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Report Produced: 04/16/2026 01:33 AM

Report Question ID Question Discussion Answer Year
20130017

Reportability--Heme & Lymphoid Neoplasms: Is reactive thrombocytosis reportable? See Discussion.

The doctor's impression: "Thrombocytosis, mild without other obvious hematologic difficulty. I would be most suspicious for early iron deficiency related to her prior menometrorrhagia. Would limit initial evaluation to iron studies, review of peripheral smear, and hepatic profile."

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

Reactive thrombocytosis is not reportable and is not an alternative name for essential thrombocythemia [9962/3].

Only the following are listed as alternate names for essential thrombocythemia in the Heme DB:

  • Essential hemorrhagic thrombocythemia

  • Essential thrombocytosis

  • ET

  • Hemorrhagic thrombocythemia

  • Idiopathic hemorrhagic thrombocythemia

  • Idiopathic thrombocythemia

  • Idiopathic thrombocytosis

  • Primary thrombocythemia

  • Primary thrombocytosis

  • Thrombocythemia vera

    • 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
    		20010002 EOD-Size of Primary Tumor: How do you code tumor size for lesions described as "at least 2 cm"? See discussion. The expression "at least 2 cm" seems to be different from "greater than 2 cm." Stating "at least" seems to indicate that if the tumor is larger than 2 cm, it is difficult to ascertain the exact tumor size. Should we accept 2 cm as the best info we have, or default to 999 because of the lack of specificity?

    For cases diagnosed between 1998-2003:

    Code the EOD-Size of Primary Tumor field to 020 [2 cm], using the rule "code what you know."

    		 2001
    		20110132 Reportability/Histology--Heme & Lymphoid Neoplasms: Is a diagnosis of "small B-cell non-Hodgkin lymphoproliferative disorder" reportable? If so, how is the histology to be coded? See Discussion. The final diagnosis of a bone marrow biopsy dated 10/99/2010 was "small B-cell non-Hodgkin lymphoproliferative disorder." The differential diagnosis includes atypical small lymphocytic lymphoma/chronic lymphocytic leukemia and marginal zone lymphoma. Mantle cell lymphoma is very unlikely based on BCL1 negativity. Lymphoplasmacytic lymphoma is also excluded due to the absence of a plasma cell component (CD138 negative).

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

    Yes. The term "small B-cell non-Hodgkin lymphoproliferative disorder" is reportable. Code the histology to 9591/3 [non-Hodgkin lymphoma, NOS] per Rule PH28. When there is a diagnosis of lymphoproliferative disorder and any lymphoma, code the lymphoma histology.

    The information in the discussion is reflective of the difficulty in diagnosing hematopoietic and lymphoid neoplasms. The differential diagnosis indicates that a number of possible specific lymphoma/leukemia diagnoses that have been ruled out, which explains why the final diagnosis is non-Hodgkin, NOS.

    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.

    		2011
    		20081017 Ambiguous terminology/Reportability--Leukemia: Is a 'suspicious peripheral blood smear' the same as a suspicious cytology? See Discussion. The final diagnosis on the path report for a peripheral blood smear is stated to be "suspicious for malignancy." The microscopic description states that the "lymphoid population raises the concern of chronic lymphocytic leukemia." Nothing further was done. Is this a reportable case? If so, should it be coded as a leukemia or a malignancy NOS?

    For cases diagnosed prior to 1/1/2010:Do not accession a leukemia case based only on a "suspicious" peripheral blood smear. If a confirmed diagnosis, clinical confirmation or further information becomes available later, accession the case at that time.

    For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

    		 2008
    		20021098 Histology (Pre-2007)--All Sites: What code is used to represent the histology with a final diagnosis of adenocarcinoma, signet ring type when the comment suggests a "mixed histologic pattern"? See discussion. The following is the comment from the pathology report: "The histologic features reveal a tumor with a mixed histologic pattern. A diffuse infiltrate of signet ring cells and a second pattern of amphophilic polygonal cells. The latter elements suggest neuroendocrine differentiation, but IHC stains fail to reveal endocrine attributes in these cells."

    For tumors diagnosed prior to 2007:

    Code the Histology field to 8490/3 [Signet ring cell adenocarcinoma]. Code the specific subtype when the diagnosis says "generic carcinoma, something type." Neuroendocrine differentiation was suspected, but not supported by the IHC stains. A combination code is not appropriate for this example.

    For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

    		 2002
    		20130009 Grade--Pancreas: Can the grade be coded when a biopsy is taken from the part of a primary tumor that has contiguously extended into an adjacent organ or structure? See Discussion. The grade rule states to code grade from tissue removed from the primary tumor only, never from a metastatic site or a site of recurrence. There is no mention of whether the grade can be coded if only the contiguous site of involvement is biopsied when a single tumor directly extends to an adjacent tissue or organ. For example, is grade coded to 2 when a pancreatic tumor extends into the duodenum, and the duodenal biopsy confirms moderately differentiated adenocarcinoma consistent with a pancreatic primary? Or does the primary organ/site have to be biopsied in order to be able to code grade?

    For one tumor involving a contiguous site, when there is no tissue specimen available from the primary site, you may code the grade based on the tissue from the tumor in the contiguous site.

    This instruction is included in the upcoming grade instruction document.

    		 2013
    		20021185 Surgery of Primary Site--Major salivary gland: How do you code Surgery of Primary Site for a submandibular gland primary when the operative report refers only to an excision of the submandibular "tumor" while the pathology report states the submandibular "gland" was removed? See discussion. The gross description on the pathology report indicates that the specimen consists of a "submandibular gland." A further description on the pathology report included, "the specimen was sectioned exposing a focally cystic mass that nearly replaces the entire specimen." For cases diagnosed on 1/1/2003 or after: Code the Surgery of Primary Site field to 40 [Total parotidectomy, NOS; total removal of major salivary gland, NOS], per the pathology report's gross description of the specimen unless the operative report description of procedure indicates that the removal was less than total. 2002
    		20100068 Histology--Heme & Lymphoid Neoplasms: How is this field coded for a JAK-2 positive myeloproliferative disorder, NOS, that is never specified as acute or chronic but was treated with Hydrea? See Discussion. The hematology oncologist referred to the case as a JAK-2 positive myeloproliferative disorder. It is never called acute or chronic. JAK-2 test was positive for mutation, and the bone marrow report indicates, "Morphological features can be seen in myeloproliferative neoplasm." Flow cytometry report indicates, "The flow data demonstrate neutrophilia with left shift. Lymphocytes are composed of a mixed population of T and B-cells with some atypical B-cells." The patient is subsequently treated with Hydrea.

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

    Code the histology to 9975/3 [myeloproliferative/myelodysplastic neoplasm, unclassifiable] which is a new code implemented in 2010. Myeloproliferative disorder NOS is equivalent to myeloproliferative disease which is listed as a synonym for code 9975/3.

    When the disease is diagnosed very early, it may manifest symptoms of two or more specific myeloproliferative neoplasms. As the disease progresses, it will manifest the symptoms of one of the specific MPN subtypes. When a more specific diagnosis becomes available, change the histology code to the more specific MPN code as directed in the PH rules. That is the scenario you describe. JAK-2 is positive, but the physician does not designate PV or ET. Hydrea is treatment for both PV and ET. In the future, the specific type of MPN may be diagnosed. In the interim, code the only diagnosis you have, MPN, NOS.

    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.

    		2010
    		20061013 CS Extension--Hematopoietic, NOS: Can this field be coded to 10 [Localized disease] for an extramedullary plasmacytoma that is limited to an extramedullary primary, such as appendix, given that this histology is not listed as one of the allowable histology/CS extension combinations for this code? See Discussion. The Hematopoietic Diseases scheme for CS lists specific histologies for which CS Extension can be coded to 10. Included is plasmacytoma, NOS [9731/3]. However, extramedullary plasmacytoma [9734/3] is not listed as one of the histologies.

    This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign code 10 [Localized disease].

    Both the 2007 SEER manual (page C-1072) and the CS Version 01.04.00 manual (page II-550) have been updated to include 9734 [extramedullary plasmacytoma] under extension code 10.

    		 2006
    		20130095 Grade--Heme & Lymphoid Neoplasms: How is grade coded for acute lymphoblastic leukemia, NOS? See Discussion. The Heme DB indicates histology code 9811/3 [B lymphoblastic leukemia/lymphoma] is the current histology code to use for the now obsolete term of acute lymphoblastic leukemia [9835/3]. The Heme DB entry for histology code 9835/3 states to "Code grade specified by pathologist. If no grade specified, code 9." The Heme DB entry for the current histology code, 9811/3, states to code the grade to 6 [B-cell]. Should grade be coded to 6 [B-cell] for all cases coded to histology code 9811/3?

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

    Code the grade to 6 [B-cell] for all cases of 9811/3 [B lymphoblastic leukemia/lymphoma] per Rule G3 in the Heme Manual.

    Acute lymphoblastic leukemia, NOS [9835/3] is an obsolete code and cannot be used for cases diagnosed 2010 and later. The Heme DB indicates the correct histology code is 9811/3 and grade 6 [B-cell] for cases diagnosed 2010 and later.

    For cases of acute lymphoblastic lymphoma, NOS [9835/3] diagnosed prior to 2010, use the pathology report information to code the grade. Code the grade as 9 [unknown] if the pathology report does not specify the grade.

    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