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This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.

Assign code 0 [No surgical resection done...based on physical exam...or other non-invasive clinical evidence] to the corresponding eval fields when CS Extension, Lymph Nodes or Mets at Diagnosis are coded based only on the TNM and no further information is available.

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

Code the histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)].

For CLL (and CLL/SLL), Richter's transformation represents when CLL changes into DLBCL. In this case, there was a biopsy that demonstrated a diagnosis of the chronic disease (CLL/SLL) transforming (Richter's transformation) into an acute disease DLBCL.

Per Rule M8, one is instructed to abstract the acute neoplasm as a single primary when both a chronic (CLL/SLL) and an acute neoplasm (diffuse large B-cell lymphoma (DLBCL)) are diagnosed simultaneously there is documentation of only one positive bone marrow biopsy, lymph node biopsy or tissue biopsy.

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.

For cases diagnosed 2007 or later, code the histology as papillary carcinoma, poorly differentiated [8260/33].

The WHO classification lists grade III papillary carcinoma as one of the synonyms for poorly differentiated thyroid carcinoma.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Other Sites Histo rules because site specific rules have not been developed for this primary.

Start with the SINGLE TUMOR: INVASIVE ONLY module, rule H8. The rules are intended to be reviewed in consecutive order within a module. Per rule H13 "phenotype" is not a term used to code a more specific histology. Moving to Rule H14 the histology is coded 8260/3 [papillary adenocarcinoma].

For tumors diagnosed prior to 2007:

Follow the rules in the 2004 manual for determining multiple primaries. When the sebaceous carcinomas are in different sites (topography code difference in the first two numeric digits after the C), they are separate primaries. When the sebaceous carcinomas are more than two months apart, they are separate primaries.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

Do not report primary acquired melanosis with atypia.

According to our expert pathologist consultant, "There has been a lot of debate in the literature about the diagnostic criteria, terminology, and natural history of primary acquired melanosis [PAM]. Your case comes down squarely on the main issue, which is whether PAM with atypia should be regarded as melanoma in situ. In most studies it appears that PAMs with no atypia or mild atypia do not progress to melanoma, and only a small percentage of those with severe atypia do so."  "PAM, even with atypia, is not melanoma in situ, and should not be reported."

For further information, see this article for a review of a large number of patients: Shields, Jerry A, Shields, Carol L, et al. Primary Acquired Melanosis of the Conjunctiva: Experience with 311 Eyes. Trans. Am Ophthalmol Soc 105:61-72, Dec 2007.

Assign code 9380/1 [glioma, borderline].

According to our pathologist consultant, the term pituicytoma is restricted to low-grade glial neoplasms of the neurohypophysis or infundibulum. The best category currently available for these is glioma.

For cases diagnosed 1998-2003:

For Primary Site and EOD, CT information has higher priority than laryngoscopy. The CT scan gives a better picture of the involvement of the deeper tissues. A laryngoscopy falls into the "physical exam" category more than the "operative" category. The laryngoscopy report is not an "operative" report like those generated from a surgical procedure.

For tumors diagnosed prior to 2007:

Code 8720 [malignant melanoma]. Assign the histology code based on the histology stated in the final diagnosis on the pathology report. The pathology report must say melanoma arising in junctional nevus to use the code 8740/3 [Malignant melanoma in junctional nevus].

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

For cases diagnosed 1998-2003:

In coding the EOD-Extension field, ignore metastasis that is discovered after the initial workup is completed regardless of the timeframe from diagnosis date until the date the metastatic deposit was discovered. The metastasis is progression of disease.

Any of the following represents progression of disease. Do not code the subsequently identified metastatic involvement in the EOD:

1) The metastatic workup was complete and treatment started before the procedure was done that found the metastatic involvement.

2) A procedure, such as a scan, was negative initially and a repeat of that procedure is now positive.

3) The treatment plan is developed for a localized disease process.

If you are unable to determine whether the newly discovered metastasis represents progression or is part of the initial workup, regard the metastasis as progression. Do not code the metastasis in the EOD-Extension field.