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Report Produced: 02/11/2026 11:39 AM

Report Question ID Question Discussion Answer Year
20130180 Histology--Pancreas: What is the difference between pancreatic endocrine neoplasm (PanNETs) [8240/3] and the new ICD-O-3 terms pancreatic endocrine tumor, benign [8150/0] and pancreatic endocrine tumor, malignant [8150/3]? See Discussion. SEER Inquiry 20120035 discusses the reportability of pancreatic endocrine neoplasm (PanNETs) tumors.

The difference is that 8150 is for islet cell tumors. The preferred name was changed by WHO/IARC to reflect the current language used by pathologists to describe islet cell tumors [8150].

The 8240 histology code added the neuroendocrine tumor, grade 1, low or well differentiated terms to the carcinoid ICD-O name.

Islet cell tumors are more aggressive than the pancreatic NET tumors. Treatment and prognosis are determined by the histologic type. While the histology code 8150 is not new, the histology name has been updated.

2013
20130027

Reportability--Are well-differentiated neuroendocrine tumors and grade 1 neuroendocrine tumors of the appendix now reportable? See Discussion.

The terminology for carcinoid tumors has changed. The current terminology used is "neuroendocrine tumor." Are well-differentiated neuroendocrine tumors of the appendix non-reportable because carcinoid, NOS of the appendix has a borderline behavior code [8240/1]? When the histology/behavior codes for the term "well-differentiated neuroendocrine tumor" became 8240/3, did SEER intend this change to also apply to appendix primaries? If so, for which diagnosis year did this change go into effect?

Well-differentiated neuroendocrine tumors and grade 1 neuroendocrine tumors of the appendix are reportable because these tumors have a morphology code 8240/3 per the WHO Classification of Tumors of the Digestive System. However, per the ICD-O-3, carcinoid tumors of the appendix have a behavior code of /1 [borderline].

The terminology of neuroendocrine tumors is evolving and current thinking at the international level is that carcinoid/WD NET of appendix is reportable. However, reportability in the United States is based on ICD-O-3. The histology code for "Carcinoid of appendix" is 8240/1; the histology code for a carcinoids of all other primary sites is 8240/3. Until the United States adopts the proposed changes for ICD-O-3, reportability of appendix cases is as follows:

  • Carcinoid
  • Well-differentiated neuroendocrine tumor
  • Grade 1 neuroendocrine tumor
  • Well-differentiated neuroendocrine tumor/carcinoid (Pathologist uses both terms in reporting the diagnosis and does not want to choose one diagnosis over the other.)
 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
20130202 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013? See Discussion.

In the Heme Manual it indicates one is to abstract a second primary when a solitary plasmacytoma (chronic) is followed by a plasma cell myeloma (acute) greater than 21 days after the chronic diagnosis.

The Heme Manual does not indicate what to do when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013. The physician specifically stated the patient does not have multiple myeloma. Is this case one or two primaries?

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

Per Rule M2, this is a single primary. According to Rule M2, the single histology is always the single primary.

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
20130077 Reportability--Heme & Lymphoid Neoplasm: What is the histology code if a myeloproliferative disorder is reportable should a physician suspect this diagnosis and treats the patient? See Discussion. Physician suspects patient has a myeloproliferative disorder and treats her with a phlebotomy and Hydrea. Patient receives Hydrea during an inpatient stay, but does not see the Heme/Onc again. The patient is subsequently only seen by a Palliative Medicine physician who also states she has an underlying myeloproliferative disorder. The patient died while an inpatient.

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

This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].

The term is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4). Also, the patient was treated for a myeloproliferative disorder, making this a reportable clinical diagnosis per the SEER Manual (Reportability, Pg 4, Exception 1).

Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.

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
20130100

Multiple primaries/Primary site--Heme & Lymphoid Neoplasms: How many primaries are there and how should I code the primary site(s)? See discussion.

Patient had a hemicolectomy and a salpingo-oophorectomy and was found to have diffuse large B cell lymphoma in the colon (10 cm cecal mass), 3/16 regional lymph nodes involved with lymphoma. Fallopian tube showed involvement with diffuse large B Cell lymphoma.

Multiple primaries - Colon and fallopian tube?

One primary - Colon? Stage IV, or lymphoma from an unknown primary? Note: There were no other lymph nodes involved.

Use Rule M2. Abstract as a single primary when there is a single histology.

When you have questions about how to code the primary site, start with the abstractor notes. If the answer isn't found there go to Module 7 (a specific module to help code primary site for lymphomas).

The abstractor notes for DLBCL in this case do not provide information you can use for this case. Go to Module 7 in the PH rules.

Use Rule PH25 Code the primary site to the organ when lymphoma is present in an organ and that organ’s regional lymph nodes. Code the primary site to colon (organ and regional lymph nodes involved). The fallopian tube is secondary involvement. As is common with lymphomas, there can be more than one organ involved. You can differentiate the primary site from the secondary site(s) because of the large colon mass with regional lymph node involvement.

2013
20130010 MP/H Rules/Histology--Skin: How is the histology coded for "infiltrative carcinoma with ductal alterations compatible with squamoid eccrine ductal carcinoma" of the skin?

Code the histology to 8413/3 [eccrine adenocarcinoma]. This is the most specific code available for this diagnosis.

According to our expert pathologist advisor, "The adnexal glands in the skin, sweat (eccrine) glands and apocrine glands, all have ducts which connect the business portion of each gland to the skin surface. Some of the adnexal tumors have features of differentiation which appear to be duct-like, hence the designation 'ductal.'"

In addition, "The 'squamoid' simply indicates some degree of squamous differentiation, but doesn't alter the usefulness of [code 8413/3] because we have no way of coding anything more specific in this case anyway."

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
20130194

Reportability--Brain and CNS: Are blood vessel tumors arising in CNS sites reportable? See Discussion.

Previous instructions from the CDC (Cancer - Collection and Coding Clarification for CNS Tumors - NPCR) stated that non-malignant blood vessel tumors in CNS sites are reportable and should be coded to the CNS site in which they arose. SINQ 20081113 also states that a blood vessel tumor, cavernoma/cavernous hemangioma, in the brain is reportable. However, SINQ 20120034 contradicts this previous answer stating the site should be coded to C490 [blood vessel] for a blood vessel tumor (venous angioma) in the brain.

If blood vessel tumors arising in a CNS site are no longer reportable, please specify the site/histology codes for these non-reportable tumors and when this change took place.

Vascular tumors of the CNS are reportable when they arise in the dura or parenchyma of the CNS and should be coded accordingly. The instructions in the CDC book regarding primary site coding are not the most current instructions.SEER assumed responsibility for brain and CNS reporting instructions in 2007.

The tumor in SINQ 20120034 is not reportable because it arises in a blood vessel. The cavernous hemangioma in SINQ 20081113 is reportable because the primary site is the white matter of the cerebral cortex.

 2013