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Code as a single primary. The histology is carcinoid.

Our expert pathology consultant replied as follows: "This patient clearly has a condition driving the proliferation of neuroendocrine cells. Possibilities include hypergastrinemia from a gastrinoma or from response of antral gastrin cells due to achlorhydria from long standing chronic atrophic gastritis, or multiple endocrine neoplasia (MEN1) syndrome (genetically driven). How should these cases be coded given we do not have a way to code the inciting situation. (I suspect the gastroenterologist knows what it is, but we haven't obtained that information.) We do not have an ICD-O-3 code for the underlying condition, MEN1 or hypergastrinemia. Therefore, the only choice is to code the resulting tumor, carcinoid [8240/3]."

SEER will answer the question about the number of primaries to accession. Submit questions about stage to the CoC CAnswer Forum.

For cases diagnosed 2007 or later: Accession two primaries: a mixed adenocarcinoma, acinar and papillary types [8255/3] and a bronchioloalveolar carcinoma, non-mucinous [8252/3].

The steps used to arrive at this decision are:

Determine the histology code for each tumor prior to applying the Multiple Primary Rules to determine the number of primaries to accession. There are two non-small cell carcinomas, NOS; the histology code for these two tumors will be 8046/3. There is a single adenocarcinoma with acinar and papillary subtypes tumor, the histology for this tumor will be 8255. There is a single bronchioloalveolar carcinoma, non-mucinous subtype tumor; the histology for this tumor will be 8252/3.

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Lung Multiple Primary rules to determine the number of primaries.

Start at the MULTIPLE TUMORS module, Rule M3, because this patient has multiple tumors. The rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] are multiple primaries.

Perform a second pass through the Multiple Primary rules to determine whether the two non-small cell carcinomas [8046/3] are multiple primaries or manifestations of the same primaries identified in Step 3.

Start at Rule M3 again because this patient has multiple tumors. Again, these rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's non-small cell carcinomas, NOS [8046/3] are a single primary when compared to the adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3]. Both of these histologies are more specific types of non-small cell carcinoma per the Lung Histology Groups and Specific Types Chart (Chart 1).

You can also apply Rule M10 for both non-small cell carcinoma, NOS [8046/3] compared to adenocarcinoma with acinar and papillary subtypes [8255/3] and non-small cell carcinoma, NOS [8046/3] compared to non-mucinous bronchioloalveolar carcinoma [8252/3].

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

"Thrombocytopenia of unknown etiology" is not reportable. Thrombocytopenia refers to a low platelet count which causes bleeding. Thrombocytopenia can be caused by viral infections, excessive alcohol usage, HIV, and other causes (including chemotherapy). If the diagnosis is not "refractory thrombocytopenia" the case is not reportable. Appendix F lists this term as non-reportable.

If you do not see the term in the Heme DB under either the Name column or the Alternative Names section for the results returned, it is not reportable. The only reportable term that contains the word thrombocytopenia is refractory thrombocytopenia. Therefore, thrombocytopenia of unknown etiology is not reportable.

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

Ambiguous terminology is NOT used to determine histology for hematopoietic or lymphoid neoplasms. Therefore, the comment that the AML is "probably" arising in myelodysplastic syndrome is not used to determine the histology code. The term "favor" is also an ambiguous term and cannot be used to code histology.

This is a single histology per M2, abstract a single primary when there is a single histology. The histology is coded to 9861/3 [acute myeloid leukemia, NOS]

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.

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary.

For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult. The histology is the same in both lobes of the thyroid.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. For a thyroid primary, use the Other Sites MP rules under one of the three formats (i.e., flowchart, matrix or text) to determine the number of primaries because the thyroid does not have site specific rules.

Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.

. This patient has multiple papillary carcinomas of the thyroid diagnosed simultaneously; no other rule applies, so this is a single primary. Abstract a single primary for this patient.

Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.

Start with the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, Rule H18. The rules are intended to be reviewed in consecutive order within the module from Rule H18 to Rule H31. You stop at the first rule that applies to the case you are processing.

. Code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS [8260].

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

This case should not be accessioned. In situ lymphoma is not reportable for any of the standard setters (CoC, NPCR, or SEER). In the Case Reportability Instructions, the NOTE under Rule 3 states, "Do report in situ (/2) lymphomas."

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.

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].

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

Per Rule M2, this is a single primary because there is a single histology. Code histology to 9823/3 [CLL/SLL]/

The distinction of CLL vs. SLL cannot be made on bone marrow biopsy in isolation. The pathologist cannot make a diagnosis of CLL vs SLL without having peripheral blood counts available for review. If the patient was treated for CLL in the past, that may alter the peripheral counts seen in 2010 (e.g., lymphocytosis). The distinguishing feature is peripheral lymphocytosis in CLL (not seen in SLL). The disease looks the same and both will often have bone marrow involvement and lymph node involvement. If the patient had true CLL in 2005, then any subsequent lymph node (or other) biopsy consistent with CLL/SLL remains consistent with the original diagnosis of CLL. I would not change the original CLL code.

I agree with the previous response. We have to assume the 2005 diagnosis included a peripheral blood supporting that diagnosis. Otherwise, CLL and SLL look the same in nodes and marrow. The interplay between the two "diseases" is expected. This is why they are considered a single disease.

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.