System Guide
Back to Search Results

Search Results

Display Options
Display Options
Select Fields
Export Results to CSV Create Report 0
+ Add all results to report

Report Produced: 02/10/2026 03:12 AM

Report Question ID Question Discussion Answer Year
20100094

Primary site--Heme & Lymphoid Neoplasms: Is a peripheral blood equivalent to bone marrow biopsy for the purposes of Rule PH26 and code the primary site to C421 [Bone marrow] for a marginal zone lymphoma found in peripheral blood when there was no additional workup (e.g., scans, etc.) for this case?

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]. Our hematopoietic specialty physicians state that involvement of peripheral blood is equivalent to bone marrow involvement because the marrow produces blood. In the absence of any other involvement, per Module 7 (Coding primary sites for lymphomas) Rule PH26, it states to code the primary site to bone marrow when the only involvement is bone marrow.

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
20100088 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient has 2005 diagnosis of multiple myeloma diagnosed returns in 2010 with extramedullary plasmacytoma and a bone marrow biopsy showing plasma cell dyscrasia that is clinically stated to "consistent with a relapse of myeloma"? See Discussion.

Patient was diagnosed in 2005 with multiple myeloma and following stem cell transplant 2005 was in complete remission.

On 2/1/10 an excisional biopsy of a soft tissue right flank mass showed plasmacytoma. On 3/2/10 the bone marrow biopsy was stated to be consistent with plasma cell dyscrasia. An outside attending physician stated the bone marrow biopsy was consistent with a relapse of myeloma. There was no radiologic evidence of disease elsewhere as of Feb 2010, only the soft tissue right flank mass. Patient initially presented for post-op radiation to the right flank and was treated 3/29/10. On 8/6/10 a biopsy of a right perinephric mass was positive for plasmacytoma. Subsequent xray on 8/16/10 of the right tibia and fibula showed lytic lesion consistent with progression of myeloma.

Using the Hematopoietic Database, the plasmacytoma in 2/1/10 is a second primary. How do the rules apply to the perinephric soft tissue disease and right tibia lesion? Are they separate new primaries? Or is all of this simply a recurrence of the original 2005 diagnosis as the attending physician states?

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

Accession a single primary with the histology coded to 9732/2 [multiple myeloma]. The disease discovered in 2010 represents further advancement of former disease. Per the Abstractor Notes section in the Heme DB, it states that bone marrow involvement, lytic bone lesions, and bone tumor masses of plasma cells are common. Under the Recurrence and Metastases section in the Heme DB it further states that extramedullary (in tissue other than the bone) involvement is a generally a manifestation of advanced disease. This case is an example of such a situation.

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
20100056

Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a case with pathologic diagnosis of "anaplastic large cell lymphoma, ALK-negative" involving the brain and a clinical statement of involvement in the right inguinal lymph nodes and the right lower extremity by a cutaneous lymphoma? See Discussion.

The final diagnosis on the pathology report for a brain biopsy is "Anaplastic large cell lymphoma, ALK-negative." Per a progress note: right inguinal lymphadenopathy. CT scan is consistent with multiple lymph node groups enlarged. Right lower extremity cutaneous nodular lesion; cutaneous lesions likely cutaneous lymphoma.

Should the histology be coded 9702/3 [anaplastic large cell lymphoma, ALK-negative], and the primary site C447 [skin of leg]? Or is the physician using "cutaneous lymphoma" as a general term indicating infiltration and the primary site is really C779 [lymph nodes, NOS]?

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

Code to primary site to C447 [skin of leg]) per Rule PH25 and histology to 9702/3 [anaplastic large cell lymphoma, ALK-negative]. Per the Abstractor Notes section in Heme DB, these are the usual presentations for this disease. It also states this disease presents with peripheral node involvement and is often generalized with infiltrates in the bone marrow, liver, spleen, and extranodal tissue. Less frequently involved sites are lung, salivary gland and CNS.

Per PH25, code the primary site to the organ when the lymphoma is present in an organ (skin, right leg) and that organ's regional lymph nodes (inguinal). Distant lymph nodes or other organs may also be involved, but should be disregarded for coding primary site.

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
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
20100063 Primary Site-Lung: Can you use a lung subsite code for a histologically confirmed lung primary when a CT scan indicates a sized mass located in one lobe of the lung as well as "too numerous to count nodules" through one or both lungs? See Discussion. For example, chest CT shows "1.6 cm RUL suspicious mass and too numerous to count nodules throughout both lungs." Core biopsy of mass in the RUL compatible with adenocarcinoma. For lung primaries with one large mass and numerous nodules, code the primary site to the subsite where the large mass is located. For your example, code the primary site to C341 [upper lobe of lung]. Note: This answer does NOT mean that the other nodules are primary or metastatic cancer. 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
20100026 Multiplicity Counter--Kidney, Renal Pelvis: How many times is this field updated after an invasive primary is originally diagnosed? Should subsequently diagnosed in situ tumors to be included in this field? See Discussion. How should the Multiplicity Counter be coded when a patient has a renal pelvis primary [C659] diagnosed 1/23/08. The patient had one tumor, invasive grade 3 of 3 papillary urothelial carcinoma arising in the depth of a calyx in mid portion of kidney. In 6/1/09, a TURBT showed three separate high grade urothelial carcinoma in-situ lesions on the right side of the bladder, the largest tumor being 7mm. In 2/8/10, another TURBT showed one lesion on the left side of bladder, high grade urothelial carcinoma in-situ, tumor was 4mm. These are all a single primary per rule M8.

Code multiplicity counter 04. Count both invasive and in situ tumors.

Multiplicity counter would have been coded 01 in 2008. Add the three in situ tumors diagnosed in 2009 to the first tumor and update multiplicity counter to 04. Make only one update to multiplicity counter. Because the multiplicity counter was updated once, the fifth tumor diagnosed in 2010 does not need to be added.

2010
20100109 Reportability--Ovary: Does the ICD-O-3 term "stromal endometriosis" [8931/3] always imply a reportable malignant disease process if the pathologist also states there is "no evidence of carcinoma" in the same report? See Discussion.

ROS Final Diagnosis: LSO: Ovary with an endometriotic cyst (1.2 cm) and stromal endometriosis with multifocal papillary syncytial eosinophilic, clear cell and tubal metaplasia, no evidence of carcinoma.

COMMENT: There is extensive endometriosis involving the ovarian stroma and the ovarian surface. The ovarian stroma contains multiple cystic endometrial glands and surrounding endometrial type stroma with variable amounts of hemorrhage. There are non-cystic foci of endometriosis comprised of small, irregular glandular structures within the stroma. The lining of larger cyst/cysts is involved by a single layer of cuboidal to columnar cells with markedly eosinophilic cytoplasm in areas of serous (tubal) metaplasia and papillary projections suggestive of papillary syncytial metaplasia. Within these areas there is epithelial tufting and stratification, raising the consideration of proliferative/borderline change (which we cannot entirely exclude), however, given the background of endometriosis and morphologic similarity to papillary syncytial metaplasia in the endometrium, we favor that this is a non-neoplastic reactive change. There is no evidence of carcinoma.

 This case is not reportable. The pathologist states that there is no evidence of carcinoma. The ICD-O-3 matrix system applies, giving the pathologist the final say on behavior. 2010
20100104 Grade--Heme & Lymphoid Neoplasms: Is the phrase "aberrant T-cell expression" enough to code the grade field to T-cell when the final diagnosis on the pathology report is "AML with aberrant T-cell antigen expression"? Yes. Code grade to 5 [T-cell]. The T cell receptor, or TCR, is a molecule found on the surface of T lymphocytes (or T cells). 2010