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Report Produced: 07/23/2025 13:01 PM

Report Question ID Question Discussion Answer Year
20130185

Reportability/Behavior: Is HGSIL (high grade squamous intraepithelial lesion) of the vulva or vagina reportable and is it a synonym for histology code 8077/2 [squamous intraepithelial neoplasia, grade III]?

For cases diagnosed 2018 and later

HGSIL of the vulva or vagina is reportable. HGSIL is a synonym for squamous intraepithelial neoplasia, grade III.

 2013
20130181 Multiple Primaries--Heme & Lymphoid Neoplasms: Should Rule M4 or the Heme DB be used to determine whether diffuse large B-cell lymphoma of the large intestine and peripheral T-cell lymphoma of the bone marrow represents one or two primaries? See Discussion.

The Heme DB identifies these as new primaries:

10/12/12 Large intestine, biopsy: Diffuse large B-cell lymphoma.

10/12/12 Bone marrow biopsy: Peripheral T-cell lymphoma.

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

Per Rule M15, accession two primaries. According to Rule M15, use the multiple primaries calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14. Per the calculator, this scenario represents two primaries.

Assuming the only area of involvement is the large intestine, code the histology to 9680/3 [diffuse Large B-Cell Lymphoma] and per Rule PH24 code the primary site to C189 [colon, NOS]. According to PH24, one is to code the primary site to the organ when lymphoma is present only in an organ.

Rule PH26 applies to the second primary. Assuming the only area of involvement is the bone marrow, code the histology to 9702/3 [peripheral T-cell lymphoma] and code the primary site to C421 [bone marrow]. According to PH26, one is to code the primary site to bone marrow (C421) when lymphoma is present only in the bone marrow.

Rule M4 does not apply for this case. Rule M4 applied when you have two or more types of non-Hodgkin lymphoma in the same anatomic location. That is not the case in this scenario.

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
20130007

MP/H Rules/Histology--Colon: What rule applies and how is histology coded if a colon tumor is composed of moderately differentiated adenocarcinoma and neuroendocrine tumor, grade 1 (G1)? See Discussion.

Intestine, large -- moderately differentiated adenocarcinoma

Pathological stage: IIIA (T2 N1a Mx) -- Neuroendocrine tumor, G1

Addendum comment: The results of the immunochemical study are compatible with a neuroendocrine tumor, G1.

For cases diagnosed 2007 or later, the correct histology code is 8244/3 [composite carcinoid]. The steps used to arrive at this decision are:

Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Colon Histology rules because site specific rules have been developed for this primary.

Step 2: Start at the SINGLE TUMOR module, rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H9. Code the histology as 8244/3 [composite carcinoid] when the diagnosis is adenocarcinoma and carcinoid tumor.

Neuroendocrine tumor, grade 1 (G1) is synonymous with carcinoid tumor [8240/3] for the purpose of rule H9.

2013
20130204 MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tubulocystic renal cell carcinoma? See Discussion. Per the resected specimen final diagnosis COMMENT in the pathology report: Tubulocystic renal cell carcinoma is a relatively new renal epithelial neoplasm that has been added to an updated WHO classification of renal tumors. (Srigley et al. The International Society of Urologic Pathology Vancouver Classification of Renal Neoplasia Am J Surg Pathol. 2013;37:1469-1489). The majority of tubulocystic renal cell carcinomas reported in the literature (greater than 90%) have behaved in an indolent manner. Code the histology to 8312/3 [renal cell carcinoma, NOS] per Rule H3. The term "tubulocystic" is not a specific renal cell histology according to our kidney pathology expert. 2013
20130127 Reportability--Heme & Lymphoid Neoplasms: When did smoldering myeloma become reportable?

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

Smoldering multiple myeloma [9732/3] has always been a reportable neoplasm. Per the Abstractor Notes section in the Heme, smoldering multiple myeloma is a variant of multiple myeloma in which the diagnostic requirements for multiple myeloma are met, but there is no organ damage. The patient is usually asymptomatic.

Smoldering myeloma is listed under the Alternate Names section in the Heme DB for multiple myeloma [9732/3] to clarify that it is a reportable neoplasm.

Report all new diagnoses of smoldering multiple myeloma now. Registries are not required to spend time and effort to find these cases if they have not been reporting them in the past. However, report earlier earlier cases if encountered today while performing casefinding or chart review procedures.

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
20130128 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient has a history of chronic myelomonocytic leukemia and a 12/08/2011 subsequent biopsy of the left leg that confirms leukemia cutis? See Discussion. Patient with a history of chronic myelomonocytic leukemia has been undergoing treatment with Dacogen for three years. On 12/8/11 the patient had a biopsy of the left leg that confirmed a diagnosis of leukemia cutis. How is the leukemia cutis coded?

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

Accession a single primary, chronic myelomonocytic leukemia [9945/3], per Rule M2. Accession a single primary when there is a single histology.

This is not a new primary. Leukemia cutis is the infiltration of neoplastic leukocytes into the skin from the existing leukemia. This is an advanced phase of the leukemia and has a poor prognosis.

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
20130148 Reportability--Brain and CNS: Are "spinal" schwannomas reportable if stated to be extradural, vertebral nerve sheath, or of specific vertebrae? See Discussion.

Are any of the following cases reportable?

Example 1: Clinical Diagnosis: Extradural spinal cord tumor compatible with schwannoma. What assumptions should be made about reportability if the tumor is described as being extradural? The extradural spinal cord includes epidural fat surrounding the thecal sac and exiting nerve roots. Does this mean there are not nerve roots in the extradural spinal cord?

Example 2: Final Pathologic Diagnosis: Designated "C3-4 nerve sheath tumor" excision: Morphologic and immunohistochemical findings consistent with cellular schwannoma. When stated to be a "nerve sheath tumor" does that mean peripheral nerve (C47_) involvement or nerve root (C72_) involvement?

Example 3: Final Pathologic Diagnosis: T-8 vertebral tumor resection: Schwannoma with degenerative changes (calcification, cyst formation) - ganglion and nerve are identified. There is no mention clinically or pathologically whether this tumor is "intradural" or "of the nerve root." In the absence of information about whether the location of the tumor is intradural or involving the nerve root, is it assumed that it does involve this part of the spinal cord when a specific vertebrae is removed?

Extradural schwannomas are not reportable. Neither vertebral nerve sheath nor a location of/on a specific vertebrae confirm the origin as being either extradural or intradural. Do not report a schwannoma if it cannot be determined to be "intradural" or "of the nerve root." 2013
20130037 Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a "cutaneous diffuse large B-cell lymphoma, leg type" that has been verified as a valid diagnosis with prognostic factors including age and number of lesions on the legs?

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

Code this histology to 9680/3 [diffuse large B-cell lymphoma]. Primary cutaneous DLBCL, leg type, is listed as an Alternate Name for DLBCL per the Heme DB.

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
20130116 Histology/Primary site--Heme & Lymphoid Neoplasms: How are the histology and primary site coded if a pleurocentesis is compatible with plasmablastic plasmacytoma/lymphoma when no further information is available?

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

Code the histology to 9735/3 [plasmablastic lymphoma] and the primary site to C809 [unknown] per Rule PH27.

Code the histology specified when the only histology for the case is preceded by ambiguous terminology. For this case, code the histology to plasmablastic lymphoma because it is the only histology mentioned in the diagnosis.

Per the Heme DB Abstractor Notes section for plasmablastic lymphoma, most patients present with Stage III-IV disease. The positive pleural fluid is likely due to advanced disease. In the absence of any other information for this case, Rule PH27 applies, "Code 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."

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
20130105

Primary Site--Heme & Lymphoid Neoplasms: How is the primary site coded for a B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma when a biopsy of the paraspinal muscle and epidural tissue is positive, but there is no indication of lymph node involvement in the chart?

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

Code the primary site to soft tissue of the back, NOS [C496] per Rule PH24 and the Abstractor Notes in the Heme DB for B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma.

Code the primary site to the organ when lymphoma is present only in an organ. The lesion is described as epidural (tissue surrounding the dura) and involving paraspinal muscle, NOS. Both are connective or other soft tissues of the trunk, NOS [C496].

B-cell lymphoma intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is a synonym for DLBCL 9680/3. When there is no primary site listed in the Heme DB, go to the Abstractor Notes. In the Abstractor Notes section it states that patients present with lymphadenopathy OR mass lesions in extranodal sites.

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