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Report Produced: 12/31/2025 19:09 PM

Report Question ID Question Discussion Answer Year
20110013

MP/H Rules/Histology--Testis: Which MP/H rule applies in coding the histology described as a "malignant mixed germ cell tumor with the following features: Histologic type: embryonal carcinoma (97%) and yolk sac tumor (3%)"? See Discussion.

Per MP/H rule H16, code the appropriate combination/mixed code (Table 2) when there are multiple specific histologies or when there is a non-specific histology with multiple specific histologies. The combination embryonal carcinoma and yolk sac tumor is not listed in Table 2, even though the pathology report indicates this is a mixed germ cell tumor.

Should rule H17 be applied and the numerically higher histology code be used?

As of 2016: Code histology to 9085/3 [mixed germ cell tumor]. Combine 9065 and 9085 for analysis purposes.                            

2011
20110012 Reportability--Sarcoma: Is "atypical lipomatous tumor/well-differentiated liposarcoma" reportable? See Discussion.

The final diagnosis for a soft tissue excision is, "atypical lipomatous tumor/well-differentiated liposarcoma". The Comment section states, "Atypical lipomatous tumor/well differentiated liposarcoma has a significant risk for local recurrence, but no metastatic potential."

Per the 2010 SEER Manual, page 3, example 4: The pathologist makes the final decision about the behavior for a particular case. In this case, the pathologist uses both a reportable and a non-reportable term in the final diagnosis and in the comment section of the pathology report. Does the pathologist's comment impact the behavior and reportability of this tumor?

 For cases diagnosed 1/1/2014 and later: Atypical lipomatous tumor (8850/1) is not reportable. If the pathologist uses the term "well-differentiated liposarcoma" (8851/3) report the case. Use of this terminology indicates a less favorable prognosis. 2011
20110011 Reportability--Heme & Lymphoid Neoplasms: Is a 2010 diagnosis of "thrombocytopenia of unknown etiology" reportable? See Discussion.

No exact match returned after entering the term "thrombocytopenia of unknown etiology" in the Heme DB. However, the program does indicate there are 17 results that could be displayed that show any of the 4 terms entered. Clicking on the search label indicates there are no matches either.

The only result returned after entering "thrombocytopenia" into the search box is "refractory thrombocytopenia."

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

"Thrombocytopenia of unknown etiology" is not reportable. Thrombocytopenia refers to a low platelet count which causes bleeding. Thrombocytopenia can be caused by viral infections, excessive alcohol usage, HIV, and other causes (including chemotherapy). If the diagnosis is not "refractory thrombocytopenia" the case is not reportable. Appendix F lists this term as non-reportable.

If you do not see the term in the Heme DB under either the Name column or the Alternative Names section for the results returned, it is not reportable. The only reportable term that contains the word thrombocytopenia is refractory thrombocytopenia. Therefore, thrombocytopenia of unknown etiology is not reportable.

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
20110010

Multiple primaries--Heme & Lymphoid Neoplasms: Is a recently diagnosed granulocytic sarcoma followed by a diagnosis of AML two primaries? See Discussion.

6/10/10 Axillary lymph node biopsy was compatible with AML. The physician noted that the patient was diagnosed with granulocytic sarcoma [9930/3] in the axillary node.

6/15/10 Bone marrow biopsy compatible with AML FAB M1 [9873/3].

After induction, a second bone marrow biopsy on 6/30/10 shows persistent/refractory AML. The physician noted that the second biopsy is compatible with AML FAB M7 [9910/3].

Is the granulocytic sarcoma a chronic form of the disease? If so, do we have one primary diagnosed 6/10/10 with primary site coded to C42.1 and histology coded to 9873/3? Does the second biopsy on 6/30/10 represent the same primary even though the persistent disease is now FAB M7?

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

Granulocytic sarcoma does not transform into AML. Per the Abstractor Notes section in the Heme DB under the term "granulocytic sarcoma," it indicates that "Myeloid sarcoma (also known as granulocytic sarcoma) may occur de novo; it may precede or coincide with AML, or represent an acute blastic transformation of myelodysplastic syndromes." This means that when granulocytic/myeloid sarcoma is seen with AML, it represents a solid manifestation of the systemically involved AML. In other words, it is all the same disease process (coded to AML) if it occurs simultaneously (i.e., at the same time or within 21 days of on another).

Apply Rule M3 to this case which states to abstract a single primary when a sarcoma is diagnosed simultaneously or after a leukemia of the same lineage. Code the primary site to C421 [bone marrow] with histology coded to 9873/3 [acute myeloid leukemia, M1]. The FAB category is an older classification that is seldom used. Changes from FAB 1 to FAB 7 do not constitute a new 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.

 2011
20110009 Diagnostic confirmation/Date of diagnosis--Heme & Lymphoid Neoplasms: How are these fields coded for a 2/11/10 negative bone marrow biopsy with cytogenetic abnormalities if the physician makes a clinical diagnosis of refractory cytopenia with multilineage dysplasia on 2/25/10? See Discussion.

2/11/10 bone marrow biopsy revealed "mild trilineal dysplastic changes in conjunction with chronicity of cytopenias is worrisome for MDS." Cytogenetics are positive for 5q deletion. Clinicopathologic correlation required for final diagnosis. On 2/25/10 the physician confirms a diagnosis of refractory cytopenia with multilineage dysplasia.

Is the date of diagnosis 2/11/10 with diagnostic confirmation of 3 or 2/25/10 with diagnostic confirmation of 8?

The date of diagnosis is 2/25/10 and diagnostic confirmation is coded to 8 [clinical diagnosis only].

As the cytogenetics state, you need clinicopathologic correlation to get confirm a reportable diagnosis. There is no reportable diagnosis from the bone marrow biopsy. The cytogenetics were done (the pathologic part) and then the physician confirmed refractory cytopenia with multilineage dysplasia [9985/3] (the clinical part). The diagnostic process and the determination of a reportable diagnosis were completed when the clinician made the statement that this is refractory cytopenia with multilineage dysplasia.

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
20110008 MP/H Rules/Histology--Vulva: How is histology coded for VIN III with focal invasion? See Discussion. Per SINQ 20000442, the histology for CIN III with microinvasion is coded to 8077 [squamous intraepithelial neoplasia, grade III] per the matrix system rules, with a behavior code of /3 [malignant]. Coding the histology to 8077/3 per the matrix principle causes IF25_3 and MorphICDO3_P1 edits to fail. Flagging the first error resolves any reporting issue. How is the MorphICDO3_P1 edit resolved? Assign 8076/3 [squamous cell carcinoma, microinvasive] for VIN III with focal invasion. This applies to all terminologies listed under 8077/2. The SINQ question from 2000 will be retired. 2011
20110007 MP/H Rules/Multiple primaries--Bladder: How many primaries are to be abstracted and how are the histologies coded when a bladder resection demonstrates tumor with invasive small cell neuroendocrine carcinoma [8041/3], high grade papillary urothelial carcinoma in situ [8130/2], adenocarcinoma in situ [8140/2], and multifocal flat urothelial carcinoma in situ? See Discussion.

Are the areas of in situ tumor to be ignored or would MP/H Rule M9 apply?

Ignore the in situ histologies. This is a single primary. Code the histology to invasive small cell neuroendocrine carcinoma [8041/3]. 2011
20110006 Reportability--Heme & Lymphoid Neoplasms: Are all stages of CLL reportable? See Discussion. If a physician notes the patient has Stage 0 CLL (increasing leukocytosis), is this reportable? CLL Stage is not mentioned in the Hematopoietic Manual or Database, but internet research reveals CLL has five stages (Stage 0, I, II, III, and IV).

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

Yes. All stages of CLL are reportable. CLL has a unique staging system. The Heme DB and Manual do not address the issue of stage. Therefore, stage information is not reported in the Abstractor Notes section of the Heme DB.

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
20110005 Histology--Heme & Lymphoid Neoplasms: How is the pre-2010 histology coded for a "follicular grade 2, non-Hodgkin lymphoma with marginal zone B-cell differentiation"? See Discussion. This patient was seen in 2010 for the same primary as diagnosed in 2006. The histology was coded to marginal zone lymphoma [9699/3] in 2006. Is this correct? Or should this have been coded as a follicular lymphoma, ignoring the modifying expression "marginal zone B-cell differentiation"?

This is a 2006 diagnosis. The histology code is 9691/3 [follicular lymphoma, grade 2]. Do not code differentiation for hematopoietic cases.

For diagnoses 2010 and forward, a small number of cases of follicular lymphoma do have marginal zone differentiation. However, there is no code for this variant of follicular lymphoma. It would simply be coded as a follicular lymphoma because that is the most accurate histology code available. The marginal zone differentiation is not to be coded as a second primary (marginal zone lymphoma).

2011
20110004 MP/H Rules/Histology--Breast: Which MP/H rule applies when coding the histology field for a tumor described as a "metaplastic carcinoma, adenosquamous and spindle cell type"? See Discussion.

Per path comment: "The neoplasm is composed of adenosquamous carcinoma which merges with spindle cell carcinoma. The cystic component shows a mixed squamous and ductal epithelial lining which shows cytologic atypia and mitotic activity and can be seen to merge with invasive carcinoma. The features suggest the possibility that the tumor may have arisen from a sclerosing and cystic papilloma with squamous metaplasia, although a clearly benign component is not evident."

Would MP/H rule H19 apply based on the pathology report comment resulting in histology for the case being coded to 8255 [adenocarcinoma with mixed subtypes]? Or, would MP/H rule H14 apply based on the final diagnosis resulting in histology for the case being coded to 8575 [metaplastic carcinoma] because adenosquamous and spindle cell are not specific types of metaplastic carcinoma?

This is a metaplastic carcinoma as stated in the path diagnosis. Rule H14 applies. Assign code 8575/3. According to the WHO Classification, metaplastic carcinoma is a general term for a group of neoplasms characterized by a mixture of adenocarcinoma with dominant areas of spindle cell, squamous, and/or mesenchymal differentiation.

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the histology for this case. Code histology to 8575/3 [metaplastic carcinoma] as stated in the pathology diagnosis.

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histo rules determine histology for the case.

Go to the SINGLE TUMOR: INVASIVE CARCINOMA ONLY module. The rules are intended to be reviewed in consecutive order within the module from Rule H10 to Rule H19. You stop at the first rule that applies to the case you are processing.

Code the histology when only one histologic type is identified. According to the WHO Classification, metaplastic carcinoma is a general term for a group of neoplasms characterized by a mixture of adenocarcinoma with dominant areas of spindle cell, squamous, and/or mesenchymal differentiation.

2011