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Report Produced: 02/17/2026 12:30 PM

Report Question ID Question Discussion Answer Year
20100083 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient with a longstanding history of follicular cell non-Hodgkin lymphoma followed by a 2010 diagnosis of "B-cell lymphoma with prominent large cell component, compatible with primary cutaneous follicle center cell lymphoma"? See Discussion.

Patient has a history of follicular cell non-Hodgkin lymphoma dating back to the 1990s. The patient was treated with chemotherapy and bone marrow transplantation, radiation and rituximab. The patient had no evidence of recurrence. In April 2010 a lesion appeared on the side of the scalp above the left ear with a diagnosis of "B-cell lymphoma with prominent large cell component, compatible with primary cutaneous follicle center cell lymphoma." The oncology diagnosis is "primary cutaneous follicle center lymphoma."

Would the Multiple Primaries Calculator be used in this case?

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

Accession two primaries per Rule M15. Per the Multiple Primaries Calculator, primary cutaneous follicle center lymphoma [9597/3] following a diagnosis of follicular lymphoma, NOS [9690/3] is a new primary.

While the pathologic diagnosis was B-cell lymphoma "compatible with" primary cutaneous follicle center cell lymphoma and ambiguous terms cannot be used to identify a more specific histology, the physician confirmed the more specific diagnosis without ambiguous terminology. Therefore, this diagnosis should be coded.

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.

2010
20100009 MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion.

A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.

Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma?

 For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. 2010
20100017 MP/H Rules/Multiple primaries--Prostate: Does adenosquamous carcinoma found in the prostate represent a second primary in a patient previously diagnosed with adenocarcinoma of the prostate? See Discussion.

Patient was diagnosed many years ago with adenocarcinoma of the prostate and treated with hormonal and radiation therapy. The patient recently underwent a TURP and is found to have adenosquamous carcinoma of the prostate. The pathology report comment states squamous carcinoma of the prostate is rare and is often associated with a history of hormonal or radiation therapy. There is no information indicating a history of a squamous carcinoma in the urinary system that could have involved the prostatic urethra.

Would the MP/H rules make this a second primary with the histology of 8560/3 [adenosquamous carcinoma]?

 For cases diagnosed 2007 or later, based on the limited information available for this unusual case, abstract a second prostate primary and code the histology as adenosquamous carcinoma. Rule M3 does not apply in this case. Apply rule M10. 2010
20100044 Primary site--Heme & Lymphoid Neoplasms: Should the primary site be coded to C499 [Blood vessels, NOS] for a case of intravascular large B cell lymphoma, Asian variant [9712/3] found in the bone marrow and liver? See Discussion. Patient has biopsy proven intravascular large B cell lymphoma, Asian variant, (9712/3) in bone marrow and liver. The Hematopoietic Database does not give a primary site code. Should the primary site be coded C49.9 because, by definition, this lymphoma arises in the blood vessels?

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

Code primary site to C499 [blood vessels]. The definition in the Heme DB does specify that this type of extranodal large B-cell lymphoma is characterized by lymphoma cells within the lumina of blood vessels with the exception of larger arteries and veins. The reason no primary site is specified is that Western variant can originate in the skin or CNS.

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.

2010
20100090 MP/H Rules/Histology: How is histology coded for a diagnosis of "poorly differentiated endometrioid adenocarcinoma intermixed with osteoid sarcomatous component, consistent with malignant mixed mullerian tumor with heterologous (osteosarcoma) elements"? Is malignant mixed mullerian tumor synonymous with carcinosarcoma? See Discussion. Given that there is no mixed code for these histologies, can the numerically higher code be used per H17 (malignant mixed mullerian tumor [8950/3]) using the logic of the MP/H rule for other sites? If so, should this histology be coded as 8980/3 [carcinosarcoma] rather than 8950/3 [malignant mixed mullerian tumor]? For cases diagnosed 2007 or later, code histology to 8980/3 [carcinosarcoma]. Recent literature states that carcinosarcoma is synonymous with mixed mullerian tumor. Mixed mullerian tumor is an obsolete term and should not be used. 2010
20100062 MP/H Rules/Histology--Lung: How is histology coded when there is a lung biopsy compatible with non-small cell carcinoma and regional lymph node biopsies compatible with adenocarcinoma? See Discussion. Which histology has priority when the pathology specimens reveal different histologies in the primary site and the regional lymph node? Do we assume the lung biopsy is the most representative tumor specimen because it is from the primary site and code to 8046 [non-small cell carcinoma] or should we use rule H5 and code to 8140 [adenocarcinoma, NOS] because adenocarcinoma is a more specific histology than non-small cell carcinoma? For cases diagnosed 2007 or later, code histology based on a pathology report from the primary site whenever possible. Code histology to 8046/3 [non-small cell carcinoma] for the case example provided. 2010
20100077 Multiple primaries--Heme & Lymphoid Neoplasms: Would it be correct to apply rule M5 for a recurrence and abstract a single primary when a patient has a history of Hodgkin disease diagnosed in 2005 followed by a diagnosis of "recurrent Hodgkin and EBV+ Diffuse large B-cell lymphoma" in 2010? See Discussion.

Does Rule M5 only apply if both diseases are present at the original diagnosis, or does it also take into account a recurrence of an old disease? The answer to this question makes a difference between stopping at rule M5 and abstracting as one disease, or going on to rule M15 to query the Hematopoietic Database to determine whether the patient has two separate primaries.

Example: Patient had Stage II Hodgkin disease in 2005 (all lymph nodes above diaphragm, supraclavicular LN biopsied at diagnosis), treated and patient achieved complete remission. In 2010, the patient is admitted for suspected recurrence. A supraclavicular lymph node biopsy showed, "Recurrent Hodgkin" AND "EBV+ Diffuse Large B-cell Lymphoma," both in the same lymph node. Applying rule M5, this is a single primary and states not to query the DB. However, this doesn't seem correct as it does not account for the new DLBCL.

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

You must first determine the histology codes for each occurrence of lymphoma. The 2005 diagnosis was stated to be Hodgkin disease (NOS) [9650/3]. The 2010 diagnosis was Hodgkin and EBV + diffuse large B-cell lymphoma (two histologies). Per Rule M5 the 2010 diagnosis is a single primary because the Hodgkin and the non-Hodgkin (DLBCL) were simultaneously present in the same lymph node. Per Rule PH14, a Hodgkin and non-Hodgkin simultaneously present in the same location should be coded to 9596/3 [B-cell lymphoma, unclassifiable].

Ultimately, there is a diagnosis of 9596/3 in 2010 that followed a diagnosis of 9650/3 in 2005. Per Rule M15, use the Multiple Primary Calculator to determine the number of primaries, which indicates the 9596/3 is a new primary.

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. https://educate.fhcrc.org/LandingPage.aspx.

 2010
20100113 Reportability--Heme & Lymphoid Neoplasms: Is hemophagocytic lymphohistiocytosis reportable?

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

No. This is not a reportable hematologic condition. When you do not find a hematologic or lymphoid condition listed in the Heme DB, it is not reportable. Hemophagocytic lymphohistiocytosis is an uncommon hematologic disorder. The patient usually presents with fever, splenomegaly, and jaundice. Laboratory findings are lymphocytosis and histiocytosis. Pathology findings are hemophagocytosis.

Appendix F lists this term as non-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.

2010
20100071 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient diagnosed in February 2010 with a plasmacytoma of the frontal skull followed by a diagnosis of smoldering myeloma by bone marrow biopsy? See Discussion.

The patient had a diagnosis of solitary plasmacytoma of the right frontal skull in 2/2010 that was totally resected (the cranial specimen final diagnosis was plasmacytoma). The patient received radiation. While undergoing radiation, the patient was seen by a medical oncologist who did a bone marrow biopsy that revealed 10-15% plasma cells, and was called smoldering myeloma. Watchful waiting was recommended. In 8/2010, the patient had multiple lytic lesions and began systemic treatment.

Per rule M15 and the Multiple primary calculator, 9731/3 [plasmacytoma] and 9732/3 [smoldering myeloma] is accessioned as two primaries. When the manual states, "Use the Hematopoietic Database to determine the primary site and histology when PH1-PH29 do not apply," does this mean to use the calculator not the database itself? By the old rules this was one primary. Did this change for cases diagnosed 1/1/10 and later? Which M rule is the correct rule to apply?

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

The smoldering myeloma is a second primary per Rule M10. Accession as multiple primaries because this case was originally diagnosed as a chronic neoplasm (plasmacytoma)phase and there was a second diagnosis of an acute neoplasm (multiple myeloma) more than 21 days after chronic diagnosis. See note 1 which indicates, "This is a change from previous rules." Note that the MP rules and the MP calculator in the Heme DB agree.

When the rules tell you to go to the DB to determine the histology and primary site, you use the DB information. (Don't forget to check the Abstractor Notes). The multiple primaries calculator is used to determine the number of primaries to abstract. Always use the M rules before using the MP calculator.

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.

2010
20100106 Reportability-Bladder: Is a case with a cytology diagnosis, "positive for malignancy, favor low grade papillary urothelial carcinoma" reportable if the diagnosis on a subsequent bladder biopsy showed only "urothelial neoplasm of low malignant potential"? See Discussion.

On 11/23/09 the patient had urine cytology diagnosis "positive for malignancy, favor low grade papillary urothelial carcinoma." On 12/28/09, the bladder biopsy showed "urothelial neoplasm of low malignant potential."

SINQ 20081086 only addresses the example of a positive FNA/biopsy followed by a negative resection. Would the previous decision hold for this case when a positive fine needle aspiration biopsy is followed by only a negative biopsy?

This case is not reportable. The pathology proved the cytology to be incorrect. The pathologic diagnosis is the "gold standard." When cytology and pathology disagree, use pathology.

2010