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For cases diagnosed prior to 1/1/2010:

Code the Histology field to 9989/3 [myelodysplastic syndrome] and the Date of Diagnosis field to June 2001.

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.

For cases diagnosed prior to 1/1/2010:Code the Histology field to 9709/3 [cutaneous lymphoma, NOS]. Code the Grade, Differentiation field to 8 [NK cell].

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.

For cases diagnosed prior to 1/1/2010:Code the Histology field to 9670/3 [Malignant lymphoma, small lymphocytic, NOS] and the Primary Site field to C77._ [lymph nodes] when CLL/SLL is diagnosed in lymph node or solid tissue, even if the clinician refers to CLL. When CLL/SLL is diagnosed in the blood, code as leukemia.

Refer to clarification #6 on the ICD-O-3 Errata and Clarifications. "...if disease is diagnosed only in the blood or bone marrow, code the primary site to C42.1, bone marrow and assign the leukemia morphology code. If the diagnosis is made on any other tissue (typically lymph nodes, lymphatic structures, breast, and stomach), code to the tissue involved and assign the lymphoma morphology. If the diagnosis is made on both blood or bone marrow and a tissue biopsy, code the tissue involved and assign the lymphoma morphology."

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.

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

Code the histology to 9735/3 [plasmablastic lymphoma] and the primary site to C809 [unknown] per Rule PH27.

Code the histology specified when the only histology for the case is preceded by ambiguous terminology. For this case, code the histology to plasmablastic lymphoma because it is the only histology mentioned in the diagnosis.

Per the Heme DB Abstractor Notes section for plasmablastic lymphoma, most patients present with Stage III-IV disease. The positive pleural fluid is likely due to advanced disease. In the absence of any other information for this case, Rule PH27 applies, "Code 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."

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.

Per Rule M14, accession this is a single primary. Per PH27, code the primary site to C809 [unknown} and per PH1, code the histology to 9680/3 [diffuse large B-cell lymphoma].

Per Rule M14, abstract as a single primary when post-transplant lymphoproliferative disorder is diagnosed simultaneously with any B-cell lymphoma, T-cell lymphoma, Hodgkin lymphoma or plasmacytoma/myeloma.

Per PH1, code the histology of the accompanying lymphoma or plasmacytoma/myeloma when the diagnoses of post-transplant lymphoproliferative disorder and any B-cell lymphoma, T-cell lymphoma, Hodgkin lymphoma, or plasmacytoma/myeloma occur simultaneously.

Per PH27, code the primary site to C809 [unknown primary site] because there is no lymph node involvement, but there is involvement of two extranodal sites.

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.

This case should be accessioned as one primary. Per Rule PH26, code the primary site to bone marrow (C421) when lymphoma is present only in the bone marrow. (We assumed all available physical exams, scans, and other work-up were negative for lymph node, tissue, or organ involvement.) Histology is coded to 9680/3 [Diffuse large B-cell lymphoma (DLBCL)]. Under the Alternate Names section of the Heme DB, a synonym for DLBCL is B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma.

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.

Per Rule M3, abstract a single primary when a sarcoma (myeloid sarcoma) is diagnosed either simultaneously or after a leukemia of the same lineage (acute myeloid leukemia). Per the notes for Rule M3, the sarcoma is a solid manifestation of the associate leukemia.

Per PH10, code the histology to 9861/3 [acute myeloid leukemia] and the primary site to C421 [bone marrow]. PH10 states one is to code the primary site bone marrow (C421) and code the histology acute myeloid leukemia, NOS (9861/3) or any of the specific AML histologies (9840/3, 9865/3-9867/3, 9869/3-9874/3, 9891/3, 9895/3-9898/3, 9910/3, 9911/3 and 9931/3) when the diagnosis is myeloid sarcoma (9930/3) AND there is a simultaneous or previous diagnosis of acute myeloid leukemia.

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:

There is considerable difference between therapy-related myelodysplastic syndrome (MDS) and drug-induced sideroblastic anemia (SA).

Therapy-related MDS is the result of irreversible damage to the bone marrow caused by certain kinds of myelotoxic drugs used to treat cancer. Examples are Cytoxan and Etoposide. There is usually a 10+ year delay between the first primary and its treatment and the therapy-related MDS. Therapy-related MDS is not reversible and is reportable as a malignancy. Because the drugs were almost always given to treat a malignancy, therapy-related MDS is almost always a second primary.

Drug-induced SA is not reportable as a malignancy. Drug-induced SA is the result of short term effects of certain drugs on the bone marrow. Drug-induced SA is reversible, as the marrow recovers once the drugs are out of the system.

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.

Code the histology using the pathology report from the most representative specimen, even if that histology is less specific.

For the case example above, code 8140 [adenocarcinoma, NOS].

The rationale is that a diagnosis from a smaller specimen will be less accurate and less representative of the true histology compared to a larger tumor specimen.