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Report Produced: 09/08/2025 12:30 PM

Report Question ID Question Discussion Answer Year
20130118 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of Langerhans cell histiocytosis with extensive bony metastatic disease and lymphadenopathy? See Discussion. Patient was diagnosed with LCH on a biopsy of the right femur. Imaging showed extensive bony metastatic disease, extensive infiltrative perinephritis, encasement of both kidneys, renal hilar, retroperitoneal and periaortic lymphadenopathy. The right femur biopsy pathology report did not state this was metastatic.

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

Code the primary site to C419 [bone, NOS] per Rule PH30.

This patient has widely metastatic disease. Per Rule PH30, one needs to reference the Heme DB to determine the primary site and histology for this case. Per the Abstractor Notes section, Langerhans cell histiocytosis arises in the bone and many times can involve multiple bones, along with other organs and lymph nodes. Although the right femur was biopsied, this does not prove that the primary site is the femur [C402] because the patient has what was described as extensive bony metastatic disease.

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
20130085

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient was treated in 1999 with Vidaza for myelodysplastic syndrome and had a recent biopsy that demonstrated a transformation to acute myeloid leukemia?

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

This case should be accessioned as a single primary, acute myeloid leukemia [9861/3].

MDS diagnosed prior to 1/1/2001 is not a reportable disease process. However, because MDS is currently a reportable disease process, it must be considered when trying to determine whether the AML represents a separate primary.

  • If the Heme DB indicates MDS and AML represent different (separate) disease processes, only one primary is reported (i.e., AML) because the 1999 diagnosed MDS is not reportable.
  • If the Heme DB indicates MDS and AML represent the same disease process, then no primaries are reported because MDS was not reportable in 1999.

Rule M2 does not apply to this case because more than one histology is mentioned in the scenario. According to the Heme DB, MDS can transform to AML. Rules M8-M13 apply to cases involving transformation. In this case, Rule M10 applies because the patient was diagnosed with a chronic neoplasm (myelodysplastic syndrome) followed greater than 21 days later by an acute neoplasm (AML).

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
20130044 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient has a biopsy diagnosis of extraosseous plasmacytoma followed fourteen days later with a diagnosis of multiple myeloma on imaging? See Discussion.

On 2/3/12 the patient was diagnosed via biopsy with an extraosseous (extramedullary) plasmacytoma filling both nasal cavities. On 2/16/12 a metastatic workup was performed and showed a lucent lesion in calvarium of Rt frontal bone. 2/17/12 radiation oncology consult states, "I believe this is most likely consistent with multiple myeloma." Subsequently, the 3/1/12 CT of the left shoulder showed a 3.6 cm lytic lesion of humeral head with cortical breakthrough consistent with metastasis or myeloma.

Per the Heme DB, extramedullary plasmacytoma can transform to multiple myeloma. Does that make this multiple primaries with the histologies coded to 9734/3 and 9732/3?

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

This case should be accessioned as a single primary, multiple myeloma [9732/3] diagnosed on 2/3/12 per Rule M8. Abstract the acute neoplasm as a single primary when both a chronic and acute neoplasm are diagnosed simultaneously or within 21 days AND there is documentation of only one positive tissue biopsy.

This patient only had a tissue biopsy of the nasal cavity proving the chronic neoplasm (extraosseous plasmacytoma). The acute neoplasm (multiple myeloma) was diagnosed clinically based on the scans.

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
20130041 Reportability--Heme & Lymphoid Neoplasms: Is a flow cytometry immunophenotyping of peripheral blood that demonstrates a chronic lymphocytic leukemia (CLL) phenotype reportable as CLL? See Discussion. Final Diagnosis: "Peripheral blood, flow cytometry immunophenotyping: Monoclonal B-cell lymphocytosis with Chronic Lymphocytic Leukemia (CLL) phenotype; Negative for Zap 70; No abnormal T-cell population identified; CD34-positive blasts are not increased.

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

This is reportable. Code the histology to 9823/3 [chronic lymphocytic leukemia (CLL)]. Per Rule PH5, Note 1, CLL will always have peripheral blood involvement. Based on the provided information, this patient's peripheral blood is positive for 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
20130193 Sex: How is sex coded for a transsexual diagnosed with a testicular primary? See Discussion. The Physical Exam states patient is male. There is a note that the patient is transsexual. There is no indication that the orchiectomy was part of gender reassignment surgery. Code sex to 1 [male]. When the natal sex is known, code that over transsexual. 2013
20130131 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded, and which PH rule applies, when chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is diagnosed simultaneously by biopsies of both lymph node(s) and the bone marrow?

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 when CLL/SLL [9823/3] involves the bone marrow.

In the later stages of CLL/SLL, there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s). As long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow.

WHO states that the diagnostic criteria for CLL versus SLL is not clearly defined. According to WHO guidelines, it is better to code to CLL/SLL and code the primary site to bone marrow when the marrow is involved and to lymph nodes, organ, or tissue when there is no bone marrow 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.

2013
20130208

Histology--Heme & Lymphoid Neoplasms: How is histology coded when a bone marrow shows slightly hypercellular marrow with acute myeloid leukemia, non-M3 type and the flow cytometry is also consistent with acute myeloid leukemia, non-M3 type?

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

Without further information as to the type of acute myeloid leukemia, code the histology to 9861/3 [acute myeloid leukemia, NOS]. If further information on the specific acute myeloid leukemia becomes available, update the histology code.

Document that the pathology report states the acute myeloid leukemia is a "non-M3 type" in a text field. This documentation will help explain the choice of 9861/3 for this case. M3 refers to one of the eight FAB subtypes described by a group of French, American, and British leukemia experts in the 1970's who divided acute myeloid leukemias into subtypes, M0 through M7. They classified the disease based on the type of cell from which the leukemia developed and how mature the cells were. This was based largely on how the leukemia cells looked under the microscope after routine staining.

In this case, all we know is that the histology does not pathologically represent the M3 (acute promyelocytic leukemia (APL)) form of acute myeloid leukemia. We do not know which type of acute myeloid leukemia it does represent.

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
20130152 Primary site/Histology--Brain and CNS: How is the primary site and histology coded for a 2013 diagnosis of squamous cell carcinoma arising in a dermoid cyst of the third ventricle? See Discussion. Patient has a dermoid cyst of the third ventricle of the brain diagnosed in 1998. In 2013 the cyst was removed and was diagnosed as squamous cell carcinoma. An internet search revealed a journal article in the Journal or Neuro-Oncology that states, "Although rare, malignant transformation of intracranial epithelial cysts has a poor prognosis." The combination of site C715 [third ventricle, NOS] and histology 8070/3 [squamous cell carcinoma] fails SEER Edit IF 38_3: Primary site and Morphology Impossible. According to the literature, intracranial squamous cell carcinoma is very rare with most cases arising from a preexisting benign epidermoid cyst. The combination of C71_ and 8070/3 should be allowed. We will submit a request to have this edit revised. 2013
20130102

Histology--Heme & Lymph Neoplasms: Is follicular lymphoma, high grade synonymous with grade 3 lymphoma [9698/3] or is the "high grade" ignored and the histology coded to follicular lymphoma, NOS [9690]?

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

Code histology to 9698/3 [follicular lymphoma, grade 3].

Follicular lymphoma, high grade is listed under the Alternate Names section of the Heme DB for Follicular lymphoma, grade 3.

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