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Report Produced: 12/19/2025 15:17 PM

Report Question ID Question Discussion Answer Year
20110019 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when bilateral testes are involved with lymphoma?

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

This is a single primary per Rule M2 which indicates to abstract a single primary when there is a single histology. Code the histology to 9590/3 [lymphoma] and the primary site to C629 [testes. Unless your software has edits that prevent coding laterality for lymphomas, code the laterality as bilateral. Up to half of extranodal lymphomas occur in multiple sites, particularly in paired sites.

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
20110059

Histology: How do you code histology for "malignant myopericytoma"?

Report malignant myopericytoma as 8824/3 for cases diagnosed 2021 and later.

 2011
20110043 MP/H Rules/Histology--Breast: Which specimen should be used to code histology when a core biopsy revealed an unknown sized DCIS, comedo type and the partial mastectomy specimen showed only a 2mm focus of DCIS, solid pattern? See Discussion.

Should the histology be coded from the needle core biopsy or the partial mastectomy specimen? Patient had a needle core biopsy that revealed DCIS, comedo type, cribriform pattern, no tumor size given. Subsequently, the patient had a partial mastectomy which revealed DCIS, noncomedo type, solid pattern, largest focus of DCIS was 0.2cm.

Should the histology code be 8501/2 or 8230/2? The microscopic description on the partial mastectomy says that the previous core needle biopsy site revealed several foci of DCIS.

 Code the histology from the most representative specimen (the specimen with the MOST tumor tissue). Compare the size of tumor in the two specimens. If the tumor size is not available for both procedural specimens, code histology from the mastectomy specimen rather than the needle biopsy specimen. 2011
20110061

Primary site/Histology--Heme & Lymphoid Neoplasms: Should the primary site and histology codes be updated when a patient with a history in 2005 of a bone marrow diagnosis of chronic lymphocytic leukemia later presents in 2010 with lymph node biopsy diagnosis of small B-cell lymphocytic leukemia?

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.

 2011
20110016 Behavior--Brain and CNS: Can hemangioblastomas occurring in the CNS be coded as /3 (malignant) based on a radiologic or clinical diagnosis by the physician? See Discussion. Hemangioblastomas are borderline (/1) according to ICD-O. The standard matrix rule in ICD-O directs registrars to change the behavior code to malignant when a malignant (/3) behavior is stated by a physician for a morphology code that appears in ICD-O with a non-malignant behavior code. The "malignant" hemangioblastomas we see are not pathologically confirmed; they are radiological or clinical diagnoses confirmed when renal cell carcinoma is a disease process listed in the malignant differential diagnoses.

The behavior code for hemangioblastoma can be coded to /3 when a pathologist indicates that the behavior is malignant. The behavior code should be based on a pathologist's opinion. It is usually not possible for a radiologist or patient care physician to make this determination clinically.

The histologic appearance of hemangioblastoma may resemble metastatic renal cell carcinoma; therefore, one will often see renal cell carcinoma listed as a possible diagnosis. This does not indicate that the hemangioblastoma is malignant. Do not code the behavior as /3 based on a differential diagnosis of renal cell carcinoma.

2011
20110020 Heme & Lymphoid Neoplasms: How is cancer status to be coded when a patient diagnosed with MDS, undergoes treatment, but the MDS subsequently transforms to AML? If the bone marrow no longer shows evidence of MDS, the cancer status for the MDS is disease-free. When cancer status is coded as disease-free (NED), it means that currently there is no clinical evidence of this disease (MDS). 2011
20110074 First course treatment/Date therapy initiated--Breast: How is the Date of Initiation of Hormone Therapy field coded when a patient undergoes "Tamoxifen blunting" to achieve better MRI imaging after a biopsy but prior to definitive surgery which is followed by adjuvant Tamoxifen therapy? See Discussion. Patients are prescribed two weeks of "Tamoxifen blunting" to achieve better MRI imaging after biopsy confirmation of an ER/PR positive breast carcinoma. The Tamoxifen is subsequently discontinued and the patient has definitive surgery. Following surgery, maintenance Tamoxifen is initiated. Which date should be recorded for the Date of Initiation of Hormone Therapy field? Is it the first date when Tamoxifen blunting started or the post-surgical date when maintenance Tamoxifen is initiated? Use the post-surgical start date of maintenance Tamoxifen to code the Date of Initiation of Hormone Therapy field. The actual hormone treatment begins after surgery when Tamoxifen blunting was performed. The low dose administered prior to surgery does not affect the cancer. 2011
20110039 Multiple primaries/Primary site--Heme & Lymphoid Neoplasms: What are the primary sites and how many primaries are abstracted, when 2004 diagnosis of grade 2 follicular lymphoma of the bilateral breasts is subsequently diagnosed with a 2010 diagnosis of diffuse large B-cell lymphoma (40%) and grade 3a follicular lymphoma (60%) of a left arm nodule? See Discussion.

Follicular lymphoma was diagnosed 7/2004, grade 2 per biopsy of the bilateral breasts. Bone marrow biopsy was positive for lymphoma involving 10% of bone marrow. Imaging showed extensive lymphadenopathy mainly in abdomen/pelvis with an 8 cm mass in the right pelvis. Smaller lymph nodes were noted in the left periaortic region and also some small precarinal lymph nodes. This was a stage IVA lymphoma. The patient had six cycles of CHOP/R with an excellent response. Per the clinician's notes on 12/2005, there was no evidence of recurrence or no sign of active disease. The plan was to follow up with the patient in 6 months.

08/22/06 imaging showed new disease in the bilateral chest wall. 8/2006 bilateral breast nodule biopsies, are positive for grade 1-2 follicular lymphoma. The patient was treated with Rituxan. Per clinician's 3/2007 note, no active disease is noted. Patient was regularly followed with no evidence of disease until 10/2010. At that time, the patient had a left arm nodule biopsy which was positive for diffuse large B cell lymphoma (40%) CD positive and grade 3a follicular lymphoma (60%). RICE was recommended due to "transformation" per oncologist.

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

Per Rule M10, this case should be accessioned as two primaries when a neoplasm is originally diagnosed as a chronic neoplasm (is follicular lymphoma (FL), grade 2) AND there is a second diagnosis of an acute neoplasm (diffuse large B-cell lymphoma) more than 21 days after the chronic diagnosis.

Code the histology for the first primary to 9691/3 [follicular lymphoma (FL), grade 2] and the primary site to bilateral C509 [breast, NOS]. FL can start as an extranodal disease; breast is one of the sites in which it originates. It is unlikely that the lymphoma extended from the nodes to the breast, but highly likely that it extended from the breast to the nodes.

Per Rule M4, abstract the 2010 disease process as a single primary when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location(s), such as the same lymph node or lymph node region(s), the same organ(s), and/or the same tissue(s). Per Rule PH11 the primary site is coded to C779 [lymph nodes, NOS] and the histology is coded to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Rule PH11 states one is to code the primary site to the site of origin, lymph node(s), lymph node region(s), tissue(s) or organ(s) and histology to diffuse large B-cell lymphoma (DLBCL) (9680/3) when DLBCL and any other non-Hodgkin lymphoma are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow.

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
20110032 Primary site--Heme & Lymphoid Neoplasms: What primary site is coded for Langerhans cell histiocytosis (LCH) [9751/3] when it is limited to the skin?

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

Per Rule PH30, use the Heme DB to determine the primary site and histology when PH1-29 do not apply, In this case, code the primary site to C449 [Skin]. According to the Abstractor Notes section in the Heme DB, the solitary form of Langerhans cell histiocytosis (LCH) [9751/3] occurs less commonly than the multisystem form of the disease; but can appear in nodes, skin and lung. This is a solitary form of LCH. Code the primary site to skin [C449].

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
20110093

Residence at dx: After living elsewhere (Florida) and traveling around the country in an RV with his spouse, is a patient a resident of this area for either primary if he was diagnosed with his first primary less than a month after arriving in the area and a second primary more than a year after parking his RV here?

Use the patient's usual residence to determine residency. If the usual residence is not known or the information is not available, use the residence the patient specifies at the time of diagnosis. The SEER rules for determining "usual residence" match the rules used by the US Census Bureau.

 2011