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Report Produced: 02/24/2026 10:38 AM

Report Question ID Question Discussion Answer Year
20130182 Primary site--Head and Neck: How is primary site coded if a floor of mouth biopsy reveals microinvasive squamous cell carcinoma but the definitive resection of the tongue and floor of mouth unifocal lesion reveals only in situ squamous cell cancer? See Discussion.

Patient with overlapping lesion of tongue and floor of mouth. Initial biopsy of floor of mouth reveals microinvasive squamous cell cancer. Definitive resection reveals in situ squamous cell cancer. Pathology report states unifocal tumor. The tumor site on pathology report is documented as involving the tongue and floor of mouth.

Should the primary site be coded to floor of mouth because it is the site of invasive disease? Or is primary site C148 [overlapping sites of lip, oral cavity and pharynx] because invasion should not be used to determine primary site?

Code the primary site to C068 [overlapping lesion of other and unspecified parts of the mouth]. Based on the information provided, this is a tumor described as a "book-leaf" lesion a lesion that overlaps the floor of the mouth and the underside of the tongue. 2013
20130052 Histology--Heme & Lymphoid Neoplasms: How is the histology coded if a biopsy final diagnosis is diffuse large B-cell lymphoma but the physician's final diagnosis favored anaplastic large cell lymphoma? See Discussion. Patient has diffuse intrathoracic, intraabdominal and pelvic lymphadenopathy. An inguinal lymph node biopsy showed diffuse large B-cell lymphoma. The physician's final diagnosis favored anaplastic large cell lymphoma, but wanted to confirm this with FISH. The patient clinically deteriorated so the FISH studies were not done. Which histology is coded?

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

The histology should be coded as diffuse large B-cell lymphoma [9680/3]. The biopsy pathology report definitively diagnosed DLBCL. The physician's diagnosis cannot be used because it is an ambiguous diagnosis only, "favored anaplastic large cell lymphoma." "Favor" is an ambiguous term.

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
20130146 Histology--Heme & Lymphoid Neoplasms: What is the histology code for a diagnosis of myeloproliferative neoplasm/myelodysplastic syndrome overlap?

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

Code the histology to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable]. Per the Definition section in the Heme DB, this neoplasm has the, "Clinical laboratory and morphological features of myeloproliferative neoplasm but fails to meet the criteria for a specific myeloproliferative neoplasm; or presents with features that overlap two or more MPN neoplasms."

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
20130184

Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable?

For cases diagnosed prior to 1/1/2022

A low-grade appendiceal mucinous neoplasm (LAMN) is not reportable. The WHO classification designates LAMN with the behavior code /1 [uncertain whether benign or malignant].

 2013
20130209

Multiple primaries--Heme & Lymphoid Neoplasms: Is a new bone marrow diagnosis of acute myelogenous leukemia that follows a 2007 treated diagnosis of a JAK-2 positive polycythemia vera a new primary?

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

Per Rule M10, abstract two primaries. Per the Heme DB, polycythemia vera [9950/3] transforms to an acute myelogenous leukemia [9861/3]. According to Rule M10, one is to abstract multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (e.g., polycythemia vera) AND there is a second diagnosis of an acute neoplasm (e.g., acute myelogenous leukemia) more than 21 days after the chronic 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.

 2013
20130149 MP/H Rules/Histology--Testis: What is the histology code for a testis primary with embryonal carcinoma (70%), yolk sac tumor (30%), and a focus of seminoma (<1%)? See Discussion.

The right orchiectomy specimen showed a mixed histology tumor. The retroperitoneal lymph nodes showed teratoma, NOS only. Does the presence of teratoma in the lymph nodes change the histology coding?

The MP/H Rules for Other Sites, Table 2 (Mixed and Combination Codes) does not include the combination of embryonal carcinoma, yolk sac tumor and seminoma. SINQ 20110013 does state the combination of embryonal carcinoma and yolk sac tumor should be coded to histology 9065/3 [germ cell tumor, nonseminomatous]. In this case, is the focus of seminoma comprising <1% included when coding the histology? If the seminoma is included, Table 2 still does not address this combination.

Code the histology to mixed germ cell tumor [9085/3] per Rule H16; code the appropriate combination/mixed code when there are multiple specific histologies.

According to the WHO Classification of Tumors of the Male Genital Organs, tumors of more than one histologic type (mixed forms) can occur in any combination of various germ cell histologies including embryonal, yolk sac, teratoma, and choriocarcinoma. Mixed teratoma and seminoma is included under histology code 9085/3 [mixed germ cell tumor] in the ICD-O-3. The revised MP/H rules will expand on these mixed testicular histologies.

Priority for coding histology is using the diagnosis from the primary site (when possible) over the histology from a metastatic site. The presence of teratoma, NOS in the retroperitoneal lymph nodes does not change the histology code.

2013
20130186

Grade: Can the FIGO grade be used to code the morphologic grade? See discussion.

FIGO Grade is coded in CS SSF 7 in the Corpus Uteri schema. The SEER Manual does not address using FIGO grade for coding grade in morphology.

Do not use FIGO grade to code the grade field. See the sentence below the table in Instruction #6 in the Grade Coding Instructions for cases diagnosed 2014 and later, http://seer.cancer.gov/tools/grade/

2013
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
20130215

Reportability--Heme & Lymphoid Neoplasms: Is hemophagocytic lymphohistiocytosis synonymous with an EBV-associated lymphoproliferative disorder in children reportable? See Discussion.

Pathology report states: Prominent T-cell infiltrate with frequent immunoblast-like cells. COMMENT: Findings consistent with an acute EBV-associated hemophagocytic process. In addition, there is a prominent CD8 + T-cell infiltrate with many large, activated forms. This T-cell process may represent an EBV-associated lymphoproliferative disorder in children.

EBV-associated lymphoproliferative disorder in children is listed in the Heme database. However, throughout multiple admissions, the oncologist states the diagnosis as "hemophagocytic lymphohistiocytosis". Are the two the same condition?

The patient is being treated with Etoposide.

Per Appendix F, do not report this case based on the information provided.

The oncologist likely used the pathology report and clinical factors to determine the diagnosis of hemophagocytic lymphohistiocytosis, which is not reportable. Hemophagocytic lymphohistiocytosis is caused by an over stimulated immune system (infection, etc.). This clinical syndrome is associated with a variety of underlying conditions. To be reportable, it must state "fulminant hemophagocytic syndrome" (in a child) to be reportable (9724/3).

The pathology report for this case is not definitive. It states that the process "may" represent the EBV-associated lymphoproliferative disorder in children.

Follow back on this case to confirm reportability if possible.

 2013
20130030

Histology--Heme & Lymphoid Neoplasms: How is histology coded for a patient diagnosed with diffuse large B-cell lymphoma, immunoblastic [9684/3] in 2009 and a recurrence in 2010 at another facility was referred to as plasmablastic lymphoma [9735/3]? See Discussion.

Which code is correct for the merged record? Is code 9735/3 [plasmablastic lymphoma] correct because code 9684/3 [DLBCL, immunoblastic] is now obsolete?

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

This case was originally diagnosed in 2009, prior to the development of Hematopoietic Database. Therefore it is necessary to use the ICD-O-3 to code histology to 9684/3 [diffuse large B-cell lymphoma, immunoblastic]. Use the original histology diagnosed for the merged record because DLBCL, immunoblastic, and plasmablastic lymphoma are the same primary. Do not change the histology to code 9735/3 [plasmablastic 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