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Report Produced: 02/20/2026 18:48 PM

Report Question ID Question Discussion Answer Year
20130014 Reportability--Heme & Lymphoid Neoplasms: Is Castleman disease reportable when diagnosed 2010 and later? When checking Castleman disease in the Hematopoietic Database, the result is a reportable histology code 9738/3. However, per an online search, Castleman disease is a very rare disorder characterized by non-cancerous growths (tumors).

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

Castleman disease, NOS, is not reportable for cases diagnosed 2010 and later. However, when Castleman disease is diagnosed in connection with large B-cell lymphoma [9738/3], it is 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.

2013
20130176

Reportability--Ovary: Is an adult granulosa cell tumor of the right adnexa reportable if the left adnexa, diaphragm and paratubal tissue are reported to be consistent with metastasis? See discussion.

Per the pathology report: Right adnexa: adult granulosa cell tumor. Left adnexa: Foci of metastatic granulosa cell tumor in paratubal tissue. Diaphragm smears: consistent with metastatic granulosa cell tumor. Comment: The morphology and immunoprofile of the cellular aggregates in the paratubal soft tissue are consistent with metastatic granulosa cell tumor.

Based on the information provided, this case of adult granulosa cell tumor is malignant and reportable. According to our expert pathologist consultant, "though granulosa cell tumor NOS/ adult NOS is 8620/1, the presence of peritoneal implants or metastases, and/or lymph node metastases indicates the tumor is malignant, and it should be coded /3."

Note that the presence of implants or metastases does not indicate malignancy in the case of low malignant potential ovarian epithelial tumors. Our path expert explains "in contrast, by convention the behavior of borderline/LMP ovarian epithelial tumors is determined by the ovarian primary, and is /1, even though there may be peritoneal implants/metastases, or metastatic disease in lymph nodes. The treatment may vary in these circumstances, but to my knowledge the decision as to the tumor designation remains based on the primary tumor."

2013
20130181 Multiple Primaries--Heme & Lymphoid Neoplasms: Should Rule M4 or the Heme DB be used to determine whether diffuse large B-cell lymphoma of the large intestine and peripheral T-cell lymphoma of the bone marrow represents one or two primaries? See Discussion.

The Heme DB identifies these as new primaries:

10/12/12 Large intestine, biopsy: Diffuse large B-cell lymphoma.

10/12/12 Bone marrow biopsy: Peripheral T-cell lymphoma.

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

Per Rule M15, accession two primaries. According to Rule M15, use the multiple primaries calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14. Per the calculator, this scenario represents two primaries.

Assuming the only area of involvement is the large intestine, code the histology to 9680/3 [diffuse Large B-Cell Lymphoma] and per Rule PH24 code the primary site to C189 [colon, NOS]. According to PH24, one is to code the primary site to the organ when lymphoma is present only in an organ.

Rule PH26 applies to the second primary. Assuming the only area of involvement is the bone marrow, code the histology to 9702/3 [peripheral T-cell lymphoma] and code the primary site to C421 [bone marrow]. According to PH26, one is to code the primary site to bone marrow (C421) when lymphoma is present only in the bone marrow.

Rule M4 does not apply for this case. Rule M4 applied when you have two or more types of non-Hodgkin lymphoma in the same anatomic location. That is not the case in this scenario.

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
20130027

Reportability--Are well-differentiated neuroendocrine tumors and grade 1 neuroendocrine tumors of the appendix now reportable? See Discussion.

The terminology for carcinoid tumors has changed. The current terminology used is "neuroendocrine tumor." Are well-differentiated neuroendocrine tumors of the appendix non-reportable because carcinoid, NOS of the appendix has a borderline behavior code [8240/1]? When the histology/behavior codes for the term "well-differentiated neuroendocrine tumor" became 8240/3, did SEER intend this change to also apply to appendix primaries? If so, for which diagnosis year did this change go into effect?

Well-differentiated neuroendocrine tumors and grade 1 neuroendocrine tumors of the appendix are reportable because these tumors have a morphology code 8240/3 per the WHO Classification of Tumors of the Digestive System. However, per the ICD-O-3, carcinoid tumors of the appendix have a behavior code of /1 [borderline].

The terminology of neuroendocrine tumors is evolving and current thinking at the international level is that carcinoid/WD NET of appendix is reportable. However, reportability in the United States is based on ICD-O-3. The histology code for "Carcinoid of appendix" is 8240/1; the histology code for a carcinoids of all other primary sites is 8240/3. Until the United States adopts the proposed changes for ICD-O-3, reportability of appendix cases is as follows:

  • Carcinoid
  • Well-differentiated neuroendocrine tumor
  • Grade 1 neuroendocrine tumor
  • Well-differentiated neuroendocrine tumor/carcinoid (Pathologist uses both terms in reporting the diagnosis and does not want to choose one diagnosis over the other.)
 2013
20130028 Primary site--CLL/SLL: How is the primary site coded and what rule applies when no bone marrow biopsy is performed on a patient diagnosed with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) which was based on the results of an axillary biopsy, positive peripheral blood and a CT scan showing multiple lymph nodes involved above and below the diaphragm? See Discussion The physician staged this as Stage 0 CLL/SLL. Should the primary site be coded to lymph nodes if the MD stated this was leukemia?

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

Code the primary site to C421 [bone marrow] per Rule PH5. Code the primary site to the bone marrow when the peripheral blood is involved, even if no bone marrow biopsy is performed.

According to the notes for Rule PH5, CLL always has peripheral blood involvement (PH5 Note 1). CLL/SLL may also have involvement of lymph node regions in later stages (PH5, Note 2). For this patient a bone marrow biopsy was not performed but he had extensive lymph node and peripheral blood involvement. Therefore, the primary site is coded to C421. In addition, the physician's documentation specifies this patient has Stage 0 disease which indicates this disease process is being classified as leukemia (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
20130210

Primary site--Heme & Lymphoid Neoplasms: Does Rule PH27 apply meaning that primary site is coded to C809 or would it be more appropriate to code to C269 GI Tract NOS since all disease involves the GI tract and this is more specific?

Extranodal lymphoma first diagnosed in the stomach (fundus and antrum) which upon further investigation also involved the small bowel (MALT Lymphoma) in the absence of lymph node findings. MD staged this IIE. Initial thought was Gastric, but PET/CT indicated abnormal uptake involving loop of distended small bowel in the pelvis.

Assign C269 for Gastrointestinal tract, NOS. Apply Rule PH24, code to the organ when only an organ is involved. This rule can be used for NOS sites such as GI tract, NOS.

Based on the information provided, this lymphoma is confined to the GI tract -- stomach and small bowel.

2013
20130160 Histology--Heme & Lymphoid Neoplasms: Should the histology be coded to a therapy-related myeloid neoplasm when the physician states the diagnosis of acute myeloid leukemia is secondary to treatment with Imuran? See Discussion.

Patient has a diagnosis of AML for which the physician recommends a bone marrow transplant. The physician indicated the diagnosis is actually a secondary AML due to treatment with Imuran for polymyalgia rheumatica. The physician also stated this is a high risk type of AML.

Imuran is not a chemotherapy agent per SEER*Rx. Can the histology be coded as 9920/3 (e.g., Therapy-related acute myeloid leukemia, NOS) when the patient has not been treated with chemotherapy for a reportable disease? The physician is a bone marrow transplant expert who states the AML is therapy-related disease. Bone marrow disease is a listed as a risk for treatment with Imuran.

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

Code this histology to 9920/3 [therapy-related myeloid neoplasm] when the physician states the acute myeloid leukemia is therapy-related.

Therapy-related AML can result from any systemic therapy for benign or malignant diseases. In this case, AML resulted from immune system-suppressing therapy with Imuran for a benign disease, polymyalgia rheumatica. The drugs that induced the AML do not have to be listed in the SEER*Rx database.

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
20130139 Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the original slides are reviewed at a later date and the revised diagnosis changes the histology? See Discussion.

Diffuse large B-cell lymphoma [9680/3] diagnosed in 5/2010 and treated with chemotherapy. In 11/2012 a bone marrow biopsy revealed small lymphocytic lymphoma (CLL/SLL) [9823/3].

The 2010 slides were reviewed and showed, "a large cell lymphoid proliferation, many of the cells which appear to be prolymphocytes. There are background smaller lymphocytes that are consistent with CLL/SLL. In retrospect, the lymph node most likely represented a prolymphocytic conversion in SLL."

The medical oncologist is calling this a recurrent lymphoma. Should the original 5/2010 diagnosis be changed to 9823/3 [CLL/SLL]? Is this documented in the Heme Manual?

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

Change the histology of the original 2010 diagnosis to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma] based on the review of the 2010 slides. The 2010 diagnosis was revised based on the review of slides and the histology should be changed accordingly. The closest example of this is located in the SEER Manual, Changing Information on the Abstract, instruction 3, example 4.

Histology code 9670/3 [SLL] is obsolete for cases diagnosed 2010 and later. All diagnoses of CLL/SLL, CLL, and SLL are now coded to histology code 9823/3 [CLL/SLL].

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
20130202 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013? See Discussion.

In the Heme Manual it indicates one is to abstract a second primary when a solitary plasmacytoma (chronic) is followed by a plasma cell myeloma (acute) greater than 21 days after the chronic diagnosis.

The Heme Manual does not indicate what to do when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013. The physician specifically stated the patient does not have multiple myeloma. Is this case one or two primaries?

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

Per Rule M2, this is a single primary. According to Rule M2, the single histology is always the single 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.

2013
20130016 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed with small lymphocytic lymphoma in 1996, received chemotherapy on and off for 15 years due to relapses, and was subsequently diagnosed with diffuse large B-cell lymphoma in 2012?

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

Per Rule M10, this case should be accessioned as two primaries. According to Rule M10, one is to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis.

The histology for the 1996 chronic neoplasm is coded to 9670/3 [small lymphocytic lymphoma]. The histology for the 2012 acute neoplasm is 9680/3 [diffuse large B-cell 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.

2013