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Report Produced: 02/10/2026 06:51 AM

Report Question ID Question Discussion Answer Year
20110020 Heme & Lymphoid Neoplasms: How is cancer status to be coded when a patient diagnosed with MDS, undergoes treatment, but the MDS subsequently transforms to AML? If the bone marrow no longer shows evidence of MDS, the cancer status for the MDS is disease-free. When cancer status is coded as disease-free (NED), it means that currently there is no clinical evidence of this disease (MDS). 2011
20110095 Reportability/Histology: Is the diagnosis "low-grade neuroendocrine neoplasm/carcinoid tumor with expression of gastrin (consistent with gastrinoma)" reportable with the histology code 8240/3 [carcinoid] or 8153/3 [malignant gastrinoma]? See Discussion. A carcinoid tumor (8240/3) is reportable but a gastrinoma, NOS (8153/1) is not.

Code histology to 8153/3 [malignant gastrinoma].

According to the WHO Classification of Tumors of the Digestive System, pages 64-65, carcinoid is a synonym for gastric neuroendocrine tumor (NET) and gastrinoma is synonymous with gastrin-producing NET. Gastrin-producing NET (gastrinoma) is coded 8153/3.

2011
20110081 MP/H Rules/Histology--Pancreas: What is the correct histology code for pancreatic neoplasia III (PanIN III) for cases diagnosed in 2007 and later?

Code histology for PanIN-III to 8148/2 [Glandular intraepithelial neoplasia, grade III]. The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology.

For cases diagnosed 2007 or later, the following steps are used to determine the histology code:

Open the Multiple Primary and Histology Coding Rules manual. For a pancreas primary, use the Other Sites Histo rules to determine the histology code because pancreas does not have site specific rules.

Go to the SINGLE TUMOR: IN SITU ONLY module, start at rule H1. Code 8148/2 [Glandular intraepithelial neoplasia, grade III]. There is only one histologic type identified.

In the next version of the MP/H rules, the H22 rule "Code 8148/2 (Glandular intraepithelial neoplasia grade III) for in situ glandular in sites such as the (PAIN III)" will be included under H2 as well. Currently the rule is only in the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module and should also be include under the SINGLE TUMOR: IN SITU only module.

2011
20110084 Histology--Heme & Lymphoid Neoplasms: Is histology coded to 9684/3 [malignant lymphoma, diffuse large B-cell, immunoblastic NOS] for a biopsy that reveals "diffuse large B-cell lymphoma, immunoblastic variant"?

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

Code histology to 9680/3 [diffuse large B-cell lymphoma]. Code 9684/3 [malignant lymphoma, diffuse large B-cell, immunoblastic NOS] is obsolete for cases diagnosed 2010 and later per the Heme DB.

Under the Definitions section in the Heme DB, it states that this is a lymphoma with diffuse proliferation of large neoplastic B lymphoid cells with nuclear size exceeding macrophage nuclei, more than twice size of normal lymphocytes. Normal architecture of node or extranodal tissue replaced in diffuse pattern. Morphologic variants: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.

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.

2011
20110043 MP/H Rules/Histology--Breast: Which specimen should be used to code histology when a core biopsy revealed an unknown sized DCIS, comedo type and the partial mastectomy specimen showed only a 2mm focus of DCIS, solid pattern? See Discussion.

Should the histology be coded from the needle core biopsy or the partial mastectomy specimen? Patient had a needle core biopsy that revealed DCIS, comedo type, cribriform pattern, no tumor size given. Subsequently, the patient had a partial mastectomy which revealed DCIS, noncomedo type, solid pattern, largest focus of DCIS was 0.2cm.

Should the histology code be 8501/2 or 8230/2? The microscopic description on the partial mastectomy says that the previous core needle biopsy site revealed several foci of DCIS.

 Code the histology from the most representative specimen (the specimen with the MOST tumor tissue). Compare the size of tumor in the two specimens. If the tumor size is not available for both procedural specimens, code histology from the mastectomy specimen rather than the needle biopsy specimen. 2011
20110101 Primary site--Heme & Lymphoid Neoplasms: Is the primary site coded to C778 or C779 for a diffuse large B cell lymphoma with abdominal lymph node, neck lymph node, and spleen involvement?

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

Use Rule PH21 to code the primary site to C778 [lymph nodes of multiple regions]. The spleen is not listed under the Primary Site(s) section in the Heme DB for diffuse large B-cell lymphoma. Per Rule PH21 code the primary site to multiple lymph node regions, NOS (C778) when multiple lymph node regions, as defined by ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated. The spleen is a primary site for only a few lymphomas (noted in the Heme DB). Because the spleen filters blood, it is often reactive (splenomegaly) or frankly involved with the lymphoma. That reaction or involvement, however, does not affect the primary site coding. Only the involved nodes are used in 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.

2011
20110120 Surgery of Primary Site--Breast: How is this field coded for a BILATERAL nipple sparing mastectomy given that SINQ 20110094 indicates that a nipple sparing mastectomy should be coded to 30 [subcutaneous mastectomy] but there is no code for bilateral subcutaneous mastectomies? The Surgery of Primary Site field reflects the type of surgery performed on the primary site. In this case, a nipple sparing mastectomy should be coded to 30 [subcutaneous mastectomy]. If the details of the case indicate this is a single primary involving both breasts, code removal of involved contralateral breast under the data item Surgical Procedure/Other Site. 2011
20110124 MP/H Rules/Histology--Lung: How is the histology coded for a single tumor of the left lower lobe that is stated to be a sarcomatoid carcinoma with features of carcinosarcoma, spindle cell carcinoma, poorly differentiated squamous cell carcinoma and giant cell carcinoma?

Histology is sarcomatoid carcinoma [8033/3]. This case was sent to the lung physician experts because of the difficulty in trying to apply the current MP/H rules. Their rationale for the coding decision follows:

"This pathologist has diagnosed a sarcomatoid carcinoma, and then listed all of the subtypes associated with that diagnosis. I would go with the primary diagnosis, sarcomatoid carcinoma. The inclusion of squamous cell differentiation would exclude spindle cell and giant cell as diagnoses, so the pathologist is using them descriptively. We have no basis for picking one of the subtypes and sarcomatoid carcinoma covers all of the diagnoses given."

See the glossary in the Lung Equivalent Terms and Definitions for Sarcomatoid carcinoma: A group of tumors that are non-small cell in type and contain spindle cells and/or giant cells. Depending on the histologic features the tumor may be designated: pleomorphic carcinoma [8022/3]; spindle cell carcinoma [8032/3]; giant cell carcinoma [8031/3], carcinosarcoma [8980/3]; or pulmonary blastoma [8972/3].

2011
20110028 MP/H Rules/Histology--Thyroid: How many primaries and what histology(ies) are coded when the pathology report shows a, 1.9 cm Hurthle cell carcinoma, probable follicular variant of papillary carcinoma, with Hurthle cell features and a 2 mm focus of follicular variant, papillary carcinoma? See Discussion.

Right lobectomy pathology report final diagnosis states: 1.9 cm Hurthle cell carcinoma (see comment). Comment: histologic diagnosis Hurthle cell carcinoma, probable follicular variant of papillary carcinoma with Hurthle cell features. Subsequent left lobectomy one week later showed a 2 mm microscopic focus of follicular variant of papillary carcinoma, encapsulated.

None of the rules seems to fit this scenario. The number of primaries reported for this case depends on the histology coded for each tumor. Does Rule M6 (Follicular and papillary tumors in the thyroid within 60 days of diagnosis are a single primary.) or M17 (Tumors with ICD-O-3 histology codes that are at the first (xxx), second (xxx) or third (xxx) number are multiple primaries.) apply? Does the case represent a single primary because both are papillary/follicular tumors or two primaries because one is Hurthle cell carcinoma, and one is papillary/follicular carcinoma (different histology at second digit)?

To code the histology for the larger tumor in the right lobe, which rule do we apply? Rule H11 (single histology of Hurthle cell carcinoma [8290] per path final diagnosis), H15 (tumor has both follicular and papillary carcinoma [8340], per path comment), or H17 (numerically higher code for 8340 because there is both Hurthle cell and papillary/follicular carcinoma)?

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary.

The Hurthle cell carcinoma is a synonym for follicular carcinoma according to the WHO. See page 67 of the 2004 WHO Classification of Tumours of Endocrine Organs. The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. For a thyroid primary, use the Other Sites MP rules under one of the three formats (i.e., flowchart, matrix or text) to determine the number of primaries because the thyroid does not have site specific rules.

Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.

. Follicular and papillary tumors in the thyroid within 60 days of diagnosis are a single primary. The patient has a tumor in each lobe of the thyroid with the same histology. Abstract a single primary for this patient.

Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.

Start with the SINGLE TUMOR: INVASIVE ONLY module, Rule H8. The rules are intended to be reviewed in consecutive order within the module from Rule H8 to Rule H18. You stop at the first rule that applies to the case you are processing.

. Code follicular and papillary carcinoma of the thyroid to papillary carcinoma, follicular variant (8340). Use the comment to code the histology for the right lobectomy. "Probable" is an acceptable ambiguous term to use for coding histology. (See the Ambiguous Terms Used to Code Histology section of the General Instructions in the MP/H manual.)

 2011
20110126 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned, and what rule applies, when the patient has a history of diffuse large B-cell lymphoma diagnosed in 2003, a follicular lymphoma diagnosed in 2009, and another diagnosis of follicular lymphoma in 2010? Is the application of the multiple primary rules effected if it is unknown whether the patient was ever disease free? See Discussion.

Patient has a history of diffuse large B-cell lymphoma involving multiple lymph node regions (site C778) with bone marrow involvement diagnosed in 2003 and a history of follicular lymphoma confined to the thyroid and neck lymph nodes diagnosed in 2009. In 2010 the patient was diagnosed with follicular lymphoma in the inguinal and abdominal lymph nodes.

The 2003 diagnosis of DLBCL and the 2009 diagnosis of follicular lymphoma are the same primary according to the 2009 rules, the Single Versus Subsequent Primaries Table.

What rule is used to determine whether the 2010 diagnosis of follicular lymphoma represents a new primary? Which histologies are compared using the rules: the 2010 follicular lymphoma diagnosis to the 2009 follicular diagnosis or the 2010 follicular lymphoma diagnosis to the 2003 DLBCL diagnosis?

This case should be accessioned as one primary.

Reportability is determined by the year of diagnosis. The original DLBCL was diagnosed in 2003 and the follicular lymphoma in 2009. The pre-2010 rules are used for both cases. Per the Single Versus Subsequent Primaries Table, these are the same primary. It is reported with the histology 9680/3 [diffuse large B-cell lymphoma]

Do not compare the DLBCL diagnosed in 2003 and the follicular lymphoma diagnosed in 2010 because the determination of the number of primaries for the two specific histologic types was done (as it should have been) using the rules in effect in 2009 when the follicular lymphoma was first diagnosed. The determination of a single or multiple primaries is made the first time the patient presents with the two different diseases; it is not changed when the same disease process reappears after 2010.

2011