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Report Produced: 02/14/2026 18:26 PM

Report Question ID Question Discussion Answer Year
20130064 Primary site--Heme & Lymphoid Neoplasms: Are hematopoietic primaries coded to C421 [bone marrow] or C420 [blood]?

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

Refer to the Hematopoietic Database and Manual to determine the primary site.

Leukemias are coded to C421 [bone marrow]. The ONLY neoplasm that is coded to C420 [blood] is Waldenstrom's macroglobulinemia [9761/3].

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
20130200 Primary Site--Heme & Lymphoid Neoplasms: What is the primary site for a diffuse large B-cell lymphoma involving the testicles, stomach, rectum and bone marrow, when no lymph nodes are involved?

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

Per PH27, code the primary site to C809 [unknown]. Rule PH27 states one is to code the primary site to unknown [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 there is 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
20130041 Reportability--Heme & Lymphoid Neoplasms: Is a flow cytometry immunophenotyping of peripheral blood that demonstrates a chronic lymphocytic leukemia (CLL) phenotype reportable as CLL? See Discussion. Final Diagnosis: "Peripheral blood, flow cytometry immunophenotyping: Monoclonal B-cell lymphocytosis with Chronic Lymphocytic Leukemia (CLL) phenotype; Negative for Zap 70; No abnormal T-cell population identified; CD34-positive blasts are not increased.

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

This is reportable. Code the histology to 9823/3 [chronic lymphocytic leukemia (CLL)]. Per Rule PH5, Note 1, CLL will always have peripheral blood involvement. Based on the provided information, this patient's peripheral blood is positive for CLL.

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
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
20130205 MP/H Rules/Multiple primaries--Breast: How many primaries are reported and what is the histology for each in a case of infiltrating duct and lobular carcinoma of the breast (8522) with Paget disease of the same breast? Abstract as two primaries according to rule M12. We interpret this as one tumor with infiltrating duct and lobular carcinoma (8522) and a second tumor with Paget disease (8540). 2013
20130083 Ambiguous terminology/Histology--Heme & Lymphoid Neoplasms: How is the histology coded if an FNA reveals high grade B-cell lymphoma, compatible with diffuse large B-cell lymphoma, and the treating physician states this is diffuse large B-cell lymphoma? See Discussion.

The FNA showed high grade B-cell lymphoma, morphologically compatible with diffuse large B cell lymphoma. Special studies state: Tumor cells are positive for Vimentin, CD45, and CD20, focally weakly positive for CD43; negative for Myeloperoxidase, CD99, AE1/AE3, CK7, CK20, S100, CD3, cyclin D1, CD34, CD5 and TTF1. The cellular findings and immunophenotype are compatible with large B-cell lymphoma.

The treating physician refers to this disease process and is treating the patient for diffuse large B-cell lymphoma. Should the histology be coded as B-cell lymphoma, NOS (9591/3) because both the FNA and the immunophenotyping use ambiguous terminology? Does the physician reference to the disease process as diffuse large B-cell lymphoma, Stage II-AE impact the histology used?

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

Code the histology to diffuse large B-cell lymphoma [9680/3] because the physician states this is a DLBCL and is treating the patient accordingly. Although the pathology report was only compatible with DLBCL, there was a subsequent clinical diagnosis that confirmed a diagnosis of DLBCL. In addition, the patient was treated for DLBCL.

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
20130094 MP/H Rules/Multiple primaries--Lung: How many primaries are accessioned and which M rule applies for a 2010 diagnosis of clear cell adenocarcinoma of the left upper lobe lung followed by a 2012 diagnosis of adenosquamous carcinoma of lung origin without evidence of a primary lung tumor? See Discussion.

Patient was diagnosed with T1 N0 M0 adenocarcinoma with prominent clear cell features [8310/3] in the LUL on 08/05/2010. The patient underwent a lobectomy only.

On 10/09/2012 the patient underwent an iliac bone biopsy showing non-small cell carcinoma with glandular and squamous features [8560/3]. Clinically, the physician is calling this stage IV adenosquamous carcinoma of lung origin involving lymph nodes, spleen and bones. There were no FDG avid pulmonary nodules found. There was no pathologic comparison to the prior lung tumor.

Should the 2012 diagnosis be a new primary because the histology is different from the 2010 diagnosis? Or should this be one primary because there appears to be only metastatic disease with no new primary lung tumor identified in 2012? The choice of one primary seems supported by the fact that the 2012 tumor showed glandular and squamous features, and the 2010 tumor also showed glandular and clear cell (NOS) features. The clear cell could have been a clear cell squamous cell carcinoma. The original tumor was not re-examined.

Accession a single primary, clear cell adenocarcinoma [8310/3] of the left upper lobe lung [C341] diagnosed on 08/05/2010.

The MP/H Rules do not apply to the 2012 diagnosis because only metastatic sites were examined and there was no re-examination of the original 2010 tumor. Therefore, the disease process in 2012 is assumed to be metastatic from the lung primary diagnosed in 2010.

2013
20130191 Systemic/Surgery Sequence--Bladder: How is the systemic treatment/surgery sequence field coded for a 2013 case if the patient has a TURBT followed by multi-agent chemotherapy, and then a cystoprostatectomy followed by post-operative multi-agent chemotherapy? For cases diagnosed in 2012 and later, code 7 (surgery both before and after systemic therapy) seems like the most appropriate answer. However, previous SINQ entries 20091055 and 20071102 have conflicting answers regarding surgery before and after systemic therapy. Do these SINQ entries apply to a 2013 diagnosis? Would the systemic treatment/surgery sequence be coded 7 because this patient had surgery then chemotherapy followed by more surgery? Should the post-operative systemic treatment be ignored in coding the sequence in this case?

Code the Systemic/Surgery Sequence to 7 [surgery both before and after systemic therapy] for this case.

The answers to SINQ 20091055 and 20071102 do not apply to a case diagnosed in 2013. These answers were posted prior to code 7 becoming effective in 2012.

2013
20130123

Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diffuse large B-cell lymphoma, immunoblastic variant involving the left maxillary vestibule and entire left maxilla? See Discussion.

The clinical history indicates a destructive, quickly growing intra-oral lesion in the left soft tissue vestibule and the entire left maxilla.

Pathology report final diagnosis: Oral cavity, left maxilla, incisional biopsy: Malignant lymphoma, non-Hodgkin, diffuse large B-cell type, immunoblastic variant.

Code the primary site to C068 [overlapping lesion of the mouth] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ.

This lesion overlaps the left soft tissue of the maxilla (the maxillary gingiva) [C030] and the left vestibule of the mouth [C061]. There is no documentation indicating in which specific site the lesion arose. The maxilla is the upper jawbone. The soft tissue that overlies the maxilla is a part of the oral cavity. It is reasonable to interpret the documentation such that the tumor in the maxilla is an extension of the overlapping oral mucosa tumor.

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
20130080 Primary site/Histology--Heme & Lymphoid Neoplasms: How are the primary site and histology coded when a right neck mass and spinal mass both show B-cell lymphoma, favor Burkitt lymphoma? See Discussion.

2/5/11 Right neck swelling. Biopsy of mass B-cell lymphoma, favor Burkitt lymphoma.

7/5/11 Hemi-laminectomy, L2-L5 spinal mass: Malignant lymphoma, B-cell phenotype, favor Burkitt lymphoma.

Should the primary site be C779? Is the correct histology Burkitt lymphoma [9687/3] or malignant lymphoma, diffuse large B-cell [9680/3]?

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

Code the primary site to C779 [lymph nodes] per Rule PH22 and the histology to 9591/3 [B-cell lymphoma, NOS].

Code the primary site to C779 [lymph nodes, NOS] when lymphoma is present in an organ and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. The patient has involvement of a lumbar spine mass and cervical lymph nodes. Cervical lymph nodes are not regional to the lumbar area of the spine.

Do not use ambiguous terminology to code histology for hematopoietic neoplasms. "Favor" is ambiguous terminology. Therefore, the histology must be coded to B-cell lymphoma and not to diagnosis which is "favored" (Burkitt lymphoma). Remember that ambiguous terminology is only used to determine case reportability, not to code histology for hematopoietic 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