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For tumors diagnosed prior to 2007:

If the pathologist states this is a malignancy, the case is reportable. Code the Histology field to 9751/3 [Langerhans cell histiocytosis, NOS] and change the Behavior Code from 1 to 3. Code the Primary Site field to skin [C44._].

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.

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."

For cases diagnosed 2007 or later, abstract a single primary. Rule M1 applies because there is no information on the number of tumors and there is no way to know whether the curettage sample was from a separate tumor or from the tumor in the hysterectomy specimen.

Apply rule H17 and code histology to 8980/3 for malignant mixed Mullerian tumor [Carcinosarcoma, NOS].

For cases diagnosed 2007 or later, code one primary with histology and behavior coded to 8522/2 [intraductal carcinoma and lobular carcinoma in situ].

The steps used to arrive at this decision are as follows

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histology rules. The module you use depends on the behavior and number of tumors identified in the primary site. The information provided does not specify whether this was a single tumor with DCIS and LCIS or multiple tumors with DCIS and LCIS. In this case, the number of tumors does not change the histology code for this patient. For this example, assume this disease process was a single tumor.

Start at the SINGLE TUMOR: In Situ Carcinoma Only module. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H8. Stop at the first rule that applies to the case you are processing. Code the histology as 8522/2 (intraductal carcinoma and lobular carcinoma in situ) when there is a combination of in situ lobular (LCIS) [8520] and intraductal carcinoma (DCIS).

Do not code the behavior as invasive in this case. The pathologist indicated that these findings were "suspicious" but not definite in the microscopic examination. If the pathologist decided that this was truly an invasive tubular element, it would have been included in the final diagnosis.

For tumors diagnosed prior to 2007:

Code histology as 8441 [serous adenocarcinoma].

The primary site for this case is fallopian tube, not the suggested site code of ovary.

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.

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

This case is not reportable. Neither plasma cell dyscrasia nor MGUS are reportable. Smoldering myeloma was given as a possible diagnosis, but never confirmed.

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.

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

Code the histology to 9837/3 [adult T cell leukemia/lymphoma] and the primary site to C778 [lymph nodes, multiple regions]. Per Rule PH8, code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. A statement of "mediastinal mass" and lymphadenopathy for lymphoma primaries is equivalent to lymph node involvement. To identify the more specific primary site, you need to move to Rule PH21 that indicates you are to code the primary site as multiple lymph node regions, NOS [C778] when multiple lymph node regions, as defined by ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated.

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.

For cases diagnosed prior to 1/1/2010:Abstract the example above as two primaries. Hematologic malignancies (including lymphoma) and solid tumors are handled differently when determining the number of primaries. For hematologic malignancies, take the physician's opinion into account. Use the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table as an aid when there is insufficient information available.

For solid tumors, follow the multiple primary rules in the SEER Program Code Manual.

For cases diagnosed 2010 forward, 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.