 2, even though the pathology report indicates this is a mixed germ cell tumor.

Should rule H17 be applied and the numerically higher histology code be used?

As of 2016: Code histology to 9085/3 [mixed germ cell tumor]. Combine 9065 and 9085 for analysis purposes.                            

2011
20110009 Diagnostic confirmation/Date of diagnosis--Heme & Lymphoid Neoplasms: How are these fields coded for a 2/11/10 negative bone marrow biopsy with cytogenetic abnormalities if the physician makes a clinical diagnosis of refractory cytopenia with multilineage dysplasia on 2/25/10? See Discussion.

2/11/10 bone marrow biopsy revealed "mild trilineal dysplastic changes in conjunction with chronicity of cytopenias is worrisome for MDS." Cytogenetics are positive for 5q deletion. Clinicopathologic correlation required for final diagnosis. On 2/25/10 the physician confirms a diagnosis of refractory cytopenia with multilineage dysplasia.

Is the date of diagnosis 2/11/10 with diagnostic confirmation of 3 or 2/25/10 with diagnostic confirmation of 8?

The date of diagnosis is 2/25/10 and diagnostic confirmation is coded to 8 [clinical diagnosis only].

As the cytogenetics state, you need clinicopathologic correlation to get confirm a reportable diagnosis. There is no reportable diagnosis from the bone marrow biopsy. The cytogenetics were done (the pathologic part) and then the physician confirmed refractory cytopenia with multilineage dysplasia [9985/3] (the clinical part). The diagnostic process and the determination of a reportable diagnosis were completed when the clinician made the statement that this is refractory cytopenia with multilineage dysplasia.

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
20110143

Multiple primaries--Heme & Lymphoid Neoplasms: How many and what primary site(s) are to be accessioned when biopsies of clavicular and neck skin lesions are both consistent with mycosis fungoides? See Discussion.

Per the Heme DB and Manual, this is a single primary; however, per the MP/H Rules, this would be multiple primaries. Which rules apply to this case?

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

When there is a question of whether the SEER MP/H Rules or Hematopoietic and Lymphoid Neoplasm Rules apply, check the histology and refer to the Case Reportability Instructions in the Hematopoietic and Lymphoid Neoplasm Manual. All ICD-O-3 morphology codes in the range 9590 - 9992 are included in the Hematopoietic Rules. Mycosis Fungoides [9700/3] is included in this range. Therefore, the SEER MP/H Rules do not apply to mycosis fungoides.

This case should be accessioned as a single primary: mycosis fungoides [9700/3] of the skin, NOS [C449]. Per Rule M2 abstract a single primary when there is a single histology.

Note that in the Primary Site(s) section of the Heme DB, it states the primary site must always be coded to skin (C440 - C449) for mycosis fungoides. Because the primary site is stated in this section of the Heme DB, it is not necessary to use the Primary Site Rules to determine the primary site. Code the primary site to C449 [skin, NOS] because the patient has multiple sites of skin involvement and there is no documentation indicating which subsite of skin was the origin of the mycosis fungoides.

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
20110055

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted for a bone marrow biopsy diagnosis of "acute myeloid leukemia (non-M3 type; favor FAB M1), probably arising in myelodysplastic syndrome;" and flow cytometry studies performed the same day were consistent with acute myeloid leukemia?

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

Ambiguous terminology is NOT used to determine histology for hematopoietic or lymphoid neoplasms. Therefore, the comment that the AML is "probably" arising in myelodysplastic syndrome is not used to determine the histology code. The term "favor" is also an ambiguous term and cannot be used to code histology.

This is a single histology per M2, abstract a single primary when there is a single histology. The histology is coded to 9861/3 [acute myeloid leukemia, NOS]

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
20110094

Surgery of Primary Site--Breast: Is a "nipple sparing mastectomy" coded to 30 [subcutaneous mastectomy] or 40 [total (simple) mastectomy] if the nipple/areolar complex was not removed but the pathology specimen indicates some breast skin was removed? See Discussion.

In the past, the SEER Manual indicated that code 30 [subcutaneous mastectomies], which captured nipple-sparing mastectomies, would rarely be used because it was not typically performed as treatment for a malignancy. This note was removed from the 2010 SEER Manual, Appendix C. Code 30 which now states, "A subcutaneous mastectomy is the removal of breast tissue without the nipple and areolar complex or overlying skin." More "nipple-sparing mastectomies" are now being performed at certain facilities.

Should the Surgery of Primary Site field be coded to 30 when a nipple-sparing mastectomy with reconstruction is performed, even if there is skin removal? Or, does the skin removal indicate that this is not a subcutaneous mastectomy, and therefore code 43 [Total (simple) mastectomy with reconstruction, NOS] applies?

Code Surgery of Primary Site to 30 [Subcutaneous mastectomy] for this case.

Assign code 30 when the nipple and areolar complex are NOT removed. Assign code 40 (or higher) when the nipple and areolar complex ARE removed.

2011
20110017

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported if a patient originally diagnosed with CLL is subsequently diagnosed several months later on a bone marrow biopsy with Richter's syndrome that transformed into a large cell lymphoma? See Discussion.

Per reviewed resources, the described condition is rare. Should the histology remain CLL or be changed to large cell lymphoma?

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

This case is accessioned as two primaries per Rule M10 which states to abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm and there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis. The first primary is CLL [9823/3] and it is a chronic neoplasm. The second primary is diffuse large B-cell lymphoma (DLBCL) [9680/3] and it is an acute neoplasm.

Richter syndrome (RS) is a complication of B cell chronic lymphocytic leukemia (CLL) or hairy cell leukemia (HCL) in which the leukemia changes into DLBCL. There is also a less common variant in which the CLL changes into a Hodgkin lymphoma. Richter's transformation affects about 5% of CLL patients. Richter syndrome is listed under the Alternate Names section in the Heme DB for diffuse large B-cell lymphoma [9680/3].

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.

 2011