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Report Produced: 05/15/2026 07:29 AM

Report Question ID Question Discussion Answer Year
20110082 First course treatment/Other therapy--Skin: How is PUVA [psoralen (P) and long-wave ultraviolet radiation (UVA)] coded when used for skin primaries such as melanoma and mycosis fungoides? Code PUVA as "Other treatment" with Code 1 - Other. We do not have a code specifically for ultraviolet radiation. 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
20110062 Histology--Heme & Lymphoid Neoplasms: Is diffuse large B-cell lymphoma, germinal cell type coded to diffuse large B-cell lymphoma?

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

Per Rule PH30, use the Heme DB, determine the histology when rules PH1-PH29 do not apply. Code diffuse large B-cell lymphoma, germinal cell type to 9680/3 [diffuse large B-cell lymphoma (DLBCL)][9680/3]. Under the Alternate Names section of the Heme DB, these two terms are synonyms that share the same histology code.

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
20110108 Primary site--Heme & Lymphoid Neoplasms: What is the primary site for a bone marrow biopsy positive for systemic mastocytosis that also involves the spleen and lymph nodes with associated leukocytosis, mild anemia and thrombocytopenia?

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

Per Rule PH30, one is to use the to determine the primary site and histology when rules PH1-PH29 do apply. Code the primary site to C421 [bone marrow] because that is the only site listed under the Primary Site section of the Heme DB.

Under the Abstractor Notes section in the Heme DB, it indicates that the bone marrow is always involved, and the white and red pulp of the spleen may be involved with systemic mastocytosis. This is how this patient presented; therefore, the bone marrow is the primary site. The spleen is secondarily involved because the spleen cleanses the blood and the neoplastic cells have infiltrated the red and white pulp of the spleen. The same is true for the lymph nodes. Although the lymph nodes are rarely involved, they may be involved when the patient has systemic mastocytosis.

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
20110046

MP/H Rules/Multiple primaries--Stomach: If there is no statement of recurrence, how many primaries are to be abstracted when a patient is diagnosed with multiple gastric carcinoid tumors between 12/2003 and 3/2009? See Discussion.

Are the multiple primary rules applicable when a patient has multiple gastric carcinoid tumors? The patient was diagnosed with carcinoid tumors starting in 12/2003 through 3/2009. According to the 2004 SEER Manual, rule 5, if a tumor with the same histology is identified in the same site at least two months after the original diagnosis, this is a separate primary. The physician does not indicate that the pre-2007 carcinoid tumors were recurrent. The patient does not have familial polyposis syndrome. Should each of the following tumors be a separate primary?

12/2003 - Gastric Polyp Removal - Path: Gastric carcinoid tumor

05/2004 - Stomach body polyp removal - Path: Carcinoid Tumor (endocrine cell tumor)

09/2004 - Single polyp in body removal - Path: Gastric carcinoid

03/2005 - Multiple gastric body polyps removed - Path: Carcinoid tumor

07/2005 - 3 small polyps in fundus removal - Path: Carcinoid tumor

02/2007 - Localized nodularity in lesser curvature - Path: Carcinoid (neuroendocrine) tumor

03/2009 - Stomach body polypectomy - Path: Carcinoid tumor

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]."

 2011
20110072 Multiplicity Counter/Date Multiple Tumors--Bladder: How are these fields coded when multiple tumors were present at the time of diagnosis and another tumor diagnosed a year later is determined to be the same primary? See Discussion. In November 2007, a nephroureterectomy showed an invasive TCC of the renal pelvis and a separate in situ TCC of the ureter. The Multiplicity Counter field is coded 02 and the Date Multiple Tumors is coded to November 2007. In December 2008, an in situ bladder tumor is found. Are the multiplicity fields to be updated to reflect the new bladder tumor?

Multiplicity Counter field was initially coded 02. Change the code to 03 because the subsequent, additional tumor was determined to be the same primary. Update the Multiplicity Counter field only once. If additional tumors are determined to be the same primary for this case, it is not necessary to update this field again.

Date of Multiple Tumors field was initially coded November 2007. Multiple tumors were present at the time of the initial diagnosis. Do not change the date of this field when additional tumors are subsequently diagnosed. This data item reflects the earliest date that multiple tumors were present. See example 2 under #3 on page 81 of the 2010 SEER manual.

2011
20110068 MP/H Rules/Multiple primaries--Bladder: Which multiple primary rule is used to determine the number of primaries to accession when a patient has a papillary transitional cell carcinoma of the bladder diagnosed in 2009 followed by a high grade invasive urothelial carcinoma with neuroendocrine features per immunohistochemistry diagnosed in 2010? See Discussion.

A patient has papillary transitional cell carcinoma of the bladder in March of 2009. In June of 2010 the patient has another TURBT that demonstrates a flat in situ and invasive high grade urothelial carcinoma. The path addendum indicates, "Genzyme IHC show results consistent with high grade invasive urothelial carcinoma with neuroendocrine features." Two months later a liver biopsy shows poorly differentiated malignant tumor. The path addendum indicates, "Genzyme IHC results show metastatic poorly differentiated carcinoma with neuroendocrine features, favor bladder primary."

Is the latter a second bladder primary with histology code 8246/3 [neuroendocrine carcinoma]?

NOTE: Neuroendocrine is not listed as an urothelial tumor in Table 1 of MP/H Rules.

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. The 2010 diagnosis is urothelial carcinoma. The presence of "neuroendocrine features" does not change the histologic category.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Urinary MP rules under one of the three formats (i.e., flowchart, matrix or text). The rules are intended to be reviewed in consecutive order within the module. You stop at the first rule that applies to the case you are processing.

Start at the MULTIPLE TUMORS module start at rule M3.

. Bladder tumors with any combination of transitional cell carcinoma and papillary transitional carcinoma are a single primary.

2011
20110051 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when bilateral breasts are involved with MALT lymphoma and the bone marrow is negative?

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 mentioned. The histology is coded to 9699/3 [MALT lymphoma]. Code the primary site to C509 [breast] per Rule PH24 which states to code the primary site to the organ when lymphoma is present only in an organ.

Unless your software has edits that prevent coding laterality for lymphomas, code the laterality as bilateral. Up to half of extranodal, extragastric MALT lymphomas occur in multiple sites, particularly in paired sites (breast is an example).

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
20110015 Primary site/Histology: Do the 4/1/09 changes in the ICD-O-3 Site/Type Validation table regarding the coding of primary site for intestinal type adenocarcinoma mean that the former valid site/histology combinations are now impossible and require review from a given diagnosis date forward? See Discussion.

Per the SEER Errata for ICD-O-3 Site/Type Validation List, April 1, 2009, adenocarcinoma, intestinal type, was removed as a valid site/histology combination for the following primary sites: C150-C155, C158-C159, C170-C173, C178-C179, C180-C189, C199, C209, C210-C212, C218.

  • Does this mean that these combinations cannot be used? If so, then why is an override allowed for these site/type combinations? Shouldn't these site/type combinations be added to the impossible site/type combinations table?

  • SINQ 20081085 states that "8144/3 will be removed from the valid site/histology list for large intestine, small intestine, and rectum." It appears from the Site/Type Validation table that a decision was made to also remove esophagus sites as a valid combination with histology code of 8144. Please explain the rationale.

  • Cases that were miscoded to 8144/3 will need to be identified for correction. What date of diagnosis should be the reference point used in making the necessary corrections related to this change? Do we only need to review cases diagnosed 1/1/2009 forward or should all cases be corrected regardless of date of diagnosis?

    • The site/type edit identifies unlikely combinations of primary site and histologic type.

  • Intestinal type adenocarcinoma occurs in the stomach. It would be rare in another primary site, but not impossible.

  • It was decided that all digestive organ sites, except stomach, would be removed from the list. That is why esophagus is not listed as a valid site.

  • The site/type edit is for all years. Cases for all years have to be reviewed for combinations of site and type that are no longer on the list. If it is documented in the medical record that the primary site and histology combination are valid, set the over-ride flag so that the case will not come up for review again.

    		• 2011
    		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