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Report Produced: 02/20/2026 15:39 PM

Report Question ID Question Discussion Answer Year
20100098 Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a 2008 diagnosis of small B cell leukemia, most consistent with mantle cell leukemia that only involved the bone marrow? See Discussion. A bone marrow biopsy was done on 6/18/2008 and showed only small B cell leukemia, most consistent with mantle cell leukemia. ICD-O-3 does not list a histology code for small B cell leukemia or mantle cell leukemia.

Code the histology to 9673/3 [mantle cell lymphoma] and the primary site to C421 [bone marrow].

Mantle cell lymphoma can present in a leukemic phase. The only code available is for mantle cell lymphoma and the only primary site that could be coded would be bone marrow.

2010
20100053 Primary site--Heme & Lymphoid Neoplasms: How is primary site coded for a myeloid sarcoma (granulocytic sarcoma) arising in the chest wall in a patient that has a negative bone marrow biopsy? See Discussion.

Patient was diagnosed with Myeloid Sarcoma (granulocytic sarcoma) by chest wall biopsy. This is an extramedullary manifestation of acute leukemia and is not in the bone marrow (bone marrow is negative).

How should primary site be coded? The Heme DB states that almost any part of the body can be involved. It also states to not code primary site to C421. In this case the only involvement is the chest wall [C493]. However, use of the primary site code C493 triggers an edit error questioning this site/histology combination. If the primary site is coded to C421 [bone marrow], there is no edit error. Please explain the site code and rationale.

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

Unless there are scans showing involvement of a lymph node or tissue other than the chest wall, the histology should be coded myeloid sarcoma [9930/3] and the primary site to C493 [soft tissue of chest wall]. Per Rule PH 30, use the Heme DB to determine primary site and histology when rules PH1-PH29 to not apply. Override the edit.

Per the Abstractor Notes section in Heme DB, for myeloid sarcoma [9930/3] the most frequently affected sites are skin, lymph nodes, gastrointestinal tract, soft tissue, and testis.

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.

2010
20100075 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when a 1/27/10 bone marrow biopsy, FISH and cytogenetics reveals chronic myelogenous leukemia (CML), BCR/ABL positive, t(9;22)(q34;q11) and a 4/15/10 bone marrow biopsy reveals B-acute lymphoblastic leukemia (Blast phase of CML)?

1/27/10 BM biopsy: CML BCR/ABL+ FISH positive for BCR/ABL and cytogenetics showing the t(9;22)q34q11.2 translocation. Treated with Imatinib. 4/15/10 BM biopsy: B-acute lymphoblastic leukemia (Blast phase of CML). Would the term "blast phase of CML" indicate the 4/15/10 bone marrow biopsy showed CML or would a new primary be abstracted with histology coded 9811/3 [B lymphoblastic leukemia/lymphoma, NOS]?

Applying rule M10, this is a new primary, but note 2 states transformations are defined in the Heme DB. The Abstractor Notes section indicates CML has three phases: chronic, accelerated, and the blastic phase or blast crisis. The accelerated phase can last weeks to months. In the chronic phase the involvement is usually limited to blood, bone marrow and spleen although the liver may be infiltrated. During the blastic phase, lymph nodes and tissue may be involved. The blastic phase is a disease progression from the chronic phase. The disease, however, remains the same histology, chronic myelogenous leukemia.

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

This case represents a multiple primary per Rule M15 which states you are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14.

The histology for the first primary is coded to 9875/3 [chronic myelogenous leukemia, BCR-ABL1 positive].

The histology for the second primary is 9811/3 [B lymphoblastic leukemia/lymphoma, NOS] in the absence of further documentation that the B-ALL was also positive for the t(9;22) translocation.

The histology code 9806/3 [Mixed phenotype acute leukemia with t(9;22)(q34;q11.2); BCR-ABL1] cannot be used for the second primary because there is no documentation that the B-ALL diagnosed on 04/15/2010 also had the t(9;22) translocation and this histology cannot be used in patients ." Per the Definition section in the Heme DB, in order to use histology code 9806/3 "This leukemia meets the criteria for mixed phenotype acute leukemia (MPAL) in which the blasts also have t(9;22) translocation of BCR-ABL1 rearrangement. Some patients with chronic myeloid leukemia may develop or even present with a mixed blast phase that would meet criteria for MPAL; however, this diagnosis should not be made in patients known to have had CML."

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.

2010
20100068 Histology--Heme & Lymphoid Neoplasms: How is this field coded for a JAK-2 positive myeloproliferative disorder, NOS, that is never specified as acute or chronic but was treated with Hydrea? See Discussion. The hematology oncologist referred to the case as a JAK-2 positive myeloproliferative disorder. It is never called acute or chronic. JAK-2 test was positive for mutation, and the bone marrow report indicates, "Morphological features can be seen in myeloproliferative neoplasm." Flow cytometry report indicates, "The flow data demonstrate neutrophilia with left shift. Lymphocytes are composed of a mixed population of T and B-cells with some atypical B-cells." The patient is subsequently treated with Hydrea.

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

Code the histology to 9975/3 [myeloproliferative/myelodysplastic neoplasm, unclassifiable] which is a new code implemented in 2010. Myeloproliferative disorder NOS is equivalent to myeloproliferative disease which is listed as a synonym for code 9975/3.

When the disease is diagnosed very early, it may manifest symptoms of two or more specific myeloproliferative neoplasms. As the disease progresses, it will manifest the symptoms of one of the specific MPN subtypes. When a more specific diagnosis becomes available, change the histology code to the more specific MPN code as directed in the PH rules. That is the scenario you describe. JAK-2 is positive, but the physician does not designate PV or ET. Hydrea is treatment for both PV and ET. In the future, the specific type of MPN may be diagnosed. In the interim, code the only diagnosis you have, MPN, NOS.

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.

2010
20100036 Behavior--Lung: Can an in situ behavior code be used for a bronchioalveolar carcinoma of the lung when the pathologist appears to use the term bronchioalveolar to describe an in situ pattern of growth exhibited by an adenocarcinoma? Is the use of the term "pattern" in this situation indicative of in situ tumor? See Discussion.

In ICD-O-3, bronchioloalveolar adenocarcinoma is described only by behavior code 3 (invasive). Would the behavior be coded as in situ for the following cases?

Example 1: Left lower lobe, partial resection shows bronchioloalveolar carcinoma with focal areas of fibrosis (see comment). Comment: Although the possibility that these areas represent stromal invasion can not be excluded, we favor the interpretation that these areas do not represent true invasion. Synoptic summary: Minimal pathologic stage: Local Extent.

Example 2: Lung tumor described as adenocarcinoma, predominantly bronchoalveolar pattern. For most sites, the term pattern is used only for in situ cancer and is not a specific term used for invasive tumors. Is the use of the term "pattern" in this situation indicative of in situ tumor?

Code the behavior indicated in the pathology report. If the pathologist states the bronchioloalveolar carcinoma is in situ, apply the ICD-O-3 matrix rule and assign 8250/2. Otherwise, code 8250/3. Do not use the term "pattern" to infer in situ behavior.

Code behavior /3 for both examples based on information provided.

2010
20100105 Surgery of Primary Site--Brain and CNS: Is "debulking" of a primary brain tumor coded to 21 [subtotal resection of tumor] or 30 [gross resection of tumor]? Assign code 21 [subtotal resection of tumor, lesion, or mass]. Debulking removes as much of the tumor volume as possible in cases where it is not possible to remove the entire tumor. Debulking should improve the effectiveness of subsequent radiation therapy and/or chemotherapy. 2010
20100103 Reportability--Corpus uteri: Is gestational trophoblastic neoplasia reportable if there is no mention of metastasis but the patient has been treated with chemotherapy? See Discussion.

Per SINQ 20021106, for tumors diagnosed prior to 2007, a clinical diagnosis of metastatic gestational trophoblastic disease was to be coded to histology 9100/3 [Choriocarcinoma]. "Gestational trophoblastic neoplasia includes the diagnosis of choriocarcinoma."

Do not report gestational trophoblastic neoplasia unless stated to be malignant. 2010
20100090 MP/H Rules/Histology: How is histology coded for a diagnosis of "poorly differentiated endometrioid adenocarcinoma intermixed with osteoid sarcomatous component, consistent with malignant mixed mullerian tumor with heterologous (osteosarcoma) elements"? Is malignant mixed mullerian tumor synonymous with carcinosarcoma? See Discussion. Given that there is no mixed code for these histologies, can the numerically higher code be used per H17 (malignant mixed mullerian tumor [8950/3]) using the logic of the MP/H rule for other sites? If so, should this histology be coded as 8980/3 [carcinosarcoma] rather than 8950/3 [malignant mixed mullerian tumor]? For cases diagnosed 2007 or later, code histology to 8980/3 [carcinosarcoma]. Recent literature states that carcinosarcoma is synonymous with mixed mullerian tumor. Mixed mullerian tumor is an obsolete term and should not be used. 2010
20100099 Histology--Heme & Lymphoid Neoplasms: Should all cases of precursor B acute lymphoblastic leukemia diagnosed 1/1/10 and later with histology coded to 9836/3 have the values changed to 9811/3 per the Heme DB Abstractor Notes section or should they remain coded 9836/3.

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

For cases diagnosed 2010 and forward, code histology to 9811/3 [B lymphoblastic leukemia/lymphoma, NOS] which is the new classification for pre-BALL. The histology code 9836/3 is obsolete as of 2010 and should not be used for cases with diagnosis date after 12/31/2009.

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.

2010
20100071 Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned for a patient diagnosed in February 2010 with a plasmacytoma of the frontal skull followed by a diagnosis of smoldering myeloma by bone marrow biopsy? See Discussion.

The patient had a diagnosis of solitary plasmacytoma of the right frontal skull in 2/2010 that was totally resected (the cranial specimen final diagnosis was plasmacytoma). The patient received radiation. While undergoing radiation, the patient was seen by a medical oncologist who did a bone marrow biopsy that revealed 10-15% plasma cells, and was called smoldering myeloma. Watchful waiting was recommended. In 8/2010, the patient had multiple lytic lesions and began systemic treatment.

Per rule M15 and the Multiple primary calculator, 9731/3 [plasmacytoma] and 9732/3 [smoldering myeloma] is accessioned as two primaries. When the manual states, "Use the Hematopoietic Database to determine the primary site and histology when PH1-PH29 do not apply," does this mean to use the calculator not the database itself? By the old rules this was one primary. Did this change for cases diagnosed 1/1/10 and later? Which M rule is the correct rule to apply?

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

The smoldering myeloma is a second primary per Rule M10. Accession as multiple primaries because this case was originally diagnosed as a chronic neoplasm (plasmacytoma)phase and there was a second diagnosis of an acute neoplasm (multiple myeloma) more than 21 days after chronic diagnosis. See note 1 which indicates, "This is a change from previous rules." Note that the MP rules and the MP calculator in the Heme DB agree.

When the rules tell you to go to the DB to determine the histology and primary site, you use the DB information. (Don't forget to check the Abstractor Notes). The multiple primaries calculator is used to determine the number of primaries to abstract. Always use the M rules before using the MP calculator.

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.

2010