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: 09/13/2025 14:27 PM

Report Question ID Question Discussion Answer Year
20110058 Date of diagnosis/Flag: Will the Date of Diagnosis Flag ever be used if the instructions for coding Date of Diagnosis are followed? See Discussion.

If an abstractor follows the instructions for coding the Date of Diagnosis and can at least estimate a year of diagnosis, in what scenario will the Flag be used?

Per the 2010 SEER Manual,

Page 49 Date of Diagnosis, second paragraph, "Regardless of the format, at least Year of diagnosis must be known or estimated. Year of diagnosis cannot be blank or unknown." The manual gives the following guidelines for coding diagnosis date/flag:

Page 50, Coding Instructions:

3. If no information about the date of diagnosis is available

a. Use the date of admission as the date of diagnosis

b. In the absence of an admission date, code the date of first treatment as the date of diagnosis.

Page 51, Coding Instructions:

9. Estimate the date of diagnosis if an exact date is not available. Use all information available to calculate the month and year of diagnosis.

Page 53, Date of Diagnosis Flag, Coding Instructions:

Always leave blank. Date of Diagnosis will always be a full or partial date recorded.

 The date of diagnosis flag should always be blank. 2011
20110007 MP/H Rules/Multiple primaries--Bladder: How many primaries are to be abstracted and how are the histologies coded when a bladder resection demonstrates tumor with invasive small cell neuroendocrine carcinoma [8041/3], high grade papillary urothelial carcinoma in situ [8130/2], adenocarcinoma in situ [8140/2], and multifocal flat urothelial carcinoma in situ? See Discussion.

Are the areas of in situ tumor to be ignored or would MP/H Rule M9 apply?

Ignore the in situ histologies. This is a single primary. Code the histology to invasive small cell neuroendocrine carcinoma [8041/3]. 2011
20110148 First course treatment/Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned and how is treatment coded when follicular lymphoma diagnosed in December 2009 is treated with CHOP and a subsequent December 2010 diagnosis of diffuse large B-cell lymphoma is treated with chemotherapy and a bone marrow transplant? See Discussion.

A follicular lymphoma [9690/3] involving multiple lymph nodes was diagnosed on 12/2/2009. The patient had no bone marrow involvement and was treated with CHOP as first course treatment. In October 2010, the patient was put on maintenance Rituxan but disease progression was noted in November 2010. A biopsy of a mesenteric lymph node in December 2010 showed diffuse large B-cell lymphoma [9680/3]. The patient subsequently had chemotherapy and an autologous bone marrow transplant.

According to the Multiple Primaries Calculator in the Heme DB, the DLBCL is a new primary but the physician calls the diagnosis of DLBCL a transformation from the follicular lymphoma diagnosed in December 2009.

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

This case should be accessioned as two primaries: follicular lymphoma [9690/3] and diffuse large B-cell lymphoma [9680/3] per Rule M10. Per Rule M10, abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm (follicular lymphoma) AND there is a second diagnosis of an acute neoplasm (diffuse large B-cell lymphoma) more than 21 days after the chronic diagnosis.

Record the CHOP as the first course of treatment for the follicular lymphoma because this was the only treatment given for the chronic neoplasm (follicular lymphoma) prior to the transformation to the acute neoplasm (DLBCL). Record the chemotherapy and bone marrow transplant as first course treatment for the DLBCL.

As noted above, follicular lymphoma does transform to DLBCL. This "transformation" is actually a new disease. Follicular lymphoma is a disease in which the lymph nodes have a prominent follicular pattern; DLBCL is a disease with diffuse proliferation of large lymphoid cells. While it is true that follicular lymphoma will transform to DLBCL, this transformation indicates it becomes a different entity.

The DLBCL is coded as a second primary for several reasons: to determine the incidence of follicular lymphomas transforming to DLBCL; survival time can be calculated for the diagnosis of the more aggressive DLBCL; death will be attributed to the DLBCL (for mortality statistics) and not the follicular lymphoma

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
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
20110140 MP/H Rules/Behavior--Breast: How are behavior and histology coded when the pathology report final diagnosis is "ductal carcinoma in situ and lobular carcinoma in situ" if the microscopic examination section of the same pathology report states there are "foci suspicious for microinvasive carcinoma"? See Discussion. The pathology report microscopic examination states, "focally, between ducts involved by DCIS, there are minute tubular structures associated with stromal fibrosis and chronic inflammation. These foci are suspicious for microinvasive carcinoma."

For cases diagnosed 2007 or later, code one primary with histology and behavior coded to 8522/2 [intraductal carcinoma and lobular carcinoma in situ].

The steps used to arrive at this decision are as follows

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Breast Histology rules. The module you use depends on the behavior and number of tumors identified in the primary site. The information provided does not specify whether this was a single tumor with DCIS and LCIS or multiple tumors with DCIS and LCIS. In this case, the number of tumors does not change the histology code for this patient. For this example, assume this disease process was a single tumor.

Start at the SINGLE TUMOR: In Situ Carcinoma Only module. The rules are intended to be reviewed in consecutive order from Rule H1 to Rule H8. Stop at the first rule that applies to the case you are processing. Code the histology as 8522/2 (intraductal carcinoma and lobular carcinoma in situ) when there is a combination of in situ lobular (LCIS) [8520] and intraductal carcinoma (DCIS).

Do not code the behavior as invasive in this case. The pathologist indicated that these findings were "suspicious" but not definite in the microscopic examination. If the pathologist decided that this was truly an invasive tubular element, it would have been included in the final diagnosis.

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
20110071 Primary site: How is this field coded for an adenocarcinoma arising in a chronic perianal fistula without extension to the anal canal, but stated to arise in "ectopic rectal tissue"? See Discussion.

The patient underwent a resection of a perineal mass. Per review of slides it was stated to be "primary mucinous adenocarcinoma arising in a chronic perianal fistula." The adenocarcinoma was invasive into the dermal connective tissue and skeletal muscle, but there was no extension into the anal canal. The discharge diagnosis from the reporting facility called this adenocarcinoma of "ectopic rectal tissue in perianal area."

Should the primary site be coded to skin based on the dermal involvement and lack of anal or rectal involvement? Or, should the primary site be coded to rectum based on the physician's assessment that this adenocarcinoma arose in ectopic rectal tissue?

For cases diagnosed 2007-2014:

Code the Primary Site field to C210 [Anus, NOS]. This is an unusual and rare presentation. According to our expert pathologist, "There is no ideal site code [for] this case. I would code to C210. In this location it can at least be located by anyone who wants to get a look at such lesions. Because of the unusual location of this tumor, I would like to be able to code it to perineum, but it will be totally lost in those site codes as they represent extensive areas beyond perianal (skin of trunk, soft tissue of pelvis, and pelvis, respectively)... I would not code to rectum [because it would be] lost among too many primary rectal carcinomas."

 2011
20110013

MP/H Rules/Histology--Testis: Which MP/H rule applies in coding the histology described as a "malignant mixed germ cell tumor with the following features: Histologic type: embryonal carcinoma (97%) and yolk sac tumor (3%)"? See Discussion.

Per MP/H rule H16, code the appropriate combination/mixed code (Table 2) when there are multiple specific histologies or when there is a non-specific histology with multiple specific histologies. The combination embryonal carcinoma and yolk sac tumor is not listed in Table 2, even though the pathology report indicates this is a mixed germ cell tumor.

Should rule H17 be applied and the numerically higher histology code be used?

As of 2016: Code histology to 9085/3 [mixed germ cell tumor]. Combine 9065 and 9085 for analysis purposes.                            

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