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Report Produced: 12/31/2025 06:10 AM

Report Question ID Question Discussion Answer Year
20100096 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a 9/30/10 biopsy diagnoses follicular lymphoma, grade 1 and the patient is subsequently diagnosed on a 10/11/10 biopsy with large B-cell lymphoma which is stated to be a transformation of the prior lymphoma?

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

Per Rule M11, this case is to be accessioned as two primaries; follicular lymphoma, grade 1 [9695/3] and diffuse large B-cell lymphoma (DLBCL) [9680/3]. The case represents a chronic neoplasm (follicular lymphoma, grade) and an acute neoplasm (diffuse large B-cell lymphoma) diagnosed within 21 days of one another and there is documentation of two biopsies, one confirming the chronic disease and the other confirming the acute disease.

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
20100069 Primary site--Heme & Lymphoid Neoplasms: How is this field coded when a 5/26/10 colonoscopy reveals ulcers in the cecum, ascending, transverse, descending, and sigmoid colon and, the final diagnosis on the pathology report is post-transplant lymphoproliferative disorder [9971/3]?

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

Code the primary site to C189 [Colon, NOS] per Rule PH1.

Code the primary site to C189 [Colon, NOS] and not C188 [Colon, overlapping lesion] because there are multiple ulcers in different segments of the colon. The .8 code is used only for a single lesion that overlaps subsites.

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
20100052 Reportability/Primary Site: What is the reportability status and primary site for a papillary carcinoma of thyroid tissue arising in an otherwise benign mature monodermal cystic teratoma (struma ovarii)? See Discussion. Final diagnosis on the pathology report states, "One ovary showing mature monodermal cystic teratoma composed of thyroid tissue (struma ovarii)." The pathology COMMENT section states, "There is a 0.1 cm focus of thyroid tissue within the struma ovarii showing cytologic features of papillary carcinoma. This finding is likely of no clinical consequence."

A papillary carcinoma of thyroid tissue in benign struma ovarii (mature cystic teratoma) is reportable.

These ovarian tumors contain a diversity of tissues including hair, teeth, bone, thyroid, etc. This reportable malignancy arose in thyroid tissue within the ovarian tumor. Code the primary site to ovary. Code to the actual organ in which the cancer arose. This will keep the case in the appropriate category for surgery coding, regional nodes, staging, etc.

2010
20100035 MP/H Rules/Multiple primaries--Colon: How many primaries are accessioned for a patient with two colon carcinomas in different segments of colon when there is no documentation that either tumor arose in a polyp, there is no statement indicating the presence of adenomatous polyposis coli and the resected pathology specimen indicates the presence of over 200 polyps? See Discussion.

The first MP/H rule that applies for this case is M4 [tumors in different segments of the colon]. Following rule M4, the case would be counted as two primaries and the histology would be coded per Rule H11. As these are multiple primaries, Rule H17 [Code 8220 (adenocarcinoma in adenomatous polyposis coli) when there are > 100 polyps identified in the specimen] would never apply, because H17 applies to multiple tumors abstracted as a single primary. However, Rule H17 seems to fit this case. Should Rule M3 be expanded to include a statement about > 100 polyps so these cases are not accessioned as multiple primaries?

Example: Total colectomy: 1) Distal tumor: - ulcerating moderately differentiated colonic adenocarcinoma, 3.2 cm in greatest dimension. Tumor invades through the muscularis propria into the subserosa (pt3). 2) Proximal tumor: exophytic moderately differentiated colonic adenocarcinoma, 2.9 cm in greatest dimension. Tumor invades submucosa (pt1). Multiple tubular adenomas present throughout the colon, approximate count greater than 200.

For cases diagnosed 2007 or later, use rule M3 for this case and abstract as a single primary. The case information makes it clear that this is adenomatous polyposis coli. Clarification will be added to rule M3 in the next revision of the rules. 2010
20100101 Multiple primaries--Heme & Lymphoid Neoplasms: Is a 10/2010 diagnosis of accelerated phase of CML following a 4/2010 diagnosis of blast phase CML a new primary? See Discussion.

Patient was diagnosed in the blast phase of CML on a 4/2010 bone marrow biopsy. Pt failed Gleevec and progressed to the accelerated phase of CML in 10/2010.

Is this a single primary? This is not addressed in the hematopoietic rules. If this is a multiple primary, what rule should be applied?

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

Per Rule M2 this is a single primary because there is only a single histology represented for this case.

Under the Alternate Names section in the Heme DB for chronic myelogenous leukemia (CML), NOS [9863/3 and chronic myelogenous leukemia, BCR-ABL1 positive [9875/3] it indicates CML-blast phase, CML-accelerated phase and CML-chronic phase are all synonyms for CML, NOS. Any combination of these terms diagnosed represents one disease process. The Gleevec was given to prevent or delay progression to the accelerated phase.

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
20100019 Histology--Ovary: How is histology coded for an ovarian mucinous neoplasm of low malignant potential (borderline mucinous cystadenoma) that shows extensive intraepithelial carcinoma and focal microinvasion? See Discussion. At surgery a 25 cm left ovarian mass is found adherent to the anterior abdominal wall. The final diagnosis per the pathology report is, "Mucinous neoplasm (26 cm) of low malignant potential (borderline mucinous cystadenoma) with extensive intraepithelial ca and focal microinvasion. Right ovary, fallopian tubes, uterus, omentum, biopsies of diaphragm, 28 para-aortic and pelvic LNS and peritoneal fluid are all negative for malignancy." Histology code 8470/3 [mucinous cystadenocarcinoma] is the best choice in this case. There is a mucinous cystadenoma [8470/0] with intraepithelial carcinoma and focal microinvasion. 8470/3 comes as close as possible to the description of the tumor. 2010
20100077 Multiple primaries--Heme & Lymphoid Neoplasms: Would it be correct to apply rule M5 for a recurrence and abstract a single primary when a patient has a history of Hodgkin disease diagnosed in 2005 followed by a diagnosis of "recurrent Hodgkin and EBV+ Diffuse large B-cell lymphoma" in 2010? See Discussion.

Does Rule M5 only apply if both diseases are present at the original diagnosis, or does it also take into account a recurrence of an old disease? The answer to this question makes a difference between stopping at rule M5 and abstracting as one disease, or going on to rule M15 to query the Hematopoietic Database to determine whether the patient has two separate primaries.

Example: Patient had Stage II Hodgkin disease in 2005 (all lymph nodes above diaphragm, supraclavicular LN biopsied at diagnosis), treated and patient achieved complete remission. In 2010, the patient is admitted for suspected recurrence. A supraclavicular lymph node biopsy showed, "Recurrent Hodgkin" AND "EBV+ Diffuse Large B-cell Lymphoma," both in the same lymph node. Applying rule M5, this is a single primary and states not to query the DB. However, this doesn't seem correct as it does not account for the new DLBCL.

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

You must first determine the histology codes for each occurrence of lymphoma. The 2005 diagnosis was stated to be Hodgkin disease (NOS) [9650/3]. The 2010 diagnosis was Hodgkin and EBV + diffuse large B-cell lymphoma (two histologies). Per Rule M5 the 2010 diagnosis is a single primary because the Hodgkin and the non-Hodgkin (DLBCL) were simultaneously present in the same lymph node. Per Rule PH14, a Hodgkin and non-Hodgkin simultaneously present in the same location should be coded to 9596/3 [B-cell lymphoma, unclassifiable].

Ultimately, there is a diagnosis of 9596/3 in 2010 that followed a diagnosis of 9650/3 in 2005. Per Rule M15, use the Multiple Primary Calculator to determine the number of primaries, which indicates the 9596/3 is a new primary.

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. https://educate.fhcrc.org/LandingPage.aspx.

 2010
20100074 Laterality--Melanoma: For a melanoma case, does the term "mid" imply that the tumor is in the midline when the site is the skin of back (trunk)? Yes. When the location is described as mid-back or mid-chest with no indication of left or right, assign laterality code 5 [midline]. 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
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