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Report Produced: 11/04/2025 16:07 PM

Report Question ID Question Discussion Answer Year
20120050 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what histology codes apply if a patient has a 1998 diagnosis of essential thrombocythemia and a recent clinical diagnosis of secondary myelofibrosis? See Discussion. The patient has a history of essential thrombocythemia (ET) since 1998. This has been treated daily with aspirin. A recent bone marrow biopsy was consistent with myeloproliferative disorder with excess blasts, marked extensive reticulin marrow fibrosis with osteosclerosis, excess blasts (11%) in the marrow aspirate and peripheral blood. JAK2 mutation was present in a small minority of cells. The physician stated patient was, "considered to have secondary myelofibrosis and was started on Jakafi."

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

Per Appendix F, a secondary myelofibrosis is not a reportable case.

Secondary myelofibrosis is not listed as a synonym for primary myelofibrosis in the Heme DB. The term "secondary myelofibrosis" means that the myelofibrosis was caused by, in this case, the essential thrombocythemia.

The diagnosis "consistent with myeloproliferative disorder" is also not a new reportable diagnosis. "Myeloproliferative disorder" refers to a group of diseases (an NOS category) that includes essential thrombocythemia, which was originally diagnosed in 1998, prior to reportability for this disease type.

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.

2012
20110147 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How is the histology coded when no bone marrow examination is performed but the peripheral blood flow cytometry listed several differential diagnoses and the physician states the diagnosis is small lymphocytic lymphoma? See Discussion.

The peripheral blood flow cytometry results state, "findings consistent with a small mature B-cell neoplasm, differential - marginal zone lymphoma, lymphoplasmacytic lymphoma, and atypical CLL." The physician states the diagnosis is "SLL." No bone marrow examination or CT scan was done to assess whether the patient had lymphadenopathy.

Per Rule PH5, if the diagnosis is B-cell CLL/SLL and peripheral blood is involved, the histology is coded to B-CLL/SLL [9823/3]. Should the primary site and histology be coded to bone marrow [C421] and CLL/SLL [9823/3] per Rule PH5 despite the physician's diagnosis of SLL [9670/3]?

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

This is a single primary and the primary site and histology is coded as bone marrow [C421] and CLL/SLL [9823/3]. The code 9670/3 [malignant lymphoma, small B lymphocytes, NOS] used for SLL is now obsolete.

Per the Abstractor Notes section in the Heme DB indicates that SLL is, "usually associated with CLL and coded CLL/SLL 9823/3. Small lymphocytic lymphoma (SLL) is almost identical to CLL. A somewhat arbitrary distinction is drawn between them based on the relative degree of marrow and nodal involvement and the numbers of circulating cells."

Per the Definition section in the Heme DB it states that, "CLL by definition involves blood and bone marrow at time of diagnosis." Check the PRIMARY SITE and MODULE RULE sections that indicate the primary site is C421, Rule PH5. Per this rule, code the primary site bone marrow (C421) and code the histology B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) [9823/3] when the diagnosis is B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) AND peripheral blood is involved (the bone marrow may also be involved).

This may appear to contradict the physician's diagnosis, but the 2008 WHO no longer codes CLL and SLL as separate neoplasms, rather one neoplasm, CLL/SLL, which reflects the actual neoplastic process. Those patients with SLL usually manifest CLL during the neoplastic process and those patients with CLL usually manifest SLL during the neoplastic process. WHO recommends coding to CLL/SLL rather than coding two primaries when the other neoplasm manifests.

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
20021112 Multiple Primaries/Histology--Hematopoietic, NOS: The subsequent primary table for 2001 and later indicates that 9863/3 [acute myelogenous leukemia (AML)] followed by 9980/3 [refractory anemia (RAEB)] is a new primary, but 9989/3 [myelodysplastic syndrome, NOS (MDS)] is not. Is the case below two primaries? See discussion. Bone marrow bx states: The morphologic blast count of 7% exceeds 5%, traditionally used to define relapse in the setting of acute leukemia. Given the clinical hx that the pt's peripheral blood counts had initially normalized after induction therapy, the recent fall in counts is worrisome for the possibility of early relapse. Alternatively, therapy may have simply reverted the pt's marrow from AML to a precursor myelodysplastic syndrome (such as RAEB given the blast count) from which the AML arose, with the falling counts being progression of the underlying MDS. The identification of significant dysplasia in the bone marrow at the time of diagnosis would tend to support the possibility of an underlying MDS. Clinically, it is unlikely to make a difference whether one regards the present situation as early relapse or progression of an underlying MDS. The final clinical diagnosis is "Myelodysplasia, classified as RAEB."

For cases diagnosed prior to 1/1/2010:

This case demonstrates a relapse of AML. The original classification of Histology as 9863/3 [AML] is correct. There is no second primary based on the information provided for this case.

For cases diagnosed 2010 forward, 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.

 2002
20031162 Multiple Primaries/Histology--Hematopoietic, NOS/Lymphoma: How many primaries are represented and what are the histologies for "B-cell lymphoma with immunophenotypic findings consistent with hairy cell leukemia" found on a bone marrow biopsy? See Description. Pathologist completed AJCC lymphoma staging form indicating this case should be abstracted as a lymphoma.

For cases diagnosed prior to 1/1/2010:Abstract as one primary, 9591/3 [B-cell lymphoma, NOS]. The bone marrow diagnosis indicates that the main/definite diagnosis is B-cell lymphoma, with a lesser indication of hairy cell leukemia. Both of these are mature B-cell neoplasms according to the WHO histological classification.

For cases diagnosed 2010 forward, 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.

 2003
20000513 Multiple Primaries/Histology (Pre-2007)--Bladder: What code is used to represent the histology and how many primaries should be coded for a TURB specimen that demonstrates carcinoma in situ, Grade I to II papillary transitional cell carcinoma, and high grade transitional cell carcinoma? See discussion.

Pathology report:

A. Biopsy, bladder neck, @ 6:00: Carcinoma in situ

B. Biopsy, Bladder wall, lateral, left:

1. Papillary carcinoma (Grade I-II)

2. Loose fragments of high-grade transitional carcinoma

C. Biopsy, Bladder neck @ 5:00: Carcinoma in situ

D. Biopsy, Bladder neck @ 7:00: Cystitis Glandularis

E. Biospsy, Bladder wall, posterior: Papillary carcinoma (Grade I)

For tumors diagnosed prior to 2007:

Code this case as one primary and code the Histology and Grade, Differentiation fields to 8130/34 [papillary transitional cell carcinoma, high grade].

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.

 2000
20120010 Multiple primaries/Behavior--Ovary: What is the diagnosis date and histology for the primary(ies) abstracted for a patient with a mucinous cystic borderline tumor of the ovary in 2003 and a metastatic ovarian adenocarcinoma in 2011? See Discussion.

The 2011 pathology report: Spine at L3 biopsy: metastatic adenocarcinoma. Per addendum: Prior total abdominal hysterectomy specimen from 2003 was reviewed and showed an ovarian mucinous cystic tumor of borderline malignancy which has a similar morphology to the invasive adenocarcinoma seen on current specimen.

Abdominal tissue and omental biopsy: invasive and non-invasive glandular implants compatible with origin from ovarian mucinous borderline tumor.

The final diagnosis per radiation oncologist was, "recurrent ovarian cancer."

This is a single primary. The diagnosis date is coded to 2003 and the histology is mucinous cystadenocarcinoma [8470/3]. The bone, abdominal tissue and omentum are metastatic sites. The MP/H Rules do not apply to metastases.

This is a case where an invasive or microinvasive element was missed in the original pathology. Because the entire tumor was not sectioned and placed on slides, the pathologist used their expertise when sectioning and selecting tissue to be examined. It is not a matter of poor judgment, just a fact that it is impossible to review the tissue from the entire tumor. The behavior must be changed to malignant [/3].

2012
20091106 Multiple Primaries--Urinary: How many primaries should be coded for an 8/9/07 invasive transitional cell carcinoma of right ureter; 7/9/08 non-invasive urothelial carcinoma of bladder; 11/18/08 non-invasive urothelial carcinoma of left ureter; 6/20/09 invasive urothelial carcinoma of left ureter? One primary. This is a good example of how the field effect occurs in the urinary system. From 2007 to 2008, Rule M8 says bladder and ureter tumors are not new primaries and would be documented as recurrences. Because other urinary sites are involved by 11/08 and by 06/09, do not make second primary of left ureter (Rule M4 does not apply). 2009
20081083 Multiple primaries--Lymphoma: Is mediastinal large B-cell lymphoma followed by classical Hodgkin lymphoma reportable as one or two primaries? See Discussion. Diagnosed 06/06/2006 with mediastinal large B-cell lymphoma, 9679/36. On 05/10/2007, another mediastinal lymph node biopsy done and the diagnosis was recurrent malignant lymphoma, classical Hodgkin's. A Hematopatholgy Consultant states, "it appears likely that the preceding mediastinal diffuse large B-cell lymphoma and the current classical Hodgkin's lymphoma are clonally related and represent different manifestations of the same entity. One might also place this in the spectrum of 'mediastinal gray zone lymphoma' described by Dr. Jaffee and colleagues."

For cases diagnosed prior to 1/1/2010:Report this case as two primaries. Report non-Hodgkin lymphoma followed by Hodgkin lymphoma as separate primaries.

According to the Table of Single and Subsequent Primaries for Hematologic Malignancies, mediastinal large B-cell lymphoma and Hodgkin disease are "D" - Different disease processes.

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.

 2008
20061075 Multiple Primaries--Lymphoma: Is a diagnosis of mycosis fungoides followed a year later with a biopsy proven diagnosis of anaplastic large T-cell lymphoma stated to represent a transformation of the previous mycosis fungoides reportable as one or two primaries?

For cases diagnosed prior to 1/1/2010:

This is one primary. Code the histology according to the original diagnosis, mycosis fungoides. The physician states that this one disease process started as mycosis fungoides and progressed into lymphoma. A physician's statement has priority over other sources in determining the number of hematopoietic primaries.

In October 2006, a committee will begin working on multple primaries among hematopoietic diseases. The committee will provide further guidance on dealing with disease transformation and other issues.

For cases diagnosed 2010 forward, 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.

 2006
20041010 Multiple Primaries--Lymphoma: How many primaries should we abstract when Single Versus Subsequent Primaries table indicates one primary but special pathological studies indicate two primaries? See Description. The patient had a malignant lymphoma, large B cell (9680) diagnosed in 2000. In 2003, he came in and had a spleen biopsy which showed follicular lymphoma (9690). These are the same NHL, according to the table lookup. However, the pathologist states in 2003, "Special stains now show a kappa clonal lymphoma. Since the first diagnosis was a lambda monoclonal lymphoma, this is not felt to be a recurrence of the original lymphoma."

For cases diagnosed prior to 1/1/2010:Abstract the example above as two primaries. Hematologic malignancies (including lymphoma) and solid tumors are handled differently when determining the number of primaries. For hematologic malignancies, take the physician's opinion into account. Use the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table as an aid when there is insufficient information available.

For solid tumors, follow the multiple primary rules in the SEER Program Code Manual.

For cases diagnosed 2010 forward, 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.

 2004