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Report Produced: 12/31/2025 06:12 AM

Report Question ID Question Discussion Answer Year
20100086 Multiple primaries/Primary site/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed with mycosis fungoides in February 2010 and in May 2010 is diagnosed with peripheral T-cell lymphoma consistent with CD 30+ large cell transformation of mycosis fungoides? See Discussion Patient was diagnosed with mycosis fungoides on 2/10/2010. On 5/11/2010 the patient underwent lymph node biopsies lymph nodes that were diagnosed as peripheral Tcell lymphoma consistent with CD 30+ large cell transformation of mycosis fungoides. There is no data on the ALK protein.

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

Accession two primaries per Rule M15 which instructs you to use the Multiple Primaries Calculator to determine the number of reportable primaries. The result is that mycosis fungoides [9700/3] and peripheral T-cell lymphoma [9702/3] represents two primaries.

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
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
20100070 Histology--Heme & Lymphoid Neoplasms: How is this field coded for a follicular lymphoma, grade 2 of 3, predominantly nodular?

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

Code histology to 9691/3 [Follicular lymphoma, grade 2]. Nodular lymphoma is an obsolete term once used to describe follicular lymphoma. (See Appendix A, Table A3)

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
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
20100011

Reportability: Should a benign gangliocytic paraganglioma [8683/0] be a reportable (malignant) tumor based on the presence of lymph node metastases? See Discussion.

"Resection, periampullary duodenum: Gangliocytic paraganglioma, with metastasis to one large periduodunal lymph node. Six other small lymph nodes negative. COMMENT: The primary tumor in the duodenum is made up mainly endocrine cell component. This component appears to have metastasized to a periduodenal lymph node."

This neoplasm is reportable because it is malignant as proven by the lymph node metastases. Code the behavior as malignant (/3) when there are lymph node metastases.

 2010
20100072 Histology/Reportability--Heme & Lymphoid Neoplasms: Is a diagnosis of follicular lymphoma in situ of the gallbladder reportable for 2010? See Discussion. Coding the histology to 9690 [Follicular lymphoma] with a behavior of 2 [in situ] causes many edits including SEER and CS edits to fail. According to the chief of pathology, this is a recently identified pathologic entity.

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

Currently, lymphoma in situ is not reportable. It is true that this is a recently identified pathologic entity. Our experts say that there is still some controversy to be ironed out regarding the criteria for identifying an in situ lymphoma. Their recommendation was to wait until clear guidelines had been established for the pathologists before we start collection of in situ lymphomas. We anticipate collecting these entities in the future.

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
20100039

Casefinding--Heme & Lymphoid Neoplasms: Is the 2010 casefinding code of 289.6 (Familial Polycythemia) addressed anywhere in the Hematopoietic Database? See Discussion.

When you enter "familial polycythemia" into the Heme DM, polycythemia vera (PV) appears; however, the term "familial polycythemia" is not listed as one of the synonyms for PV.

Familial polycythemia by itself is not reportable. This is a benign condition which occurs within families. Familial polycythemia can progress to polycythemia vera (9950/3), which would then be reportable. The code, 289.6, which is the ICD-9-CM code for Familial polycythemia is not included on the reportable list for casefinding. There is only one ICD-9-CM code for Polycythemia vera, 238.4. "Familial polycythemia" is listed in Appendix F: Non-Reportable List for Hematopoietic Diseases.

2010
20100081 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: Should a single primary be accessioned with the histology coded 9732/3 [multiple myeloma] when a patient is diagnosed initially with a plasmacytoma on an excision and a single bone marrow biopsy showed only 4% plasma cells, then the subsequent workup led to a clinical diagnosis of multiple myeloma? See Discussion.

This patient had a plasmacytoma removed from the sphenoid sinus and was started on Dexamethasone. The patient had a bone marrow biopsy with 4% plasma cells. A statement in the hematology notes read, "it can increase the rate of false negative results with a bone marrow biopsy." The bone marrow biopsy was done 15 days after the surgery for the plasmacytoma.

Workup yielded the diagnosis of multiple myeloma. Per a statement in hematology notes, "I found her having 4% blasts, atypical plasma cells in the bone marrow biopsy and also lytic lesions involving the T7 and lucencies involving L4 and L5 vertebral bodies and also the upper sacrum. The PET-CT scan did not show significant metabolic activities in those lesions. The patient had a small amount of Bence-Jones in the urine and also an abnormal kappa to lambda ratio in the serum. The ratio was 12 to 1. The beta 2 microglobulin was 1.4. The albumin in the serum was 3.4. Based on that, the patient has been diagnosed with Durie-Salmon stage III in ISS stage II multiple myeloma."

The abstractor notes for multiple myeloma state that the diagnosis is made when the proportion of plasma cells in the bone marrow is 10% or greater. Should a diagnosis of MM be accessioned and coded when the bone marrow is less than 10% plasma cells, but a clinical diagnosis of MM is made?

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

Accept the physician's diagnosis of multiple myeloma [9732/3]. Code the multiple myeloma as a single primary using rule M8 if there was only ONE positive biopsy. Code as multiple primaries (both the solitary plasmacytoma and multiple myeloma) using Rule M11 if there are TWO positive biopsies, one confirming the chronic neoplasm and the other confirming the acute neoplasm.

Per the Heme DB Abstractor Notes: The registrar DOES NOT CODE plasma cell myeloma based on the percentage of plasma cells. There must be a diagnosis of plasma cell myeloma. In addition, a clinical diagnosis of plasma cell myeloma may be made based on amyloidosis with associated renal impairment, anemia and/or hypercalcemia supported by radiologic evidence of multiple lytic bone lesions. he biopsy confirmed plasma cell malignancy (plasmacytoma) and the clinical workup confirmed myeloma.

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
20100050

Reportability--Colon: Would a carcinoid tumor, NOS, of the appendix with perineural or angiolymphatic invasion be reportable if there is no mention of malignancy in the pathology report?

Carcinoid, NOS, of the appendix diagnosed in 2015 or later is reportable.

For cases diagnosed prior to 2015

Carcinoids of the appendix are reportable when they meet any of the following conditions.

  • The pathologist designates the carcinoid as malignant

  • Regional lymph nodes are positive for MALIGNANT carcinoid (not reportable if lymph nodes are reported to be involved with benign carcinoid disease)

  • There are discontinuous metastatic implants or involvement

    • Note that the implants/involvement must be designated as malignant. Many benign tumors will spawn implants that are also benign. If implants are benign, this is not a reportable tumor.

    		2010
    		20100098 Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a 2008 diagnosis of small B cell leukemia, most consistent with mantle cell leukemia that only involved the bone marrow? See Discussion. A bone marrow biopsy was done on 6/18/2008 and showed only small B cell leukemia, most consistent with mantle cell leukemia. ICD-O-3 does not list a histology code for small B cell leukemia or mantle cell leukemia.

    Code the histology to 9673/3 [mantle cell lymphoma] and the primary site to C421 [bone marrow].

    Mantle cell lymphoma can present in a leukemic phase. The only code available is for mantle cell lymphoma and the only primary site that could be coded would be bone marrow.

    		2010