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Report Produced: 02/20/2026 05:11 AM

Report Question ID Question Discussion Answer Year
20100074 Laterality--Melanoma: For a melanoma case, does the term "mid" imply that the tumor is in the midline when the site is the skin of back (trunk)? Yes. When the location is described as mid-back or mid-chest with no indication of left or right, assign laterality code 5 [midline]. 2010
20100066 MP/H Rules/Multiple Primaries--Breast: How many primaries should be accessioned if two tumors are present in the same breast, a 1.7 cm colloid carcinoma and a 1.5 cm colloid carcinoma with infiltrating ductal carcinoma? See Discussion.

If a patient has two masses in the same breast with different histology codes and different sizes, should this be accessioned as two primaries? Or should this be a single primary based on the largest tumor size or numerically higher histology code?

  1. Size 1.7 cm for the largest tumor size, but histology is colloid carcinoma. Histology code: 8480/3.

  • Size: 1.5 cm with colloid with infiltrating ductal carcinoma. Histology code 8523/3.

    		•

    For cases diagnosed 2007 or later, abstract this case as two primaries.

    Mucinous/colloid carcinoma of the breast is rare. The first tumor describes (1.7 cm) fits this criteria because the pathologist simply says mucinous carcinoma. The diagnostic criteria for mucinous carcinoma is that pools of extracellular mucin make up at least 1/3 of the volume throughout the tumor mass. If focal areas are not at least 33% mucinous, the designation is a mixed mucinous/ductal. That fits the second tumor (1.5 cm).

    For this case, you must get the histology codes for both tumors in order to use the Multiple Primary rules. Per H14 the first tumor is coded mucinous carcinoma [8480/3]. Per H17 the second tumor is coded duct carcinoma mixed with any other carcinoma [8523/3]. Now go to the MP rules. Per M12 abstract this case as multiple primaries because the ICD-O-3 histology codes are different at the second and third digit.

    		 2010
    		20100087 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned for one patient with history of marginal zone lymphoma initially diagnosed in 1994, followed by a 2010 diagnosis of large B-cell lymphoma and another patient with both B-cell chronic lymphocytic leukemia/small cell lymphoma (CLL/SLL) and diffuse large B-cell (DLBCL) in 2009? See Discussion.

    Case 1 - Patient has a history of marginal zone lymphoma diagnosed in 1994 with recurrences in 2007 and 2009. The patient now presents for a bone marrow biopsy in May 2010 and is found to have large B-cell lymphoma, transformation. The first primary, marginal zone lymphoma, falls under the 2009 rules and the second primary, large B-cell lymphoma, falls under the 2010 and forward rules?

    Case 2 - Patient was diagnosed with B-cell CLL/SLL and a DLBCL in 2009. If the 2009 rules only apply, these are a single primary. If the patient is admitted and treated in 2010 are the rules still based on the diagnosis date?

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

    Case 1: Accession two primaries per Rule M10 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 first primary is 9699/3 [marginal zone lymphoma] represents a chronic neoplasm and the second primary is 9680/3 [diffuse large B-cell lymphoma] is an acute neoplasm which was diagnosed more than 21 days after the first primary.

    Case 2: Do not use the Heme DB and Manual rules for this case. Both diagnoses were made prior to 2010. The Heme DB and Manual are only effective for cases diagnosed 1/1/2010 and forward. Use the ICD-O-3 Hematopoietic Primaries Table to determine the number of primaries for this case. Per the Table, a second diagnosis of DLBCL [9680/3] following a diagnosis of CLL/SLL [9823/3] is one 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.

    		2010
    		20100043

    Primary site--Heme & Lymphoid Neoplasms: When only pathology reports are available, how should the primary site be coded when a both a bone marrow biopsy and colon biopsy demonstrate "mantle cell lymphoma"?

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

    For this case, code primary site to C189 [colon, NOS] per Rule PH24.

    Mantle cell lymphoma usually begins with lymph node involvement and spreads to other tissue. However, it can begin in a lymphocyte such as those in the GI tract. Per the Abstractor Notes section in the Heme DB, patients usually present with advanced disease. About half will have some combination of B symptoms. Swelling of lymph nodes and spleen are usually present. Bone marrow, liver and GI tract involvement occurs in a very high percentage

    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
    		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
    		20100015

    Type of Multiple Tumors/Multiplicity Counter--Breast. Are the data items "Type of Multiple Tumors Reported as One Primary" and "Multiplicity Counter" related? How should they be coded for breast cases in which there are multiple measured invasive tumors, plus DCIS which is not measured nor stated whether it is separate from the invasive tumors? See Discussion.

    		For example, path report states only "multifocal invasive ductal carcinoma, 1.5 cm and 0.8 cm, and low-grade DCIS." The Multiplicity Counter instructions tell us to ignore/do not count foci that are not measured. Should we interpret this to mean, count only the two invasive foci and ignore the DCIS? Should Type of Multiple Tumors then be coded 30 or 40, because only the invasive tumors are coded in Multiplicity Counter? Code Type of Multiple Tumors 30 [in situ and invasive]. The code in Type of Multiple Tumors may or may not reflect the tumors that were counted in Multiplicity Counter. For this case, it is correct to code 02 in multiplicity counter. 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
    		20100017 MP/H Rules/Multiple primaries--Prostate: Does adenosquamous carcinoma found in the prostate represent a second primary in a patient previously diagnosed with adenocarcinoma of the prostate? See Discussion.

    Patient was diagnosed many years ago with adenocarcinoma of the prostate and treated with hormonal and radiation therapy. The patient recently underwent a TURP and is found to have adenosquamous carcinoma of the prostate. The pathology report comment states squamous carcinoma of the prostate is rare and is often associated with a history of hormonal or radiation therapy. There is no information indicating a history of a squamous carcinoma in the urinary system that could have involved the prostatic urethra.

    Would the MP/H rules make this a second primary with the histology of 8560/3 [adenosquamous carcinoma]?

    		 For cases diagnosed 2007 or later, based on the limited information available for this unusual case, abstract a second prostate primary and code the histology as adenosquamous carcinoma. Rule M3 does not apply in this case. Apply rule M10. 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
    		20100106 Reportability-Bladder: Is a case with a cytology diagnosis, "positive for malignancy, favor low grade papillary urothelial carcinoma" reportable if the diagnosis on a subsequent bladder biopsy showed only "urothelial neoplasm of low malignant potential"? See Discussion.

    On 11/23/09 the patient had urine cytology diagnosis "positive for malignancy, favor low grade papillary urothelial carcinoma." On 12/28/09, the bladder biopsy showed "urothelial neoplasm of low malignant potential."

    SINQ 20081086 only addresses the example of a positive FNA/biopsy followed by a negative resection. Would the previous decision hold for this case when a positive fine needle aspiration biopsy is followed by only a negative biopsy?

    This case is not reportable. The pathology proved the cytology to be incorrect. The pathologic diagnosis is the "gold standard." When cytology and pathology disagree, use pathology.

    		2010