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Report Produced: 05/27/2026 14:29 PM

Report Question ID Question Discussion Answer Year
20100032 First course treatment--Prostate: Is Degarelix coded as hormonal treatment for prostate cancer? Code the administration of Degarelix in the "Hormone Therapy" field. Assign code 01 [Hormone therapy administered as first course therapy]. This drug will be added to the next update of SEER*Rx. 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
20100088 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient has 2005 diagnosis of multiple myeloma diagnosed returns in 2010 with extramedullary plasmacytoma and a bone marrow biopsy showing plasma cell dyscrasia that is clinically stated to "consistent with a relapse of myeloma"? See Discussion.

Patient was diagnosed in 2005 with multiple myeloma and following stem cell transplant 2005 was in complete remission.

On 2/1/10 an excisional biopsy of a soft tissue right flank mass showed plasmacytoma. On 3/2/10 the bone marrow biopsy was stated to be consistent with plasma cell dyscrasia. An outside attending physician stated the bone marrow biopsy was consistent with a relapse of myeloma. There was no radiologic evidence of disease elsewhere as of Feb 2010, only the soft tissue right flank mass. Patient initially presented for post-op radiation to the right flank and was treated 3/29/10. On 8/6/10 a biopsy of a right perinephric mass was positive for plasmacytoma. Subsequent xray on 8/16/10 of the right tibia and fibula showed lytic lesion consistent with progression of myeloma.

Using the Hematopoietic Database, the plasmacytoma in 2/1/10 is a second primary. How do the rules apply to the perinephric soft tissue disease and right tibia lesion? Are they separate new primaries? Or is all of this simply a recurrence of the original 2005 diagnosis as the attending physician states?

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

Accession a single primary with the histology coded to 9732/2 [multiple myeloma]. The disease discovered in 2010 represents further advancement of former disease. Per the Abstractor Notes section in the Heme DB, it states that bone marrow involvement, lytic bone lesions, and bone tumor masses of plasma cells are common. Under the Recurrence and Metastases section in the Heme DB it further states that extramedullary (in tissue other than the bone) involvement is a generally a manifestation of advanced disease. This case is an example of such a situation.

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
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
20100002 Reportability/Histology--Colon: Is a colon tumor reportable if the pathology report final diagnosis is high grade dysplasia but CAP protocol histologic type designation is adenocarcinoma in situ? See Discussion. The microscopic description and the final diagnosis on the pathology report indicate the tumor is a large tubulovillous adenoma of the cecum with focal surface high grade dysplasia. The CAP protocol histologic type designation is adenocarcinoma in situ and pT designation is pTis. Which has priority? Is the case reportable?

The case is reportable because carcinoma in situ is stated. Carcinoma in situ has higher priority than severe dysplasia or high grade dysplasia.

Per AJCC 6th edition colon chapter, the terms "high grade dysplasia" or "severe dysplasia" may be synonymous with carcinoma in situ. Because the pathologist gave carcinoma in situ information within the CAP, (s)he is apparently defining the dysplasia as in situ carcinoma.

 2010
20100018 Reportability/Heme & Lymphoid Neoplasms--Hematopoietic, NOS: Is light chain disease reportable if it is treated with chemotherapy agents? See Discussion.

A patient was diagnosed in 2010 with light chain disease based on SPEP and urine testing. Bone marrow aspiration and biopsy were done. Flow cytometry, cytogenetic studies and FISH for plasma cell disorders are all normal. Medical oncologist states diagnosis is light chain disease. Patient was started on Revlimid, dexamethasone and Velcade.

In reviewing the case reportability instructions, this seems to fall under Instruction 1, note 1. Immunoglobulin deposition disease, preferred term for light chain disease, is coded as 9769/1. This is normally a non-reportable diagnosis, but the patient was given cancer-directed treatment. Would this case be accessioned using the above morphology code and primary site of bone marrow [C42.1]?

Updated May 2026

Light chain disease (9769/1) is not reportable for any year of diagnosis. See the Hematopoietic Database for further information.

Light chains are produced in neoplastic plasma cells (multiple myeloma) and are called Bence-Jones proteins. The physician did the cytogenetic studies and FISH to rule out plasma cell disease. 50-60% of people with Light-chain deposition disease (LCDD) have an associated lymphoproliferative disorder, most commonly multiple myeloma. The remaining patients develop LCDD in the setting of progression of monoclonal gammopathy of unknown significance (MGUS) with no evidence of neoplastic plasma cell proliferation. This patient falls in this category, MGUS, which is not reportable.

 2010
20100044 Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C499 [Blood vessels, NOS] for a case of intravascular large B cell lymphoma, Asian variant [9712/3] found in the bone marrow and liver? See Discussion. Patient has biopsy proven intravascular large B cell lymphoma, Asian variant, (9712/3) in bone marrow and liver. The Hematopoietic Database does not give a primary site code. Should the primary site be coded C49.9 because, by definition, this lymphoma arises in the blood vessels?

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

Code primary site to C499 [blood vessels]. The definition in the Heme DB does specify that this type of extranodal large B-cell lymphoma is characterized by lymphoma cells within the lumina of blood vessels with the exception of larger arteries and veins. The reason no primary site is specified is that Western variant can originate in the skin or CNS.

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
20100014 Reportability: Are there criteria other than a pathologist or clinician's statement that a registrar can use to determine reportability of gastrointestinal stromal tumors (GIST)? See Discussion.

Per SINQ 20091021 and 20021151, GIST cases are not reportable unless they are stated to be malignant. A pathologist or clinician must confirm the diagnosis of cancer. There are cases that are not stated to be malignant in the pathology report or confirmed as such by a clinician; however, these cases do have information that for other primary sites would typically be taken into consideration when determining reportability. The final diagnosis on the pathology report for all 16 cases is "GIST." The additional comment(s) for each of the 16 different cases is reported below. Are any of the following cases reportable?

1) Pathology report indicates that the bulk of the tumor is submucosal. It extends through the muscularis propria and abuts the serosa.

2) Pathology report states tumor extends to serosal surface of transverse colon, but not into muscularis propria. CD 117 and CD 34 are positive.

3) Pathology report indicates that tumor invades through the gastric wall to the serosal surface.

4) Pathology report indicates that tumor invades pericolic fat tissue.

5) No further information in pathology report, however, scans indicate omental caking.

6) No further information in pathology report, however, scans indicate hepatic metastases. Hepatic metastases are not biopsied.

7) Tumor stated to be unresectable and extends into pancreas. Chemotherapy given.

8) Pathology report states tumor is low to intermediate grade and involves serosal (visceral peritoneum).

9) Tumor size is 17.5 cm. Pathology report states "malignant risk".

10) Pathology report states tumor "into muscularis propria" or tumor "involves muscularis propria" or "infiltrates into muscularis propria".

11) Pathology report states, "high malignant potential; omentum inv by tumor." It is not stated in path report or final diagnosis to be malignant GIST.

12) Pathology report states that tumor arises from wall of small bowel and extends into thin serosal surface.

13) Pathology report states minimal invasion of lamina propria; does not penetrate muscularis propria.

14) Pathology report states, "high mitotic activity >10/50 HPF; high risk for aggressive behavior; moderate malignant potential."

15) Pathology report states tumor size is >5 cm. Intermediate risk for aggressive behavior; CD117+ KIT exon 11+.

16) Pathology report states "high risk of malignancy."

 For GIST to be reportable, the final diagnosis on the pathology report must definitively state that the GIST is malignant, or invasive, or in situ. Case 6 is the only exception. It would be reportable assuming the scan actually states "hepatic metastases." Based only on the information provided, none of the other examples are reportable. The type of extension and/or invasion mentioned in the other examples are not sufficient to confirm malignancy. Borderline neoplasms can extend and invade, but do not metastasize. Only malignant neoplasms metastasize. 2010
20100095

MP/H Rules/Multiple primaries--Kidney, renal pelvis: In a patient who was never disease free because of multiple recurrences of invasive transitional cell carcinoma of the bladder originally diagnosed in 2004, is an invasive high grade urothelial carcinoma of the renal pelvis diagnosed in 2010 a new primary? See Discussion.

Patient has invasive TCC of the bladder diagnosed in 2004, and has never been disease free.

In 2/18/10 a left renal pelvis wash showed urothelial carcinoma, high grade.

On 4/7/10 a nephroureterectomy revealed high grade urothelial carcinoma with sarcomatous and squamous differentiation invading through pelvic wall and perihilar soft tissue.

Is this a new renal pelvis primary?

For cases diagnosed 2007 or later, the renal pelvis is a new primary per rule M7. M7 will be better explained in the revised MP/H rules, but the rationale is that no field effect was present for more than 3 years. Although the bladder CA continued to recur, there were no other organs involved until 2010. M7 is intended to make the renal pelvis a new primary because there was no field effect (no organs other than bladder involved) for more than 3 years.

 2010
20100045

Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"?

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 (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for for DLBCL.

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