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Report Produced: 02/27/2026 14:16 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
20100009 MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion.

A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.

Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma?

 For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. 2010
20100076 Reportability--Heme & Lymphoid Neoplasms: If not specified as primary, idiopathic, or essential, is thrombocytosis, NOS reportable?

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

Unless the disease is specified as primary, idiopathic, essential, or the physician states there is a myeloproliferative neoplasm, the term thrombocytosis, NOS is not reportable. Thrombocytosis, NOS, is the presence of high platelet counts in the blood. Thrombocytosis can be associated with chronic infections and other diseases as well as with myeloproliferative disease. Thrombocytosis, NOS is listed in Appendix F as a Non-Reportable Term.

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
20100037

Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries should be accessioned for a patient diagnosed with essential thrombocythemia [9962/3] in 2002 who had a 2010 biopsy consistent with the fibrotic stage for a chronic myeloproliferative disorder that "suggests the patient is transforming to an acute myeloid leukemia"? See Discussion.

Patient had a diagnosis of essential thrombocythemia [9962/3] in 2002 and was treated with Hydroxyurea. In 2010, the patient was admitted with severe bone pain and a diagnosis described as, "The overall features of the biopsy are consistent with a fibrotic stage of a chronic myeloproliferative disorder. The presence of up to 15% CD34+ immature cells seen in the biopsy suggests that the patient is transforming to an acute myeloid leukemia." In addition, cytogenetic studies and molecular testing for JAK2 were ordered. These findings confirmed a myeloproliferative disorder. JAK2 mutation was not detected. The patient died within 2 weeks. Is this a new primary?

Was this patient diagnosed with AML (which requires 20% or more blasts and this is only 15%)? If this is a new primary, is the histology 9861/3 [AML, NOS] or 9895/3 [AML with myelodysplasia-related changes]? Was the second diagnosis of AML definitively diagnosed?

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

This case is a single primary, essential thrombocythemia [9962/3] in 2002. The 2010 diagnosis is chronic myeloproliferative disorder [9960/3].

According to Rule M15, the Multiple Primaries Calculator is to be used to first determine the number of primaries. Per the calculator, essential thrombocythemia and chronic myeloproliferative disorder are the same primary. (Acute myeloid leukemia is not used as the second histology because it is preceded by a non-reportable ambiguous term, "suggests." "Suggests" is not on the list of reportable ambiguous terms in the Hematopoietic and Lymphoid Neoplasm Coding Manual.

In 2010, this patient was in a late stage of ET. When any of the specific MPN neoplasms such as ET are in the late stage of disease, the characteristics of the specific disease (ET) will no longer be detectable. Accordingly, for this patient the diagnostic testing was positive for MPN, unclassifiable. In this case, do not change the diagnosis from the more specific disease (ET) to the NOS (MPN, unclassifiable).

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
20100066 MP/H Rules/Multiple Primaries--Breast: How many primaries should be accessioned if two tumors are present in the same breast, a 1.7 cm colloid carcinoma and a 1.5 cm colloid carcinoma with infiltrating ductal carcinoma? See Discussion.

If a patient has two masses in the same breast with different histology codes and different sizes, should this be accessioned as two primaries? Or should this be a single primary based on the largest tumor size or numerically higher histology code?

  1. Size 1.7 cm for the largest tumor size, but histology is colloid carcinoma. Histology code: 8480/3.

  • Size: 1.5 cm with colloid with infiltrating ductal carcinoma. Histology code 8523/3.

    		•

    For cases diagnosed 2007 or later, abstract this case as two primaries.

    Mucinous/colloid carcinoma of the breast is rare. The first tumor describes (1.7 cm) fits this criteria because the pathologist simply says mucinous carcinoma. The diagnostic criteria for mucinous carcinoma is that pools of extracellular mucin make up at least 1/3 of the volume throughout the tumor mass. If focal areas are not at least 33% mucinous, the designation is a mixed mucinous/ductal. That fits the second tumor (1.5 cm).

    For this case, you must get the histology codes for both tumors in order to use the Multiple Primary rules. Per H14 the first tumor is coded mucinous carcinoma [8480/3]. Per H17 the second tumor is coded duct carcinoma mixed with any other carcinoma [8523/3]. Now go to the MP rules. Per M12 abstract this case as multiple primaries because the ICD-O-3 histology codes are different at the second and third digit.

    		 2010
    		20100006

    MP/H Rules/Multiple primaries--Kidney: In a patient with a history of renal cell carcinoma, would a new primary be accessioned per Rule M10 for a soft tissue mass in the renal fossa not stated to be a metastasis but that was referred to as recurrent renal cell carcinoma, clear cell per the excision pathology report? See Discussion.

    This patient was diagnosed with clear cell carcinoma of the right kidney in 2003, treated with nephrectomy. The tumor was limited to the kidney. An FNA of the pancreas in 11/07 was consistent with metastatic renal cell carcinoma. In 2009 the patient was diagnosed with a right renal fossa mass by CT. The mass was excised on 8/26/09 and showed, "recurrent renal cell ca, clear cell." The path specimen was labeled as, "soft tissue, rt renal fossa." The original 2003 slides were not reviewed and the renal fossa mass was not described as being metastatic.

    If the renal fossa soft tissue mass is a new tumor, the MP/H rules for Other Sites directs you to code it as a new primary per rule M10 [Tumors diagnosed more than one (1) year apart are multiple primaries]. Would this be a new soft tissue tumor per rule M10? Or would this be a recurrence of the original kidney primary?

    For cases diagnosed 2007 or later:

    This is not a new primary. The patient has metastatic disease from the 2003 kidney primary. Clear cell carcinoma metastasized to the pancreas in 2007 and to the right renal fossa in 2009.

    		 2010
    		20100045

    Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"?

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

    Code histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for 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.

    		2010
    		20100024

    Histology: How is this field coded for a perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential that is malignant based on the presence of metastases? See Discussion.

    In 11/2006 the patient had surgery for a 6cm mass in the RUQ arising in the falciform ligament. The pathologic final diagnosis was: Perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential. In 10/2009 a liver biopsy showed metastatic perivascular epithelioid cell neoplasm.

    Assign histology code 8005/3 [malignant clear cell tumor]. According to our expert pathology consultant, this is the best histology code available at this time for the occasional tumor which is designated as malignant. The appearance of metastatic disease clearly defines this case as malignant.

    		 2010
    		20100041

    Reportability--Heme & Lymphoid Neoplasms: Are "anemia of chronic disorders" or "hemolytic anemia" reportable given that a search of the Hematopoietic Database returns many different reportable conditions but no exact terminology match for either diagnosis? See Discussion.

    Searching the Heme Database for the term ANEMIA OF CHRONIC DISORDERS yields 71 results. However, none of the results match the terminology entered, yet all 71 "matched terms" are reportable. Is this diagnosis reportable?

    Another example is HEMOLYTIC ANEMIA. The search results showed 28 "matched terms" which are all reportable, but none are exact matches.

    Please clarify how we should interpret the results of these searches when using the Heme Database.

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

    Neither diagnosis is reportable. Anemia of chronic disorder or disease is seen when a patient has a chronic immune disorder or a malignancy; the anemia itself is not a malignancy. Hemolytic anemia can be caused by many conditions, but is not malignant.

    The problem you are having using the Heme DB is that you are searching for the entire term such as "anemia of chronic disorder." The DB search engine is not the same as those used in Google or other widely used internet search engines. The words lymphoma, leukemia, etc. are so common in the DB that the traditional search is not effective.

    In order to make your search easier, search on a unique word. For example, for "anemia of chronic disorder" search on the words (use the quotes) "anemia of" and for the term hemolytic anemia, search on "hemolytic" By using the unique word search you will cut down on the number of terms displayed. If you do get several terms, click on "Name" in the header and all of the results will be alphabetized for quick identification. You may also use the "diseases matching any term" or the "disease match all terms" options to narrow down the results when searching the whole term phrase.

    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
    		20100068 Histology--Heme & Lymphoid Neoplasms: How is this field coded for a JAK-2 positive myeloproliferative disorder, NOS, that is never specified as acute or chronic but was treated with Hydrea? See Discussion. The hematology oncologist referred to the case as a JAK-2 positive myeloproliferative disorder. It is never called acute or chronic. JAK-2 test was positive for mutation, and the bone marrow report indicates, "Morphological features can be seen in myeloproliferative neoplasm." Flow cytometry report indicates, "The flow data demonstrate neutrophilia with left shift. Lymphocytes are composed of a mixed population of T and B-cells with some atypical B-cells." The patient is subsequently treated with Hydrea.

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

    Code the histology to 9975/3 [myeloproliferative/myelodysplastic neoplasm, unclassifiable] which is a new code implemented in 2010. Myeloproliferative disorder NOS is equivalent to myeloproliferative disease which is listed as a synonym for code 9975/3.

    When the disease is diagnosed very early, it may manifest symptoms of two or more specific myeloproliferative neoplasms. As the disease progresses, it will manifest the symptoms of one of the specific MPN subtypes. When a more specific diagnosis becomes available, change the histology code to the more specific MPN code as directed in the PH rules. That is the scenario you describe. JAK-2 is positive, but the physician does not designate PV or ET. Hydrea is treatment for both PV and ET. In the future, the specific type of MPN may be diagnosed. In the interim, code the only diagnosis you have, MPN, 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.

    		2010