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Report Produced: 09/17/2025 18:19 PM

Report Question ID Question Discussion Answer Year
20110066 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned for a patient with a history of CLL undergoing chemotherapy who is subsequently diagnosed on a liver biopsy with diffuse large B-cell lymphoma (Richter transformation)?

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

Abstract the diffuse large B-cell lymphoma (Richter transformation) as a second primary per Rule M10. Rule M10 states to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (CLL) AND there is a second diagnosis of an acute neoplasm (the diffuse large B-cell lymphoma (Richter transformation)) more than 21 days after the chronic diagnosis.

"Richter transformation," also known as "Richter syndrome," is a term that indicates CLL has transformed to DLBCL. Richter syndrome is listed under the Alternate Names section in the Heme DB for DLBCL (9680/3).

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
20110103 MP/H Rules/Histology/Ambiguous terminology: Can synonyms of listed terms, such as "variety" for the list termed "type," be used to code a more specific histology? See Discussion. The list of terms denoting a more specific histology does not include "variety." During MP/H training sessions there was an emphasis placed on only using terms listed to code a more specific histology. However, the results of an audit indicated that because "variety" is a synonym for "type" it could be used to code a more specific histology. Are synonyms of listed terms to be used to code histology? No. Synonyms of listed words used in the MP/H rules (e.g., "variety" for the listed term "type") cannot be used to designate a more specific histology. 2011
20110070 MP/H Rules/Histology--Endometrium: How is histology coded when clear cell adenocarcinoma [8310/3] is stated to involve a "1.5 cm endometrial polyp"? See Discussion.

The CAP formatted pathology report histology field states, "Clear cell adenocarcinoma, NOS 98310/3)" and the tumor size comment field states, "Carcinoma involves a 1.5 cm endometrial polyp." Does rule H11 apply? Is the histology coded to clear cell adenocarcinoma [8310/3] because this is one histologic type identified in the CAP formatted histology field? Or should rule H12 apply and the histology coded as clear cell adenocarcinoma arising in a polyp [8210/3]? Or should we code the higher histology per rule H17 apply because clear cell adenocarcinoma and adenocarcinoma in a polyp are two specific histologies?

For colon primaries, whether or not the tumor arose in a polyp is quite important. Is this also the case for primaries listed in the Other Sites category?

Code histology to 8310/3 [clear cell adenocarcinoma]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later.

The following steps are used to determine the histology code:

Open the Multiple Primary and Histology Coding Rules manual. For an endometrial primary, use the Other Sites Histo rules to determine the histology code because endometrium does not have site specific rules.

Go to the SINGLE TUMOR: INVASIVE ONLY module, which starts at Rule H8.

. Code clear cell adenocarcinoma [8310/3] because only one histologic type is identified.

2011
20110078 MP/H Rules/Histology--Bladder: What is the histology code for "high-grade urothelial carcinoma, plasmacytoid variant"? See Discussion. Per the MP/H Manual, Urinary Equivalent Terms & Definitions, Table 1, plasmacytoid is a specific type of Urothelial/Transitional Cell Tumor. What is the correct histology, and rule used, when a bladder resection pathology report states, "high-grade urothelial carcinoma, plasmacytoid variant"?

Code the histology to 8082/3 [urothelial carcinoma, plasmacytoid].

The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later. Unfortunately, in this case there is no current rule that directs you appropriately to Table 1 from Rule H7 to find this histology combination. We need to add an example under Rule H7 that instructs you to "See Table 1" for an urothelial carcinoma diagnosis that mentions a more specific cell type (e.g., plasmacytoid). We will add a reference to Table 1 in Rule H7 in the updates to MP/H Rules.

2011
20110119 MP/H Rules/Primary Site--Bladder: How is the primary site coded when a patient is diagnosed with synchronous, non-invasive papillary urothelial carcinomas of the bladder and renal pelvis? See Discussion.

This patient was diagnosed with at least three non-invasive papillary urothelial carcinomas of the bladder in 11/09. The patient subsequently underwent a complete nephroureterectomy in 12/09 showing a single non-invasive papillary urothelial carcinoma of the renal pelvis.

Per the MPH Rule M8, this is a single primary. Is the primary site to be coded C659 [renal pelvis] or C689 [urinary system, NOS]?

Assign code C68.9 when multiple tumors are found in multiple urinary sites at the same time. 2011
20110058 Date of diagnosis/Flag: Will the Date of Diagnosis Flag ever be used if the instructions for coding Date of Diagnosis are followed? See Discussion.

If an abstractor follows the instructions for coding the Date of Diagnosis and can at least estimate a year of diagnosis, in what scenario will the Flag be used?

Per the 2010 SEER Manual,

Page 49 Date of Diagnosis, second paragraph, "Regardless of the format, at least Year of diagnosis must be known or estimated. Year of diagnosis cannot be blank or unknown." The manual gives the following guidelines for coding diagnosis date/flag:

Page 50, Coding Instructions:

3. If no information about the date of diagnosis is available

a. Use the date of admission as the date of diagnosis

b. In the absence of an admission date, code the date of first treatment as the date of diagnosis.

Page 51, Coding Instructions:

9. Estimate the date of diagnosis if an exact date is not available. Use all information available to calculate the month and year of diagnosis.

Page 53, Date of Diagnosis Flag, Coding Instructions:

Always leave blank. Date of Diagnosis will always be a full or partial date recorded.

 The date of diagnosis flag should always be blank. 2011
20110137 MP/H Rules/Histology--Skin: How is the histology coded for a "malignant baso-melanocytic tumor" arising in the skin of right shoulder?

Code the histology as melanoma, NOS [8720/3].

This is a malignant skin tumor with both melanoma and basal cell carcinoma histologies. There is no ICD-O-3 code for this entity. Per our subject matter expert, code the histology to 8720/3 [melanoma, NOS] and document the diagnosis of malignant baso-melanocytic tumor in a text field because melanoma is reportable to SEER and basal cell carcinoma is not.

 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
20110123

Reportability--Heme & Lymphoid Neoplasms: Are the terms EBV positive B-cell lymphoproliferative disorder with or without the term "of the elderly" and iatrogenic EBV positive lymphoproliferative disorder reportable? See Discussion.

The only reportable term listed is "EBV positive B-cell lymphoproliferative disorder of the elderly." Are the following cases reportable?

  • Does the diagnosis of EBV positive B-cell lymphoproliferative disorder specifically have to include the expression "of the elderly" to be reportable? Is there an age range associated with the term "of the elderly"?
  • Is "iatrogenic EBV positive lymphoproliferative disorder" reportable?
  • Is a diagnosis of "EBV positive B-cell lymphoproliferative disorder" reportable when there is no further classification of the LPD as lymphoma?

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

  1. EBV positive B-cell lymphoproliferative disorder is reportable. Code EBV positive lymphoproliferative disorder as DLBCL [9680/3], the term "of the elderly" does not have to be part of the diagnosis.
  • The term "iatrogenic" simply means that there is no known cause for the disease. Iatrogenic EBV positive lymphoproliferative disorder is reportable.
  • EBV positive B-cell lymphoproliferative disorder is a synonym for DLBCL [9680/3]. You do not need to have the lymphoma (DLBCL) diagnosis.

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