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Report Produced: 09/22/2025 13:45 PM

Report Question ID Question Discussion Answer Year
20110153 Reportability--Heme & Lymphoid Neoplasms: Is macrocytic anemia reportable?

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

Macrocytic anemia is not reportable. Anemia refers to a condition of having a low count of red blood cells. The term "macrocytic" refers to the enlarged size of the red blood cells. Macrocytic anemia is usually caused by vitamin deficiencies, alcohol use, medications or thyroid disorders.

See Appendix F: Non-Reportable List for Hematopoietic Diseases.

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
20110092

MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned when a pathology specimen reveals one tumor with invasive mucinous carcinoma [8480/3] and a second tumor with in situ ductal carcinoma, solid and cribriform types [8523/2]?

For cases diagnosed 2007 or later, accession two primaries, invasive mucinous carcinoma [8480/3] and in situ ductal carcinoma, solid and cribriform types [8523/2].

The steps used to arrive at this decision are:

Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor (8480/3 and 8523/2).

Start at the MULTIPLE TUMORS module, rule M4. These tumors have ICD-O-3 histology codes that are different at the second (xxx) and third (xxx) number and are, therefore, multiple primaries.

 2011
20110135

MP/H Rules/Histology--Lung: Per SINQ 20110115, why is micropapillary adenocarcinoma of the lung coded to 8260 [papillary adenocarcinoma] rather than 8050 [papillary carcinoma]?

The histology codes for lung tumors are based on the World Health Organization Classification of Lung Tumors. Chart 1 in the MP/H Lung Equivalent Terms, Definitions, Charts, Tables and Illustrations (2007 MP/H Rules Manual) illustrates the WHO Classification of Lung Tumors.

Using Chart 1, note that papillary adenocarcinoma [8260] is located under the Adenocarcinoma (NOS) branch. The histology in question was stated to be "micropapillary adenocarcinoma" and not "papillary carcinoma." Papillary carcinoma, NOS [8050] is not actually located on the chart. However, papillary squamous cell carcinoma is listed under the Squamous Cell Carcinoma, NOS branch, histology code 8052.

Next, look up papillary carcinoma [8050] in the Morphology - Numerical listing section of the ICD-O-3. Papillary carcinoma, NOS is a Squamous Cell Neoplasm. (Refer also to SINQ 20091040.)

The key word used to determine the appropriate histology in this case is "adenocarcinoma." This is a papillary adenocarcinoma and not a papillary squamous neoplasm.

 2011
20110110

MP/H Rules/Multiple primaries--Head & Neck: If a 1991 neuroesthesioblastoma [9522/3] of the nasal cavity has subsequent recurrences of the same histology but later "recurs" in 2008 with "sarcoma, NOS, high grade" on a biopsy and a "high grade fibrosarcomatous transformation of esthesioneuroblastoma" [8810/3] on resection, should the subsequent tumor be reported as a new primary if the clinician continues to refer to the tumor as a "recurrence"? See Discussion.

Are histologic transformations always recurrences of the original tumor?

Assuming the same primary site for the 2008 lesion, according to the current MP/H rules the high grade fibrosarcoma [8810/3] is a new primary per Head & Neck MPH rule 11 because it is a different histology.

The revised MP/H rules will include tables to define tumors that de-differentiate (transform) and recur with what is seemingly a different histology. Although the rules will be changed in the future, we must use the rules in place at this time for this case.

 2011
20110004 MP/H Rules/Histology--Breast: Which MP/H rule applies when coding the histology field for a tumor described as a "metaplastic carcinoma, adenosquamous and spindle cell type"? See Discussion.

Per path comment: "The neoplasm is composed of adenosquamous carcinoma which merges with spindle cell carcinoma. The cystic component shows a mixed squamous and ductal epithelial lining which shows cytologic atypia and mitotic activity and can be seen to merge with invasive carcinoma. The features suggest the possibility that the tumor may have arisen from a sclerosing and cystic papilloma with squamous metaplasia, although a clearly benign component is not evident."

Would MP/H rule H19 apply based on the pathology report comment resulting in histology for the case being coded to 8255 [adenocarcinoma with mixed subtypes]? Or, would MP/H rule H14 apply based on the final diagnosis resulting in histology for the case being coded to 8575 [metaplastic carcinoma] because adenosquamous and spindle cell are not specific types of metaplastic carcinoma?

This is a metaplastic carcinoma as stated in the path diagnosis. Rule H14 applies. Assign code 8575/3. According to the WHO Classification, metaplastic carcinoma is a general term for a group of neoplasms characterized by a mixture of adenocarcinoma with dominant areas of spindle cell, squamous, and/or mesenchymal differentiation.

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the histology for this case. Code histology to 8575/3 [metaplastic carcinoma] as stated in the pathology diagnosis.

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histo rules determine histology for the case.

Go to the SINGLE TUMOR: INVASIVE CARCINOMA ONLY module. The rules are intended to be reviewed in consecutive order within the module from Rule H10 to Rule H19. You stop at the first rule that applies to the case you are processing.

Code the histology when only one histologic type is identified. According to the WHO Classification, metaplastic carcinoma is a general term for a group of neoplasms characterized by a mixture of adenocarcinoma with dominant areas of spindle cell, squamous, and/or mesenchymal differentiation.

2011
20110088

Chemotherapy/Neoadjuvant treatment: Should neoadjuvant chemotherapy be coded for an incidental second primary discovered at the time of surgery? If so, how is the diagnosis date coded? See Discussion.

The patient had neoadjuvant chemotherapy for rectal carcinoma. An AP resection revealed an incidental second primary intramucosal carcinoma in adenomatous polyp in the descending colon. Is the chemotherapy coded as therapy for the intramucosal carcinoma of the descending colon?

Record the neoadjuvant therapy only for the first primary and do not record the neoadjuvant therapy for the incidental new primary found on surgery. 

 2011
20110079 MP/H Rules/Histology: In the MP/H Manual, where is the documentation indicating "focal" is not a term that can be used to code histology? See Discussion. Example: neuroendocrine carcinoma with focal squamous differentiation. For the purposes of the MP/H rules, the term "focal" is not used to indicate a more specific histology. Terms that may be used to indicate a more specific histology are listed in the relevant histology rules. For example, see Breast histology rule H3. Notice the terms listed in the note for this rule are "type, subtype, predominantly, with features of, major, with ___ differentiation, architecture or pattern." The term "focal" is not included. This concept will be clarified in future revisions to MP/H rules. 2011
20110090 MP/H Rules/Histology/Behavior--Ovary: How are these fields coded for a 20 cm borderline mucinous tumor with a 0.3 cm minor focus of intraepithelial carcinoma of the ovary that the pathologist stages as T1a?

According to the MP/H rules, code histology to 8010/2 [intraepithelial carcinoma] for cases diagnosed 2007-2014. Borderline mucinous tumor is not reportable to SEER.

The steps used to arrive at this decision are:

Go to the Other Sites Histo rules found in the Multiple Primary and Histology Coding Rules Manual.

Start at the SINGLE TUMOR: IN SITU ONLY module, rule H1. Code the histology when only one histologic type is identified. The only reportable histology in this case is intraepithelial carcinoma [8010/2].

2011
20110118

Reportability--Colon: Is a polypectomy that is suspicious for invasive adenocarcinoma followed by a partial colectomy with no residual neoplasm reportable? See Discussion.

08/28/2009 Cecum biopsy showed an adenomatous polyp with focal areas suspicious for invasive adenocarcinoma.

SINQ 20071060 states a suspicious biopsy that is disproven by a subsequent surgical procedure is not reportable. That does not seem to apply in this case because the patient had a suspicious finding on a surgical procedure (polypectomy), followed by a second surgical procedure that was negative. Is it possible that the polypectomy removed the entire tumor and the suspicious diagnosis should be reported?

This case is reportable.

It is possible that the polypectomy removed the entire tumor. Invasive carcinoma in a polyp does not mean that is has invaded the stalk of the polyp. If the stalk is not invaded, all of the cancer may have been removed by a polypectomy.

 2011
20110149

Ambiguous Terminology/Histology--Heme & Lymphoid Neoplasms: How are the histology and diagnostic confirmation to be coded when the pathology report's final diagnosis is "plasma cell dyscrasia consistent with plasma cell myeloma" and the physician subsequently states this diagnosis was plasma cell myeloma? See Discussion.

Pathologists often use the diagnosis "plasma cell dyscrasia" followed by an ambiguous term such as "consistent with" or "favors" with a more specific histology such as "plasma cell myeloma." Per initial training for Hematopoietic, ambiguous terminology is not used to code the histology for Heme & Lymphoid Neoplasms. Should the histology be coded as plasma cell dyscrasia (which is not found in the Heme DB or Manual) because the pathology report uses ambiguous terminology to describe the plasma cell myeloma?

If the physician subsequently states the diagnosis is "plasma cell myeloma" in a note following the pathology, should the histology be coded as plasma cell myeloma based on that diagnosis as there was no ambiguous terminology used?

How is the diagnostic confirmation coded for this case? Should this be a positive histology diagnosis (diagnostic confirmation code 1) if the pathology diagnosis uses ambiguous terminology only?

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

The histology is coded as Plasma cell myeloma [9732/3]. The diagnostic confirmation is coded to 1 [positive histology].

Under the Definitive Diagnostic Methods section in the Heme DB it indicates that a bone marrow aspiration and bone marrow biopsy are procedures used to diagnose this disease process. This patient's diagnosis was based on the pathology (presumably from a bone marrow biopsy).

NOTE: This is a reportable case. Ambiguous terminology is used to accession cases (determine reportability) because it has been used for over 30 years to do so. Any deviation from using ambiguous terminology to determine case reportability would cause the reporting of incidence counts to vary. In this case, there was a reportable, ambiguous terminology diagnosis of plasma cell myeloma on the pathology report; as well as a reportable physician's statement/diagnosis of plasma cell myeloma.

Ambiguous terminology, however, is not used to report a more specific diagnosis for the Heme & Lymphoid neoplasms. For example, if the pathology report final diagnosis was "Myeloproliferative neoplasm, probably Polycythemia Vera" the histology would be coded as myeloproliferative neoplasm, unclassifiable [9975/3]. The ambiguous terminology indicates that the genetic testing, immunophenotyping, etc., probably are not complete or are not diagnostic of the more specific disease. Wait to code the histology until there is a definite diagnosis given.

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