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Report Produced: 12/31/2025 23:58 PM

Report Question ID Question Discussion Answer Year
20110027 MP/H Rules/Multiple primaries/Histology--Thyroid: How many primaries and what histology(ies) are coded when a patient is diagnosed with a single papillary carcinoma in the left thyroid lobe and multiple foci of papillary microcarcinoma in the right thyroid lobe? See Discussion.

Is the term papillary microcarcinoma being used to describe the size of the foci only, or are the right thyroid lobe lesions a different histologic type? Does rule M6 apply (single primary)? Or does rule M11 apply (multiple primaries)?

Case summary: Left thyroid with 2.2 cm papillary carcinoma and right thyroid with "multiple microscopic foci of papillary carcinoma (papillary microcarcinoma) ranging from less than 1 mm to 2 mm in greatest dimension."

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary.

For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult. The histology is the same in both lobes of the thyroid.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. For a thyroid primary, use the Other Sites MP rules under one of the three formats (i.e., flowchart, matrix or text) to determine the number of primaries because the thyroid does not have site specific rules.

Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.

. This patient has multiple papillary carcinomas of the thyroid diagnosed simultaneously; no other rule applies, so this is a single primary. Abstract a single primary for this patient.

Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.

Start with the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, Rule H18. The rules are intended to be reviewed in consecutive order within the module from Rule H18 to Rule H31. You stop at the first rule that applies to the case you are processing.

. Code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS [8260].

 2011
20110024 MP/H Rules/Histology--Breast: How is histology coded, and which MP/H rule applies for a diagnosis of ductal carcinoma in situ with clear cell features? See Discussion.

None of the histology rules for in situ breast seem to apply to this case:

  • Rule H3 doesn't seem to apply because "clear cell" is not a specific intraductal carcinoma.

  • Rule H6 doesn't seem to apply because there is not a combination of intraductal and 2 or more specific types of intraductal.

  • Rule H8 wouldn't apply because one of the types is intraductal.

    • For cases diagnosed 2007 or later:

    Code 8523/2 [intraductal carcinoma mixed with other types of in situ carcinoma]. Rule H6 should apply to this case.

    The wording in the Rule H6 needs to be clarified to handle a case of intraductal carcinoma with one or more subtypes that are not ductal. This will also require a modification to Table 3. A row needs to be added to the table labeled, "Intraductal and one or more of the histologies in Column 2." The Column 3 text for the newly added row would read, " Intraductal mixed with other types of carcinoma." The appropriate histology code to be reported per Column 4 would be 8523/2. This will be done in the next revision of the rules.

    		2011
    		20110023 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported in a patient with a November 2009 diagnosis of refractory anemia and a 10/25/2010 biopsy diagnosis of refractory anemia with excess blasts type 2 with ringed sideroblasts that the clinician indicates actually demonstrates progression to AML? See Discussion.

    Refractory anemia, NOS diagnosed in November 2009. The diagnosis on a bone marrow biopsy performed on 10/25/10 is myelodysplastic syndrome - refractory anemia with excess blasts type 2 with ringed sideroblasts. Per the medical oncologist, in the 12/16/10 clinic note it states, "Pt underwent bone marrow biopsy on 10/25/10 and ultimately this marrow demonstrates progression to AML.

    When applying the Hematopoietic Rules, the refractory anemia, NOS and the myelodysplastic syndrome - refractory anemia with excess blasts type 2 with ringed sideroblasts is the same primary. However, the refractory anemia NOS and the AML are multiple primaries.

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

    First, note that myelodysplastic syndrome (MDS) is a term that includes a number of diseases. Refractory anemia, NOS and refractory anemia with ringed sideroblasts are types of MDS. These two diseases are an NOS and a more specific disease, which is accessioned as one primary per Rule M7.

    Next, assess the change from refractory anemia to AML. In checking the Heme DB, AML is listed under transformations for refractory anemia with ringed sideroblasts. This patient has a chronic disease (refractory anemia with ringed sideroblasts) and an acute disease (AML). Per Rule M10, abstract as multiple primaries when a neoplasm is originally diagnosed in a chronic (less aggressive) phase AND second diagnosis of a blast or acute phase more than 21 days after the chronic diagnosis.

    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
    		20110020 Heme & Lymphoid Neoplasms: How is cancer status to be coded when a patient diagnosed with MDS, undergoes treatment, but the MDS subsequently transforms to AML? If the bone marrow no longer shows evidence of MDS, the cancer status for the MDS is disease-free. When cancer status is coded as disease-free (NED), it means that currently there is no clinical evidence of this disease (MDS). 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
    		20110018

    Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted for a case with a history of follicular lymphoma, grade 2 and a subsequent splenectomy diagnosis of diffuse large B-cell lymphoma? See Discussion.

    The patient was treated over a period of time for follicular lymphoma, grade 2. The oncologist thought the spleen was congested and removed it. The diagnosis was DLBCL.

    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 follicular lymphoma, grade 2 [9691/3] and it is a chronic neoplasm. The second primary is diffuse large B-cell lymphoma (DLBCL) [9680/3] and it is an acute neoplasm.

    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
    		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
    		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
    		20110015 Primary site/Histology: Do the 4/1/09 changes in the ICD-O-3 Site/Type Validation table regarding the coding of primary site for intestinal type adenocarcinoma mean that the former valid site/histology combinations are now impossible and require review from a given diagnosis date forward? See Discussion.

    Per the SEER Errata for ICD-O-3 Site/Type Validation List, April 1, 2009, adenocarcinoma, intestinal type, was removed as a valid site/histology combination for the following primary sites: C150-C155, C158-C159, C170-C173, C178-C179, C180-C189, C199, C209, C210-C212, C218.

  • Does this mean that these combinations cannot be used? If so, then why is an override allowed for these site/type combinations? Shouldn't these site/type combinations be added to the impossible site/type combinations table?

  • SINQ 20081085 states that "8144/3 will be removed from the valid site/histology list for large intestine, small intestine, and rectum." It appears from the Site/Type Validation table that a decision was made to also remove esophagus sites as a valid combination with histology code of 8144. Please explain the rationale.

  • Cases that were miscoded to 8144/3 will need to be identified for correction. What date of diagnosis should be the reference point used in making the necessary corrections related to this change? Do we only need to review cases diagnosed 1/1/2009 forward or should all cases be corrected regardless of date of diagnosis?

    • The site/type edit identifies unlikely combinations of primary site and histologic type.

  • Intestinal type adenocarcinoma occurs in the stomach. It would be rare in another primary site, but not impossible.

  • It was decided that all digestive organ sites, except stomach, would be removed from the list. That is why esophagus is not listed as a valid site.

  • The site/type edit is for all years. Cases for all years have to be reviewed for combinations of site and type that are no longer on the list. If it is documented in the medical record that the primary site and histology combination are valid, set the over-ride flag so that the case will not come up for review again.

    		• 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