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Report Produced: 02/14/2026 03:50 AM

Report Question ID Question Discussion Answer Year
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
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
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
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
20130220 Reportability--Thyroid: Is a hyalinizing trabecular neoplasm of the thyroid reportable? See Discussion. The pathology comment states: Hyalinizing trabecular neoplasm is considered by some to represent a variant of papillary thyroid carcinoma because of the similar nuclear cytology, immunoprofile and RET-oncogene rearrangements.

Hyalinizing trabecular neoplasm is not reportable.

Hyalinizing trabecular neoplasm, or hyalinizing trabecular tumor, is a synonym for hyalinizing trabecular adenoma [8336/0] in the ICD-O-3. The 2004 WHO classification states that "fine needle aspiration biopsy is often interpreted as papillary carcinoma because of the nuclear features in the tumor."

2013
20130160 Histology--Heme & Lymphoid Neoplasms: Should the histology be coded to a therapy-related myeloid neoplasm when the physician states the diagnosis of acute myeloid leukemia is secondary to treatment with Imuran? See Discussion.

Patient has a diagnosis of AML for which the physician recommends a bone marrow transplant. The physician indicated the diagnosis is actually a secondary AML due to treatment with Imuran for polymyalgia rheumatica. The physician also stated this is a high risk type of AML.

Imuran is not a chemotherapy agent per SEER*Rx. Can the histology be coded as 9920/3 (e.g., Therapy-related acute myeloid leukemia, NOS) when the patient has not been treated with chemotherapy for a reportable disease? The physician is a bone marrow transplant expert who states the AML is therapy-related disease. Bone marrow disease is a listed as a risk for treatment with Imuran.

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

Code this histology to 9920/3 [therapy-related myeloid neoplasm] when the physician states the acute myeloid leukemia is therapy-related.

Therapy-related AML can result from any systemic therapy for benign or malignant diseases. In this case, AML resulted from immune system-suppressing therapy with Imuran for a benign disease, polymyalgia rheumatica. The drugs that induced the AML do not have to be listed in the SEER*Rx database.

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
20130207 Multiple primaries--Heme & Lymphoid Neoplasms: Is a new primary reported for the diagnosis of plasmacytoma associated with a pathological fracture if it follows a diagnosis five years ago of multiple myeloma? See Discussion.

Multiple myeloma was diagnosed more than 5 years prior to admission. The patient underwent multimodality treatment.

Currently, the patient suffered a fracture. The pathology report diagnosis was "plasmacytoma." The discharge summary states, "multiple myeloma advanced with multiple lytic lesions".

Does this scenario represent a single primary dating back to the original diagnosis? Or does the diagnosis of plasmacytoma on the recent biopsy indicate a new primary because it was originally diagnosed as acute and reverts to a chronic neoplasm after treatment more than 21 days later?

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

Per the Abstractor Notes section, this case represents a single primary. Histology is coded to 9732/2 [multiple myeloma], which is now advanced.

Review the Abstractor Notes section in the Heme DB for multiple myeloma. It states that in multiple myeloma there is generalize bone marrow involvement. It further states that lytic bone lesions and bone tumor masses of plasma cells (plasmacytomas) are signs of advanced disease. According to the Discharge Summary, this patient had multiple lytic lesions and plasmacytoma which indicates advanced disease.

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
20130054 MP/H Rules/Multiple primaries--Lung: How many primaries are accessioned if a lobectomy has two tumors that are both stated to be adenocarcinoma but the pathologist states they are synchronous primaries? See Discussion.

Left upper lung lobectomy: Adenocarcinoma, poorly-differentiated (grade 3), tumor size 1.2 cm, confined to lung. Second primary lung tumor: adenocarcinoma, well-differentiated (grade 1), tumor size 0.9 cm, confined to lung. Diagnosis COMMENT: The two tumors, although both adenocarcinoma, show markedly different histologies and thus are classified as synchronous primaries. Multiple synchronous primaries are staged separately according to the 7th edition of AJCC.

The AJCC Staging Manual 7th ed states, "Multiple tumors may be considered to be synchronous primaries if they are of different histological cell types. When multiple tumors are of the same cell type, they should only be considered to be synchronous primary tumors if, in the opinion of the pathologist, based on features such as ..., they represent different subtypes of the same histologic cell type..."

In this case, the pathologist insists these are two synchronous primaries, although different subtypes are not given, because the tumors have different grades and look completely different under the microscope. The MP/H rules indicate this is a single primary. How many primaries are accessioned?

For cases diagnosed 2007 or later, accession a single primary, adenocarcinoma [8140/3] of the left upper lobe lung [C341]. The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Lung MP rules because site specific rules exist for this primary.

Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. The patient has two tumors in the same lung with the same histology.

Do not use the AJCC Manual to make multiple primary decisions. Use the MP/H Rules to determine the number of primaries to accession.

2013
20130075

Reportability/Ambiguous terminology--Heme & Lymphoid Neoplasms: Is 'suspicious for an evolving acute leukemia' reportable?

For cases diagnosed 2010 and later

Please see the Hematopoietic database, https://seer.cancer.gov/seertools/hemelymph/

 2013
20130183

Reportability--Heme & Lymphoid Neoplasms: Is a peripheral blood finding consistent with involvement by monoclonal, lambda-restricted mature B cell population with co-expression of CD5 and CD23 reportable if, immunophenotypically, the case is consistent with a chronic lymphocytic leukemia/small lymphocytic lymphoma? See Discussion.

Peripheral blood: Final diagnosis: Leukocytosis absolute lymphocytosis monoclonal, lambda restricted B-cell population w/co-expression of CD5 and CD23 absolute increase in CD4=helper T cells. See comment.

Comment: Peripheral blood findings are consistent with involvement by monoclonal, lambda-restricted mature B cell population with co-expression of CD5 and CD23, which is immunophenotypically consistent with a chronic lymphocytic leukemia/small lymphocytic lymphoma immunophenotype. However, the absolute monoclonal population is only 3.02k/ul.

According to WHO criteria, in the absence of extramedullary tissue involvement, the monoclonal lymphocyte population must be greater than or equal to 5.0 k/ul. Therefore, in the absence of clinical evidence of extramedullary tissue involvement, the diagnosis is most consistent with a monoclonal B cell lymphocytosis. Review of initial analysis reveals well-defined groups of cells within lymphocyte, monocyte and granulocyte gates as defined by CD45 and sid-scatter characteristics (%'s are listed). Overall, peripheral blood findings are consistent with involvement by monoclonal, lambada-restricted B cell population with a chronic lymphocytic leukemia/small lymphocytic lymphoma immunophenotype.

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

This case is reportable. Code histology to 9823/3 [CLL/SLL].

Ambiguous terminology is used to accession cases (determine reportability) because it has been used for over 30 years to do so. Any deviation from using ambiguous terminology to determine case reportability would cause the reporting of incidence counts to vary. In this case, there was a reportable, ambiguous terminology diagnosis on peripheral blood that is "consistent with" involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) immunophenotype.

The ambiguous terminology "consistent with" in the flow cytometry report is acceptable to determine reportability. Given that it is the only reportable histology mentioned in the scenario, it is also used to code histology. The instruction "Do not code histology based on ambiguous terminology" is intended to be used when there is a reportable NOS histology and reportable more specific histology stated in the diagnosis. Ambiguous terminology cannot be used to report the more specific diagnosis in cases of Heme & Lymphoid 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