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Report Produced: 02/26/2026 16:23 PM

Report Question ID Question Discussion Answer Year
20130080 Primary site/Histology--Heme & Lymphoid Neoplasms: How are the primary site and histology coded when a right neck mass and spinal mass both show B-cell lymphoma, favor Burkitt lymphoma? See Discussion.

2/5/11 Right neck swelling. Biopsy of mass B-cell lymphoma, favor Burkitt lymphoma.

7/5/11 Hemi-laminectomy, L2-L5 spinal mass: Malignant lymphoma, B-cell phenotype, favor Burkitt lymphoma.

Should the primary site be C779? Is the correct histology Burkitt lymphoma [9687/3] or malignant lymphoma, diffuse large B-cell [9680/3]?

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

Code the primary site to C779 [lymph nodes] per Rule PH22 and the histology to 9591/3 [B-cell lymphoma, NOS].

Code the primary site to C779 [lymph nodes, NOS] when lymphoma is present in an organ and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. The patient has involvement of a lumbar spine mass and cervical lymph nodes. Cervical lymph nodes are not regional to the lumbar area of the spine.

Do not use ambiguous terminology to code histology for hematopoietic neoplasms. "Favor" is ambiguous terminology. Therefore, the histology must be coded to B-cell lymphoma and not to diagnosis which is "favored" (Burkitt lymphoma). Remember that ambiguous terminology is only used to determine case reportability, not to code histology for hematopoietic neoplasms.

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.

2013
20130219 Date of diagnosis/Ambiguous terminology--Breast: Can a mammogram BIRADS 4 or 5 assessment be used to assess reportability and can the date of the mammogram be used to code the date of diagnosis? See Discussion.

  1. Assessment: BIRADS category 4-suspicious. Findings are considered suspicious/indeterminate for malignancy

  • Assessment: BIRADS 5- highly suspicious. Findings are highly suggestive of malignancy.

  • Assessment: BIRADS 4- suspicious abnormality consider biopsy

    • Can the BIRADS number be used to assess reportability? Can a BIRADS assessment of "suspicious" be used to code the date of diagnosis?

    		BIRADS category 4 and category 5 mammograms are not to be interpreted as a reportable "malignancy" for cancer registry purposes nor are they to be used to code the date of diagnosis should the patient subsequently have a malignancy confirmed. 2013
    		20130002

    Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned, and what is the year of diagnosis, when the patient was initially diagnosed with poorly differentiated, diffuse lymphocytic lymphoma, small cleaved cell [9591/3] in 1991, followed by multiple recurrences and transformations? See Discussion.

    5/1991 Left groin biopsy: Poorly differentiated, diffuse lymphocytic lymphoma, small cleaved cell [9591/3].

    Subsequently, the patient had multiple recurrences.

    7/1/08 Left axillary biopsy: Disease transformed to malignant lymphoma, large B-cell and a small focus of follicular lymphoma.

    Patient was followed until there was no evidence of disease.

    4/22/10 Left axillary biopsy: Recurrence of follicular lymphoma, grade 1. No large cell component was found. The bone marrow biopsy was negative for lymphoma. The patient was on observation.

    11/02/10 MD note indicates the disease progressed to follicular lymphoma, grade 3. No large cell component was identified. The patient clinically has no evidence of disease on maintenance Rituxan.

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

    This case should be accessioned as a single primary, non-Hodgkin lymphoma (previously called poorly differentiated, diffuse lymphocytic lymphoma, small cleaved cell) [9591/3] diagnosed in 1991.

    Determining the number of primaries is based on the rules in effect at the time of each diagnosis. The original lymphoma was diagnosed in 1991 and the first transformation to follicular lymphoma in 2008. The pre-2010 rules for coding histology and determining multiple primaries must be applied first because the rules changed for diagnoses occurring 2010 or later. Per the Single Versus Subsequent Primaries Table, poorly differentiated, diffuse lymphocytic lymphoma, small cleaved cell [9591/3] is the same primary as follicular lymphoma [9690].

    The Heme DB and Manual are used to confirm that the 2010 recurrences of follicular lymphoma, grade 1 [9695/3], and follicular lymphoma, grade 3 [9698/3], are the same primary according to the Heme Calculator check required per Rule M15. Per the Heme DB page, the diagnoses follicular lymphoma, grade 3 [9698/3] and follicular lymphoma, grade 1 [9695/3] are comparable to follicular lymphoma [9690] as stated in the section.

    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.

    		 2013
    		20130198 MP/H Rules/Multiple primaries--Rectosigmoid: How many primaries are accessioned for a synchronous diagnosis of neuroendocrine carcinoma and a separate adenocarcinoma arising in a villous adenoma when both arise in the rectosigmoid junction? See Discussion. Total colectomy showed neuroendocrine carcinoma of the rectosigmoid junction, as well as a separate adenocarcinoma arising in a villous adenoma of the rectosigmoid junction. Is this a single primary per Rule M13 (a frank adenocarcinoma and an adenocarcinoma in a polyp) or Rule M16 (adenocarcinoma and a more specific adenocarcinoma)? Or are these two primaries?

    Accession two primaries per Rule M17, neuroendocrine carcinoma [8246/3] of the rectosigmoid junction [C199], and adenocarcinoma in a villous adenoma [8261/3] of the rectosigmoid junction [C199]. There are two tumors with ICD-O-3 histology codes that differ at the third number.

    Rule M13 does not apply to neuroendocrine carcinoma. Rule M16 does not apply to this case because there are two specific histologies.

    		2013
    		20130176

    Reportability--Ovary: Is an adult granulosa cell tumor of the right adnexa reportable if the left adnexa, diaphragm and paratubal tissue are reported to be consistent with metastasis? See discussion.

    Per the pathology report: Right adnexa: adult granulosa cell tumor. Left adnexa: Foci of metastatic granulosa cell tumor in paratubal tissue. Diaphragm smears: consistent with metastatic granulosa cell tumor. Comment: The morphology and immunoprofile of the cellular aggregates in the paratubal soft tissue are consistent with metastatic granulosa cell tumor.

    Based on the information provided, this case of adult granulosa cell tumor is malignant and reportable. According to our expert pathologist consultant, "though granulosa cell tumor NOS/ adult NOS is 8620/1, the presence of peritoneal implants or metastases, and/or lymph node metastases indicates the tumor is malignant, and it should be coded /3."

    Note that the presence of implants or metastases does not indicate malignancy in the case of low malignant potential ovarian epithelial tumors. Our path expert explains "in contrast, by convention the behavior of borderline/LMP ovarian epithelial tumors is determined by the ovarian primary, and is /1, even though there may be peritoneal implants/metastases, or metastatic disease in lymph nodes. The treatment may vary in these circumstances, but to my knowledge the decision as to the tumor designation remains based on the primary tumor."

    		2013
    		20130127 Reportability--Heme & Lymphoid Neoplasms: When did smoldering myeloma become reportable?

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

    Smoldering multiple myeloma [9732/3] has always been a reportable neoplasm. Per the Abstractor Notes section in the Heme, smoldering multiple myeloma is a variant of multiple myeloma in which the diagnostic requirements for multiple myeloma are met, but there is no organ damage. The patient is usually asymptomatic.

    Smoldering myeloma is listed under the Alternate Names section in the Heme DB for multiple myeloma [9732/3] to clarify that it is a reportable neoplasm.

    Report all new diagnoses of smoldering multiple myeloma now. Registries are not required to spend time and effort to find these cases if they have not been reporting them in the past. However, report earlier earlier cases if encountered today while performing casefinding or chart review procedures.

    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.

    		2013
    		20130032 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for plasma cell myeloma with radiologic evidence of multiple lytic lesions? See Discussion.

    Patient complained of pain in the right side and back right upper flank area. CT shows an anterior mediastinal mass and abnormal appearance of skeleton. CXR: Age indeterminate T8 compression fracture. CT chest: abnormal appearance of skeleton. Correlate clinically for myeloma or mets. Acute T5 or T8 compression fractures. Anterior mediastinal mass which may represent thymoma, lymph nodes or metastases. 03/22/12 Metastatic Series: Nonspecific hypodensities in pelvis, left hip and right acromion. Possibility of myeloma can't be totally excluded. Bone marrow right post iliac crest core biopsy, clot section and aspirate: plasma cell myeloma.

    Should the primary site be coded to the bone marrow because the diagnosis of plasma cell myeloma was supported by radiologic evidence of multiple lytic lesions? The bone marrow biopsy confirmed the radiology reports.

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

    Code the primary site to C421 [bone marrow] per the Heme DB and Rule PH30. The Primary Site(s) section in the Heme DB indicates the primary site for plasma cell myeloma is C421 [bone marrow].

    The Primary Site Coding Instructions in the Heme Manual (Rule 1) states that when a specific code is listed under the Primary Site(s) section of the Heme DB it is the only primary site code that can be assigned for that leukemia, myelodysplastic syndrome or myeloproliferative syndrome. Applying the PH Rules will result in the same answer for primary site, bone marrow [C421].

    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.

    		2013
    		20130030

    Histology--Heme & Lymphoid Neoplasms: How is histology coded for a patient diagnosed with diffuse large B-cell lymphoma, immunoblastic [9684/3] in 2009 and a recurrence in 2010 at another facility was referred to as plasmablastic lymphoma [9735/3]? See Discussion.

    Which code is correct for the merged record? Is code 9735/3 [plasmablastic lymphoma] correct because code 9684/3 [DLBCL, immunoblastic] is now obsolete?

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

    This case was originally diagnosed in 2009, prior to the development of Hematopoietic Database. Therefore it is necessary to use the ICD-O-3 to code histology to 9684/3 [diffuse large B-cell lymphoma, immunoblastic]. Use the original histology diagnosed for the merged record because DLBCL, immunoblastic, and plasmablastic lymphoma are the same primary. Do not change the histology to code 9735/3 [plasmablastic lymphoma].

    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.

    		 2013
    		20130123

    Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diffuse large B-cell lymphoma, immunoblastic variant involving the left maxillary vestibule and entire left maxilla? See Discussion.

    The clinical history indicates a destructive, quickly growing intra-oral lesion in the left soft tissue vestibule and the entire left maxilla.

    Pathology report final diagnosis: Oral cavity, left maxilla, incisional biopsy: Malignant lymphoma, non-Hodgkin, diffuse large B-cell type, immunoblastic variant.

    Code the primary site to C068 [overlapping lesion of the mouth] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ.

    This lesion overlaps the left soft tissue of the maxilla (the maxillary gingiva) [C030] and the left vestibule of the mouth [C061]. There is no documentation indicating in which specific site the lesion arose. The maxilla is the upper jawbone. The soft tissue that overlies the maxilla is a part of the oral cavity. It is reasonable to interpret the documentation such that the tumor in the maxilla is an extension of the overlapping oral mucosa tumor.

    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.

    		 2013
    		20130119 Reportability--Heme & Lymphoid Neoplasms: Would this case be reportable? Patient with a myelodysplastic syndrome secondary to a copper deficiency. Myelodysplastic syndrome is a reportable disease. Document in the text that the MDS was due to a copper deficiency. 2013