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Report Produced: 10/07/2026 19:55 PM

Report Question ID Question Discussion Answer Cancer Site Category Data Item Category Year
20081077 MP/H Rules--Ovary: How do you code histology for a diagnosis of "clear cell CA, predominately cystic." For cases diagnosed 2007 or later, assign histology code 8310 [Clear cell carcinoma]. Cystic describes the appearance of the tumor. Clear cell is the histologic type. Code clear cell carcinoma 8310/3. Rule H11 applies. Ovary N/A 2008
20120021

Multiple primaries--Heme & Lymphoid Neoplasms: How are the terms "chronic" and "acute" used to help determine the number of primaries to be abstracted and what rule applies when a diagnosis of diffuse large B-cell lymphoma is followed two years later by a diagnosis of follicular lymphoma, grade 3A of 3? See Discussion.

7/31/08 Biopsy of the left supraclavicular lymph node diagnosed Stage IIIB DLBCL [9680/3]

10/14/10 Biopsy of a right supraclavicular lymph node diagnosed follicular lymphoma, grade 3A or 3 [9698/3].

Which multiple primary rule applies to determine the number of primaries to report? Is Rule M4 ignored? Does Rule M13 apply because follicular lymphoma normally transforms to DLBCL? Is this still a transformation because the follicular lymphoma came AFTER the DLBCL (the "acute" reverted to "chronic")? Or does Rule M15 apply, and the Multiple Primaries Calculator should be used to determine the number of primaries to report?

Are "transformations" the acute phases of the more chronic disease? The Heme Manual and previous training sessions do not make this apparent.

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 per Rule M13. Code the histology for the 7/31/08 diagnosis to 9680/3 [diffuse large B-cell lymphoma] and the code the histology for the 10/14/2010 diagnosis to 9698/3 [follicular lymphoma, grade 3A of 3]. Rule M13 applies to this case because the neoplasm was originally diagnosed in the blast or acute phase (DLBCL) and reverted to a less aggressive or chronic phase (follicular lymphoma) after treatment.

Per the "Transformations to" section in the Heme DB for follicular lymphoma, grade 3 transforms to diffuse large B-cell lymphoma [9680/3]. This means that the follicular lymphoma is the chronic neoplasm and that DLBCL is the acute neoplasm. In this case, the chronic neoplasm was diagnosed after the acute neoplasm was diagnosed and treated (with chemotherapy).

Do not Stop at Rule M4 because diffuse large B-cell lymphoma and follicular lymphoma (both NHL's) were not present in the same node(s) AT THE SAME TIME.

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.

 Heme & Lymphoid Neoplasms N/A 2012
20000553 EOD-Size of Primary Tumor--Lung: Can tumor size of 002 [Malignant cells present in bronchopulmonary secretions] be used when there is a lung mass seen but the diagnosis is from a positive bronchopulmonary secretion?

For cases diagnosed 1998-2003:

EOD-Size of Primary Tumor code 002 [Malignant cells present in bronchopulmonary secretions] is used only when there is no visible primary lung tumor and bronchopulmonary secretions are positive for lung malignancy.

Even if the diagnosis was made by cytology of broncho-pulmonary secretions, if there is a visible mass, code the size of the mass if known, code 999 if size is unknown.

 Lung N/A 2000
20000844 EOD-Pathologic Review of Number of Regional Lymph Nodes Positive and Examined--Colon: What codes are used to represent these fields when the pathology from a colon cancer resection describes 2/16 positive pericolonic lymph nodes and a "metastatic nodule in the pericolonic fat"?

For cases diagnosed 1998-2003:

Code the Number of Regional Lymph Nodes Positive field to 03 and the Number of Regional Lymph Nodes Examined field to 17. Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.

 Colon, Lymph nodes N/A 2000
20130077 Reportability--Heme & Lymphoid Neoplasm: What is the histology code if a myeloproliferative disorder is reportable should a physician suspect this diagnosis and treats the patient? See Discussion. Physician suspects patient has a myeloproliferative disorder and treats her with a phlebotomy and Hydrea. Patient receives Hydrea during an inpatient stay, but does not see the Heme/Onc again. The patient is subsequently only seen by a Palliative Medicine physician who also states she has an underlying myeloproliferative disorder. The patient died while an inpatient.

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

This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].

The term is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4). Also, the patient was treated for a myeloproliferative disorder, making this a reportable clinical diagnosis per the SEER Manual (Reportability, Pg 4, Exception 1).

Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, 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.

Heme & Lymphoid Neoplasms N/A 2013
20081026 MP/H rules/Multiple primaries: Is a 2007 cytology diagnosis of adenocarcinoma in bile duct a new primary for a patient with a 2005 diagnosis of adenocarcinoma of gallbladder? See Discussion.

A case abstracted for an adenocarcinoma of gallbladder (C23.9) in 2005. In 2007, cytology diagnosis of adenocarcinoma in bile duct(C24.0). Oncologist calls this recurrence. There is no pathologist statement of recurrence.

Using Other Sites multiple primary rules, rule M10 indicates this is multiple primaries. Sequence 01 dx in 2005 and sequence 02 dx in 2007. Is this correct? There is no statement of a primary tumor; the MP/H rules talk in terms of mass, lesion, tumor in a primary site.

 For cases diagnosed 2007 or later, abstract the 2007 bile duct diagnosis as a new primary unless it is described as metastatic. N/A N/A 2008
20091002

Multiplicity Counter--Ovary: Given the diffuse nature of ovarian cancer, should we count bilateral parenchymal involvment of ovaries as two tumors? See Discussion.

Are peritoneal implants mets and not counted as separate tumors, even though they're not stated to be metastatic in the path report, and are not coded as distant mets?

Code Multiplicity Counter to 02 [Two tumors present] for an epithelial ovarian primary involving both ovaries. Do not count the peritoneal implants; they are regional metastasis and not included in the multiplicity counter. An example like this will be added to the manual in the next revision.

 Ovary N/A 2009
20081017 Ambiguous terminology/Reportability--Leukemia: Is a 'suspicious peripheral blood smear' the same as a suspicious cytology? See Discussion. The final diagnosis on the path report for a peripheral blood smear is stated to be "suspicious for malignancy." The microscopic description states that the "lymphoid population raises the concern of chronic lymphocytic leukemia." Nothing further was done. Is this a reportable case? If so, should it be coded as a leukemia or a malignancy NOS?

For cases diagnosed prior to 1/1/2010:Do not accession a leukemia case based only on a "suspicious" peripheral blood smear. If a confirmed diagnosis, clinical confirmation or further information becomes available later, accession the case at that time.

For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 N/A N/A 2008
20071087 MP/H Rules/Multiple Primaries--Breast: How many primaries are abstracted when bilateral breasts contain DCIS? Is a physician statement referring to this situation as one primary ignored? See Discussion. Patient has microcalcifications both breasts. Has bilateral mastectomy. Path report states Left breast multifocal DCIS predominantly micropapillary. Right breast two foci of DCIS micropapillary.

For cases diagnosed 2007 or later:

There are two primaries in this case.

Using the 2007 MP/H rules for breast, go to the multiple tumors module and start with Rule M4. Stop at rule M7. Tumors on both sides (right and left) are multple primaries.

Always use the 2007 Multiple Primary rules to determine the number of primaries. Do not use the physician statement.

 Breast N/A 2007
20031166 EOD-Regional Lymph Nodes--Breast: Are subpectoral nodes the same as interpectoral nodes and, therefore, regional for breast primaries? Subpectoral lymph nodes are regional nodes for breast primaries. Subpectoral is the term generally used to describe the placement of a prosthesis during reconstruction (under/behind the pectoralis major muscle). That is the same location for interpectoral, or Rotter's, nodes. Breast N/A 2003