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Report Produced: 01/01/2026 05:08 AM

Report Question ID Question Discussion Answer Year
20110084 Histology--Heme & Lymphoid Neoplasms: Is histology coded to 9684/3 [malignant lymphoma, diffuse large B-cell, immunoblastic NOS] for a biopsy that reveals "diffuse large B-cell lymphoma, immunoblastic variant"?

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]. Code 9684/3 [malignant lymphoma, diffuse large B-cell, immunoblastic NOS] is obsolete for cases diagnosed 2010 and later per the Heme DB.

Under the Definitions section in the Heme DB, it states that this is a lymphoma with diffuse proliferation of large neoplastic B lymphoid cells with nuclear size exceeding macrophage nuclei, more than twice size of normal lymphocytes. Normal architecture of node or extranodal tissue replaced in diffuse pattern. Morphologic variants: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.

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
20110081 MP/H Rules/Histology--Pancreas: What is the correct histology code for pancreatic neoplasia III (PanIN III) for cases diagnosed in 2007 and later?

Code histology for PanIN-III to 8148/2 [Glandular intraepithelial neoplasia, grade III]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology.

For cases diagnosed 2007 or later, the following steps are used to determine the histology code:

Open the Multiple Primary and Histology Coding Rules manual. For a pancreas primary, use the Other Sites Histo rules to determine the histology code because pancreas does not have site specific rules.

Go to the SINGLE TUMOR: IN SITU ONLY module, start at rule H1. Code 8148/2 [Glandular intraepithelial neoplasia, grade III]. There is only one histologic type identified.

In the next version of the MP/H rules, the H22 rule "Code 8148/2 (Glandular intraepithelial neoplasia grade III) for in situ glandular in sites such as the (PAIN III)" will be included under H2 as well. Currently the rule is only in the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module and should also be include under the SINGLE TUMOR: IN SITU only module.

2011
20110040

Reportability--Melanoma: Is a pathology report with a final diagnosis stating only non-reportable terms, followed by a re-excision pathology report that indicates "no residual melanoma" reportable? See Discussion.

Is a case reportable if the final diagnosis on an initial pathology report states a non-reportable term (e.g., evolving melanoma, early/evolving melanoma or melanocytic nevus) and followed by a subsequent re-excision pathology report stating there is "No residual melanoma"? There is no mention in the clinical history on the subsequent pathology report that the diagnosis was thought to be melanoma following the first procedure. The first mention of the reportable term was in the final diagnosis of the subsequent pathology report that stated "no residual melanoma."

No. This case is not reportable based on the information provided. "No residual melanoma" is not diagnostic of a reportable neoplasm.

We recommend that you try to obtain more information from the clinician/pathologist for this case due to the poor documentation. Check for any additional resection performed.

 2011
20110148 First course treatment/Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned and how is treatment coded when follicular lymphoma diagnosed in December 2009 is treated with CHOP and a subsequent December 2010 diagnosis of diffuse large B-cell lymphoma is treated with chemotherapy and a bone marrow transplant? See Discussion.

A follicular lymphoma [9690/3] involving multiple lymph nodes was diagnosed on 12/2/2009. The patient had no bone marrow involvement and was treated with CHOP as first course treatment. In October 2010, the patient was put on maintenance Rituxan but disease progression was noted in November 2010. A biopsy of a mesenteric lymph node in December 2010 showed diffuse large B-cell lymphoma [9680/3]. The patient subsequently had chemotherapy and an autologous bone marrow transplant.

According to the Multiple Primaries Calculator in the Heme DB, the DLBCL is a new primary but the physician calls the diagnosis of DLBCL a transformation from the follicular lymphoma diagnosed in December 2009.

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

This case should be accessioned as two primaries: follicular lymphoma [9690/3] and diffuse large B-cell lymphoma [9680/3] per Rule M10. Per Rule M10, abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (follicular lymphoma) AND there is a second diagnosis of an acute neoplasm (diffuse large B-cell lymphoma) more than 21 days after the chronic diagnosis.

Record the CHOP as the first course of treatment for the follicular lymphoma because this was the only treatment given for the chronic neoplasm (follicular lymphoma) prior to the transformation to the acute neoplasm (DLBCL). Record the chemotherapy and bone marrow transplant as first course treatment for the DLBCL.

As noted above, follicular lymphoma does transform to DLBCL. This "transformation" is actually a new disease. Follicular lymphoma is a disease in which the lymph nodes have a prominent follicular pattern; DLBCL is a disease with diffuse proliferation of large lymphoid cells. While it is true that follicular lymphoma will transform to DLBCL, this transformation indicates it becomes a different entity.

The DLBCL is coded as a second primary for several reasons: to determine the incidence of follicular lymphomas transforming to DLBCL; survival time can be calculated for the diagnosis of the more aggressive DLBCL; death will be attributed to the DLBCL (for mortality statistics) and not the follicular 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.

2011
20110115 MP/H Rules/Histology--Lung: How is micropapillary adenocarcinoma of the lung coded given that a literature search indicates that this is a distinct subtype of adenocarcinoma of the lung with poor prognosis? Code the histology to 8260/3 [papillary adenocarcinoma]. An expert pathologist states that the WHO notes micropapillary to be a pattern seen in papillary carcinomas, but does not specify it as a separate histologic type. 2011
20110066 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned for a patient with a history of CLL undergoing chemotherapy who is subsequently diagnosed on a liver biopsy with diffuse large B-cell lymphoma (Richter transformation)?

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

Abstract the diffuse large B-cell lymphoma (Richter transformation) as a second primary per Rule M10. Rule M10 states to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (CLL) AND there is a second diagnosis of an acute neoplasm (the diffuse large B-cell lymphoma (Richter transformation)) more than 21 days after the chronic diagnosis.

"Richter transformation," also known as "Richter syndrome," is a term that indicates CLL has transformed to DLBCL. Richter syndrome is listed under the Alternate Names section in the Heme DB for DLBCL (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
20110123

Reportability--Heme & Lymphoid Neoplasms: Are the terms EBV positive B-cell lymphoproliferative disorder with or without the term "of the elderly" and iatrogenic EBV positive lymphoproliferative disorder reportable? See Discussion.

The only reportable term listed is "EBV positive B-cell lymphoproliferative disorder of the elderly." Are the following cases reportable?

  • Does the diagnosis of EBV positive B-cell lymphoproliferative disorder specifically have to include the expression "of the elderly" to be reportable? Is there an age range associated with the term "of the elderly"?
  • Is "iatrogenic EBV positive lymphoproliferative disorder" reportable?
  • Is a diagnosis of "EBV positive B-cell lymphoproliferative disorder" reportable when there is no further classification of the LPD as lymphoma?

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

  1. EBV positive B-cell lymphoproliferative disorder is reportable. Code EBV positive lymphoproliferative disorder as DLBCL [9680/3], the term "of the elderly" does not have to be part of the diagnosis.
  • The term "iatrogenic" simply means that there is no known cause for the disease. Iatrogenic EBV positive lymphoproliferative disorder is reportable.
  • EBV positive B-cell lymphoproliferative disorder is a synonym for DLBCL [9680/3]. You do not need to have the lymphoma (DLBCL) 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
20110154

Behavior--Breast: Is a breast biopsy diagnosis of "ductal carcinoma in situ with focal and very early stromal invasion" an invasive tumor with a behavior code 3?

Code the behavior to /3 [malignant, invasive].

"Stromal invasion" means the cancer is invasive. "Stroma" is the supporting connective tissue around and between ducts. It is outside the duct basement membrane. If the tumor cells extend into the stroma, the proper behavior designation for the tumor is invasive.

 2011
20110104 Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C421 [bone marrow] or C770-C779 [lymph nodes] for an adult T-cell leukemia/lymphoma [9827/3] that presented with a positive bone marrow biopsy and involvement of lymph nodes and the lung?

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

Code the primary site to the involved lymph nodes [C770-C779]. Per Rule PH 8, it indicates you are to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. Note 2 further states that the bone marrow may or may not be involved. If the bone marrow is involved, code this information in the CS Extension field.

Per the Abstractor Notes section in the Heme DB, this is a systemic disease with widespread lymph node involvement as well as involvement of the peripheral blood. In addition, systemic involvement of extranodal sites (including lung) are often involved.

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
20110072 Multiplicity Counter/Date Multiple Tumors--Bladder: How are these fields coded when multiple tumors were present at the time of diagnosis and another tumor diagnosed a year later is determined to be the same primary? See Discussion. In November 2007, a nephroureterectomy showed an invasive TCC of the renal pelvis and a separate in situ TCC of the ureter. The Multiplicity Counter field is coded 02 and the Date Multiple Tumors is coded to November 2007. In December 2008, an in situ bladder tumor is found. Are the multiplicity fields to be updated to reflect the new bladder tumor?

Multiplicity Counter field was initially coded 02. Change the code to 03 because the subsequent, additional tumor was determined to be the same primary. Update the Multiplicity Counter field only once. If additional tumors are determined to be the same primary for this case, it is not necessary to update this field again.

Date of Multiple Tumors field was initially coded November 2007. Multiple tumors were present at the time of the initial diagnosis. Do not change the date of this field when additional tumors are subsequently diagnosed. This data item reflects the earliest date that multiple tumors were present. See example 2 under #3 on page 81 of the 2010 SEER manual.

2011