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Report Produced: 04/21/2026 21:32 PM

Report Question ID Question Discussion Answer Year
20100061 MP/H Rules/Histology: The 2010 SEER Manual has omitted some useful information in the Histologic Type ICD-O-3 section, specifically the statement of "Do not revise or update the histology code based on subsequent recurrence(s)". Will this statement be added to the revisions of the MPH rules? See Discussion. Example: A 2005 diagnosis of left breast lobular carcinoma [8520/3], followed by a 2009 diagnosis of left breast ductal carcinoma [8500/3]. Rule M10 states this is a single primary, but there is no information in the Histology rules (Multiple Tumors Abstracted as a Single Primary) that the original histology should be retained, thus a person could potentially use these rules to change the original histology to 8522/3 [duct and lobular carcinoma] per rule H28. We will reinstate the instruction not to change the histology code based on recurrence in future versions of the histology coding instructions. However, this instruction may not be applicable to all anatomic sites. It will be reinstated on a site-by-site basis. You may also refer to the instructions on Page 7 of the 2010 SEER Manual under the heading "Changing Information on the Abstract." 2010
20100088 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient has 2005 diagnosis of multiple myeloma diagnosed returns in 2010 with extramedullary plasmacytoma and a bone marrow biopsy showing plasma cell dyscrasia that is clinically stated to "consistent with a relapse of myeloma"? See Discussion.

Patient was diagnosed in 2005 with multiple myeloma and following stem cell transplant 2005 was in complete remission.

On 2/1/10 an excisional biopsy of a soft tissue right flank mass showed plasmacytoma. On 3/2/10 the bone marrow biopsy was stated to be consistent with plasma cell dyscrasia. An outside attending physician stated the bone marrow biopsy was consistent with a relapse of myeloma. There was no radiologic evidence of disease elsewhere as of Feb 2010, only the soft tissue right flank mass. Patient initially presented for post-op radiation to the right flank and was treated 3/29/10. On 8/6/10 a biopsy of a right perinephric mass was positive for plasmacytoma. Subsequent xray on 8/16/10 of the right tibia and fibula showed lytic lesion consistent with progression of myeloma.

Using the Hematopoietic Database, the plasmacytoma in 2/1/10 is a second primary. How do the rules apply to the perinephric soft tissue disease and right tibia lesion? Are they separate new primaries? Or is all of this simply a recurrence of the original 2005 diagnosis as the attending physician states?

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

Accession a single primary with the histology coded to 9732/2 [multiple myeloma]. The disease discovered in 2010 represents further advancement of former disease. Per the Abstractor Notes section in the Heme DB, it states that bone marrow involvement, lytic bone lesions, and bone tumor masses of plasma cells are common. Under the Recurrence and Metastases section in the Heme DB it further states that extramedullary (in tissue other than the bone) involvement is a generally a manifestation of advanced disease. This case is an example of such a situation.

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
20100054 MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a pathology specimen reveals an infiltrating mammary carcinoma with mixed tubular and lobular features, 2.3 cm, low grade cribriform in situ ductal carcinoma, and Paget disease of the overlying skin with ulceration? See Discussion. According to SINQ 20081134 the histology would be 8524 if this is one primary.

For cases diagnosed 2007 or later, this is a single primary.

In order to determine whether this case represents a single or multiple primary, you must first determine the correct histology code for the underlying tumor. Using rule H9, ignore the DCIS.

See Table 3 in the equivalent terms and definitions. Infiltrating lobular, tubular, and Paget are coded to a single histology code (8524/3). Our current multiple primary rules do not say infiltrating lobular and tubular and Paget are a single primary. This was an omission and will be corrected in a future revision. Thank you for bringing this omission to our attention.

 2010
20100058 Grade: Can the nuclear grade value be coded in the grade field for any site, or is it restricted to sites where it is specifically listed as an option in the coding manual, i.e., breast, kidney, urinary sites, etc.? There is no restriction on sites for which nuclear grade can be coded in the grade field. If both differentiation and nuclear grade are specified, differentiation takes priority. 2010
20100043

Primary site--Heme & Lymphoid Neoplasms: When only pathology reports are available, how should the primary site be coded when a both a bone marrow biopsy and colon biopsy demonstrate "mantle cell lymphoma"?

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

For this case, code primary site to C189 [colon, NOS] per Rule PH24.

Mantle cell lymphoma usually begins with lymph node involvement and spreads to other tissue. However, it can begin in a lymphocyte such as those in the GI tract. Per the Abstractor Notes section in the Heme DB, patients usually present with advanced disease. About half will have some combination of B symptoms. Swelling of lymph nodes and spleen are usually present. Bone marrow, liver and GI tract involvement occurs in a very high percentage

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
20100108 MP/H Rules/Histology--Brain and CNS: How is histology coded for a left occipital parietal area tumor stated to be a "low grade neuroectodermal neoplasm most consistent with neuronal tumor but lacking classic features of ganglioma" if the pathologist states the tumor is not malignant? Code 9505/0 [Ganglioglioma, benign] is the best option according to our pathology expert. He states, "There recently has been a spate of tumors called low grade glio-neuronal tumors that are not PNETs and have no propensity to become malignant." 2010
20100112 Primary site--Heme & Lymphoid Neoplasms: Is C448 [overlapping lesion of skin] or C449 [skin, NOS] the appropriate site code for a 2008 diagnosis of mycosis fungoides involving over 40 percent of the skin surface, including both upper and lower extremities and trunk? Code the primary site to C449 [skin, NOS]. The code C448 should be used when there is a single overlapping lesion that includes all the disease. The patient has extensive skin coverage involving multiple skin subsites (upper and lower extremities and the trunk), but it is unlikely there is ONE plaque (one lesion) overlapping all these different skin subsites. The disease has more likely presented as multiple plaques (lesions) in these different areas. 2010
20100057 First course treatment--Heme & Lymphoid Neoplasms: Is the use of the corticosteroid, Clobetasol, cancer-directed treatment for mycosis fungoides or is it only used to treat the side effects of that disease?

Clobetasol is not cancer-directed treatment at this time.

Note: Question originally submitted in 2010. During 2014 review, this was checked and Clobetasol is still not cancer directed treatment for Mycosis Fungoides.

2010
20100018 Reportability/Heme & Lymphoid Neoplasms--Hematopoietic, NOS: Is light chain disease reportable if it is treated with chemotherapy agents? See Discussion.

A patient was diagnosed in 2010 with light chain disease based on SPEP and urine testing. Bone marrow aspiration and biopsy were done. Flow cytometry, cytogenetic studies and FISH for plasma cell disorders are all normal. Medical oncologist states diagnosis is light chain disease. Patient was started on Revlimid, dexamethasone and Velcade.

In reviewing the case reportability instructions, this seems to fall under Instruction 1, note 1. Immunoglobulin deposition disease, preferred term for light chain disease, is coded as 9769/1. This is normally a non-reportable diagnosis, but the patient was given cancer-directed treatment. Would this case be accessioned using the above morphology code and primary site of bone marrow [C42.1]?

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

This case is not reportable. The histology is 9769/1 [light chain disease] in the Heme DB.

Light chains are produced in neoplastic plasma cells (multiple myeloma) and are called Bence-Jones proteins. The physician did the cytogenetic studies and FISH to rule out plasma cell disease. 50-60% of people with Light-chain deposition disease (LCDD) have an associated lymphoproliferative disorder, most commonly multiple myeloma. The remaining patients develop LCDD in the setting of progression of monoclonal gammopathy of unknown significance (MGUS) with no evidence of neoplastic plasma cell proliferation. This patient falls in this category, MGUS, which is not reportable.

2010
20100067 MP/H Rules/Reportability--Ovary: Should an ovarian tumor with the histology of mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma be accessioned based on the presence of a foci of intraepithelial carcinoma? See Discussion.

The final diagnosis on the pathology report, "Omentum: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma. Peritoneal fluid for cytology: neoplastic cells present; low grade serous neoplasm. Lymph nodes, right pelvic: one lymph node harboring implants of serous borderline tumor and endosalpingiosis within the subcapsular sinus. Bilateral fallopian tubes and ovaries: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma involving ovarian surface and serosal surface of the tube. Detached fragment of borderline tumor within the tubal lumen. Uterus, cervix, and segment of colon: mixed epithelial borderline tumor with multiple foci of intraepithelial carcinoma involving parametrial and paracervical tissue, cul de sac, uterine and colonic serosa. Nine pericolonic lymph nodes negative for tumor. Stage III.

I&R # 45622 asked if a mucinous borderline tumor with intraepithelial carcinoma and focal microinvasion is reportable. The answer given on that site was that the case is not reportable. According to MPH, FORDS, and Collaborative Stage, intraepithelial carcinoma is in situ, behavior code 2, and is reportable. Has this changed?

This case is reportable because there is a diagnosis of carcinoma (intraepithelial carcinoma). 2010