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Report Produced: 02/15/2026 01:50 AM

Report Question ID Question Discussion Answer Year
20130195 Laterality--Heme & Lymphoid Neoplasms: Is laterality coded to 0 [not paired] for all lymphoma cases including paired sites (e.g., breast, lung)?

Laterality coding for lymphomas is based on the primary site not histology. Laterality describes the side of a paired organ or side of the body on which the reportable tumor originated. Determine whether laterality should be coded for each primary.

Laterality coding instructions are located in the SEER Program Coding and Staging Manual. See pages 68-70 in the 2013 manual,

http://www.seer.cancer.gov/manuals/2013/SPCSM_2013_maindoc.pdf.

 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
20130150

MP/H Rules/Histology--Bladder: What is the histology code histology code for a bladder TUR that demonstrates mixed invasive urothelial and small cell carcinoma? See Discussion.

SINQ 20041104 (prior to 2007 MP/H rules) states to code histology to 8045. The MP/H rules do not address this combination of urothelial and small cell carcinoma. The current MP/H rule that applies is Rule H8, code the higher histology (8120/3). However, if the histology is coded to 8120/3, the fact that small cell carcinoma exists will be lost. If the small cell carcinoma drives the treatment plan/prognosis, shouldn't this situation be reflected in the rules for coding histology?

Code the histology to 8045/3 [mixed small cell carcinoma]. The presence of small cell carcinoma drives the treatment decisions for this case.

This issue will be addressed in the next revision of the MP/H rules.

2013
20130089 MP/H Rules/Histology--Breast: How is the histology coded when a pre-treatment core biopsy showed ductal carcinoma, but the mastectomy specimen following neoadjuvant chemotherapy showed lobular carcinoma? See Discussion. 11/06/2012 Ultrasound-guided biopsy of the left breast and left axilla showed invasive ductal carcinoma. The patient underwent 6 months of chemotherapy. In 05/2013 the patient underwent a mastectomy that showed invasive lobular cancer, pleomorphic type, with 11 axillary lymph nodes negative.

The histology is coded to lobular carcinoma, NOS [8520/3] because the mastectomy (the most representative specimen) showed only lobular carcinoma.

The MP/H Rules state to code the histology from the most representative tumor specimen examined. Although this patient underwent neoadjuvant treatment, there is no indication that the ultrasound-guided biopsy contained more tumor than the mastectomy. The mastectomy is the most representative specimen and should be used to code the histology.

2013
20130044 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient has a biopsy diagnosis of extraosseous plasmacytoma followed fourteen days later with a diagnosis of multiple myeloma on imaging? See Discussion.

On 2/3/12 the patient was diagnosed via biopsy with an extraosseous (extramedullary) plasmacytoma filling both nasal cavities. On 2/16/12 a metastatic workup was performed and showed a lucent lesion in calvarium of Rt frontal bone. 2/17/12 radiation oncology consult states, "I believe this is most likely consistent with multiple myeloma." Subsequently, the 3/1/12 CT of the left shoulder showed a 3.6 cm lytic lesion of humeral head with cortical breakthrough consistent with metastasis or myeloma.

Per the Heme DB, extramedullary plasmacytoma can transform to multiple myeloma. Does that make this multiple primaries with the histologies coded to 9734/3 and 9732/3?

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

This case should be accessioned as a single primary, multiple myeloma [9732/3] diagnosed on 2/3/12 per Rule M8. Abstract the acute neoplasm as a single primary when both a chronic and acute neoplasm are diagnosed simultaneously or within 21 days AND there is documentation of only one positive tissue biopsy.

This patient only had a tissue biopsy of the nasal cavity proving the chronic neoplasm (extraosseous plasmacytoma). The acute neoplasm (multiple myeloma) was diagnosed clinically based on the scans.

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
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
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
20130197 MP/H Rules/Histology--Urinary System: What is the histology code for a 2007 and later diagnosis of papillary carcinoma of the urinary system organs? See Discussion.

Will histology code 8050 [papillary carcinoma, NOS] be used for cases diagnosed 2007 and later? The MP/H Rule H4 for urinary primaries states to code papillary carcinoma to code 8130, but Rule M6 includes tumors coded to 8050.

The IARC publication Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs uses code 8130 only for papillary carcinoma.

Code the histology to 8130 [papillary transitional cell carcinoma] for cases of papillary carcinoma of the urinary system diagnosed 2007 and later.

Histology code 8050 [papillary carcinoma, NOS] should not be used for papillary carcinoma of the urinary system diagnosed starting in 2007. Rule M6 includes this histology to take pre-2007 cases into consideration.

2013
20130020 Reportability--Heme & Lymphoid Neoplasms: Is aplastic anemia reportable and is it an alternate name for refractory anemia?

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

Aplastic anemia is not reportable and it is not an alternative name for refractory anemia.

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
20130206 Primary site--Heme & Lymphoid Neoplasms: What rule applies to code a primary site for a peripheral blood diagnosis of marginal zone lymphoma that has a positive flow cytometry/FISH analysis when no biopsies are performed, scans show no evidence of disease, exam indicates no lymph nodes are palpable and the physician's clinical diagnosis "marginal zone lymphoma, unspecified site, stage 1"? See Discussion.

PE: No palpable lymph nodes.

PET scan: No spleen or lymph node uptake; no uptake anywhere in the body.

Peripheral blood and flow cytometry/FISH analysis diagnosis: Marginal zone lymphoma.

No bone marrow or biopsy of any lymph nodes done. Doctor states "marginal zone lymphoma, unspecified site, stage 1."

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

Per Rule PH27, code the primary site to C809 [unknown primary]. According to Rule PH27 one is to code the primary site to unknown primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR multiple organ involvement without any nodal involvement.

If further workup is done and a primary site is determined, update the primary site for this case.

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