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Report Produced: 02/11/2026 10:12 AM

Report Question ID Question Discussion Answer Year
20130222 MP/H Rules/Histology--Bladder: How is the histology coded for a single bladder tumor showing invasive urothelial carcinoma with extensive divergent differentiation including small cell carcinoma, micropapillary carcinoma, and squamous cell carcinoma features? See Discussion. MP/H rules seem to lead to Rule H8 which indicates that one use the numerically higher ICD-O-3 code. If one applies Rule H8, the histology is coded to 8131/3 [micropapillary urothelial carcinoma]. That would ignore the small cell carcinoma, which seems prognostically more significant. Code the histology to 8045/3 [mixed small cell carcinoma], a combination of small cell with other types of carcinoma. There is currently no rule in the urinary site MP/H Rules for this combination of histologies. This will be included in the next revision of the MP/H Rules. 2013
20130201 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported for a patient with a 6/5/12 RUL biopsy that is positive for MALT lymphoma and a 6/7/12 cervical lymph node biopsy that is positive for follicular lymphoma?

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

Per Rule M15, abstract two primaries for this case. According to M15, use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14. The result is two primaries, MALT lymphoma [9699/3] and follicular cell lymphoma [9690/3].

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.

2013
20130028 Primary site--CLL/SLL: How is the primary site coded and what rule applies when no bone marrow biopsy is performed on a patient diagnosed with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) which was based on the results of an axillary biopsy, positive peripheral blood and a CT scan showing multiple lymph nodes involved above and below the diaphragm? See Discussion The physician staged this as Stage 0 CLL/SLL. Should the primary site be coded to lymph nodes if the MD stated this was leukemia?

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

Code the primary site to C421 [bone marrow] per Rule PH5. Code the primary site to the bone marrow when the peripheral blood is involved, even if no bone marrow biopsy is performed.

According to the notes for Rule PH5, CLL always has peripheral blood involvement (PH5 Note 1). CLL/SLL may also have involvement of lymph node regions in later stages (PH5, Note 2). For this patient a bone marrow biopsy was not performed but he had extensive lymph node and peripheral blood involvement. Therefore, the primary site is coded to C421. In addition, the physician's documentation specifies this patient has Stage 0 disease which indicates this disease process is being classified as leukemia (CLL).

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.

2013
20130031

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a plasmacytoma of the intervertebral disc is diagnosed in 2010 followed by a diagnosis of immature plasma cell myeloma by a right hip biopsy in 2011? See Discussion.

The patient was diagnosed with intervertebral disc plasmacytoma and had radiation therapy to the pelvic bones in 2010. In 2011 (more than 21 days later) a right hip biopsy revealed immature plasma cell myeloma. There is clinical documentation that this is progression into myeloma. Per the Heme DB (Primary Site(s) and Definition sections) and Rule PH30, in the Heme Manual, the primary site is coded to C421 [bone marrow] and the histology is coded 9732/3 [plasma cell myeloma] when there is a clinical diagnosis of multiple myeloma and/or there is no documentation of a bone marrow biopsy or the results are unknown. This patient did have a bone marrow biopsy that indicates there are an increased plasma cells present; plasma cells represent less than 10%. The skeletal survey and bone scan did not reveal any further lesions.

Is this progression of disease because there is only one lesion in the right hip 8 months after the diagnosis of plasmacytoma? Or is this a second primary based on the right hip biopsy that showed plasma cell myeloma and the physician's documentation of disease progression? Plasmacytomas are usually single lesions. Would this disease process have multiple lesions if they are diagnosed at different times?

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

This case is accessioned as two primaries: Plasmacytoma diagnosed in 2010 and plasma cell myeloma diagnosed in 2011 per Rule M10. The patient has a diagnosis of a solitary plasmacytoma (chronic neoplasm) followed by a diagnosis of plasma cell myeloma (acute neoplasm) diagnosed greater than 21 days later.

The physician is calling this a progression to plasma cell myeloma even though the bone marrow has less than 10% plasma cells, take this statement as progression or a clinical diagnosis of plasma cell myeloma.

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.

 2013
20130136 Multiple primaries--Heme & Lymphoid Neoplasms: If a neoplasm is listed under the Transformations section in the Heme DB, is this always a new primary? See Discussion.

Where are the instructions for coding transformations? When a disease is listed under the transformations, the Multiple Primaries Calculator states it is a new primary. Is this a new primary when the physician calls it a transformation?

For example, patient was diagnosed in 2000 with chronic lymphocytic leukemia (CLL). A biopsy of a stomach mass on 4/26/12 was positive for diffuse large B-cell lymphoma. DLBCL is listed under the Transformations To section in the Heme DB for CLL. Is this a new primary because it is a transformation?

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

Transformations do not always indicate a multiple primary is to be reported. Always apply the M Rules to determine the number of primaries. Refer to Rules M8-M13 in the Heme Manual address to determine the number of reportable primaries when chronic and acute neoplasms (transformations) are indicated on a case. Do not use the MP Calculator to determine the number of primaries unless the M Rules direct you to use it.

This case should be accessioned as two primaries, chronic lymphocytic leukemia [9823/3] diagnosed in 2000, and diffuse large B-cell lymphoma [9680/3] diagnosed on 04/26/2012 per Rule M10. Abstract a new primary when a neoplasm is originally diagnosed as a chronic (less aggressive) neoplasm (CLL) and there is a second diagnosis of an acute neoplasm (DLBCL) more than 21 days later.

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.

2013
20130165 MP/H Rules/Multiple primaries--Thyroid: How many primaries are reported and what is histology for the papillary carcinomas if a Classical cytomorphology with a follicular architecture is on the right and a Columnar cell cytomorphology with a follicular and papillary architecture is on the left? See Discussion.

  • Dominant Tumor: Tumor

  • Laterality: Right lobe

  • Tumor Size: Greatest dimension: 9 cm

  • Histologic Type: Papillary carcinoma

  • Variant, specify: Classical

  • Architecture: Follicular

  • Cytomorphology: Classical

  • Tumor Size: Greatest dimension: 6 cm

  • Histologic Type: Papillary carcinoma

  • Variant, specify: Columnar cell

  • Architecture: Solid, follicular, and papillary

  • Cytomorphology: Columnar cell

    • The answer seems to hinge on whether or not the two tumors differ at the third digit of histology. Can we code the histology based on the terms listed for variant or architecture?

    		This is a single thyroid primary. The tumors are both papillary carcinoma with follicular architecture for the most part. Apply Rule M6 and abstract a single primary. 2013
    		20130073

    Reportability--Brain and CNS: Is Rosai-Dorfman disease a neoplastic reportable disease process if it occurs in the brain? See Discussion.

    The pathology report diagnosis is: Cranium, right temporal area, resection of intradural, extra-axial mass: Severe acute and chronic inflammation, histiocytic reaction, and proliferative fibrosis. See comment.

    Comment: Among potential alternative considerations are an infectious process, or non-infectious inflammatory CNS lesions such as inflammatory pseudotumor, Rosai-Dorfman disease, plasma cell granuloma, idiopathic hypertrophic pachymeningitis, and inflammatory myofibroblastic tumor.

    The clinicians discuss this and review other chart information and conclude the patient has a clinical diagnosis of Rosai-Dorfman disease.

    This is a rare disorder characterized by proliferation of histiocytes.

    This case is not reportable. Rosai-Dorfman disease is not listed in the ICD-O-3. To be reportable, a neoplasm must be listed in the ICD-O-3 and originate in a reportable brain/CNS site.

    		 2013
    		20130192 MP/H Rules/Histology--Pleura: How is histology coded when the pathology report final diagnosis is "malignant neoplasm, compatible with malignant mesothelioma" if the COMMENT section of the pathology report indicates the tumor has a mixed epithelial and sarcomatoid pattern? See Discussion. This case was discussed with a pathologist who feels the correct histology should be biphasic mesothelioma (9053/3) because there are both epithelial and sarcomatoid components to this tumor. However, applying the current MP/H Rules, the histology is coded to 9050/3 (mesothelioma, NOS) because the term "pattern" cannot be used to code a more specific histologic type for invasive tumors. If this truly is a biphasic mesothelioma, that data is lost for researchers because the current MP/H Rules fail to capture this information. Should the term pattern be used to code the more specific histology in this case? Code the histology to malignant mesothelioma, NOS [9050/3]. Apply the MP/H Rules as written until they are revised. The word "pattern" and other terms will be reconsidered for the next iteration of the rules. 2013
    		20130111 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2008 diagnosis of extralymphatic follicular lymphoma in the breast is subsequently diagnosed in 2011 with ocular follicular lymphoma? See Discussion.

    The patient was diagnosed with follicular lymphoma in the breast in 2008. Per notes, there was no evidence of disease again until 2011 when the patient presented with ocular lymphoma. The physician stated this was part of the same disease process as the prior breast diagnosis. The bone marrow was not involved in either case.

    Is this a single primary (recurrence) of follicular lymphoma? Or are these multiple primaries because they arise in different extralymphatic sites?

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

    Accession a single primary, follicular lymphoma [9690/3] of the breast diagnosed in 2008 per Rule M2.

    Accession a single primary when there is a single histology. This is a recurrence of the patient's 2008 follicular lymphoma.

    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.

    		2013
    		20130084 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed on a 3/16/12 lymph node biopsy with diffuse large B-cell lymphoma which was followed on 4/18/12 with bone marrow biopsy diagnosis of follicular lymphoma? See Discussion. The patient has extensive right-sided cervical, supraclavicular, hilar, mediastinal and gastrohepatic adenopathy. A cervical node biopsy on 3/16/2012 showed DLBCL. On 04/18/2012 a bone marrow biopsy showed follicular lymphoma. The patient was started on CHOP/Rituxan after the bone marrow biopsy.

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

    This case is accessioned as a single primary, diffuse large B-cell lymphoma [9680/3] per Rule M12. Abstract the acute neoplasm (DLBCL) when a patient is originally diagnosed with an acute neoplasm and the neoplasm reverts to the chronic neoplasm (follicular lymphoma) AND the patient has not been treated for the acute neoplasm.

    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.

    		2013