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Report Produced: 07/22/2025 04:37 AM

Report Question ID Question Discussion Answer Year
20110045 Reportability--Ovary: Is immature teratoma of the ovary reportable if a subsequent comment states that "the teratoma shows immature neuroepithelium, but no malignant elements"? There is conflicting information for this case. The final diagnosis conflicts with the comment. Go back and check with the physician to clarify his/her intent. If no further information can be obtained, the final diagnosis is preferred over the comment. This case is reportable based on the final diagnosis: "immature teratoma." 2011
20110143

Multiple primaries--Heme & Lymphoid Neoplasms: How many and what primary site(s) are to be accessioned when biopsies of clavicular and neck skin lesions are both consistent with mycosis fungoides? See Discussion.

Per the Heme DB and Manual, this is a single primary; however, per the MP/H Rules, this would be multiple primaries. Which rules apply to this case?

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

When there is a question of whether the SEER MP/H Rules or Hematopoietic and Lymphoid Neoplasm Rules apply, check the histology and refer to the Case Reportability Instructions in the Hematopoietic and Lymphoid Neoplasm Manual. All ICD-O-3 morphology codes in the range 9590 - 9992 are included in the Hematopoietic Rules. Mycosis Fungoides [9700/3] is included in this range. Therefore, the SEER MP/H Rules do not apply to mycosis fungoides.

This case should be accessioned as a single primary: mycosis fungoides [9700/3] of the skin, NOS [C449]. Per Rule M2 abstract a single primary when there is a single histology.

Note that in the Primary Site(s) section of the Heme DB, it states the primary site must always be coded to skin (C440 - C449) for mycosis fungoides. Because the primary site is stated in this section of the Heme DB, it is not necessary to use the Primary Site Rules to determine the primary site. Code the primary site to C449 [skin, NOS] because the patient has multiple sites of skin involvement and there is no documentation indicating which subsite of skin was the origin of the mycosis fungoides.

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
20110096 Behavior--Lung: How is behavior to be coded for a diagnosis of adenocarcinoma of a lung tumor that is further classified per the CAP protocol as, "non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)" while the pathologist also classifies the tumor as pT1b, pN0? See Discussion. Is the following case coded with an invasive or in situ behavior when a RUL lobectomy specimen reveals adenocarcinoma and the Histologic Type per the CAP protocol layout is non-mucinous bronchiolo-alveolar carcinoma (adenocarcinoma in situ)? The stage per the pathologist is pT1b, pN0. Per the COMMENT section in the pathology report, "The terminology adenocarcinoma in situ is based on a recent publication in the Journal of Thoracic Oncology (Volume 6, #2, February 2011). Based on this criterion, the behavior represents adenocarcinoma in situ with no evident invasive component." Code the behavior as in situ. The pathologist has the final say on the behavior of the tumor. This pathologist is indicating that in his opinion based on a recent publication, this tumor is in situ. 2011
20110008 MP/H Rules/Histology--Vulva: How is histology coded for VIN III with focal invasion? See Discussion. Per SINQ 20000442, the histology for CIN III with microinvasion is coded to 8077 [squamous intraepithelial neoplasia, grade III] per the matrix system rules, with a behavior code of /3 [malignant]. Coding the histology to 8077/3 per the matrix principle causes IF25_3 and MorphICDO3_P1 edits to fail. Flagging the first error resolves any reporting issue. How is the MorphICDO3_P1 edit resolved? Assign 8076/3 [squamous cell carcinoma, microinvasive] for VIN III with focal invasion. This applies to all terminologies listed under 8077/2. The SINQ question from 2000 will be retired. 2011
20110068 MP/H Rules/Multiple primaries--Bladder: Which multiple primary rule is used to determine the number of primaries to accession when a patient has a papillary transitional cell carcinoma of the bladder diagnosed in 2009 followed by a high grade invasive urothelial carcinoma with neuroendocrine features per immunohistochemistry diagnosed in 2010? See Discussion.

A patient has papillary transitional cell carcinoma of the bladder in March of 2009. In June of 2010 the patient has another TURBT that demonstrates a flat in situ and invasive high grade urothelial carcinoma. The path addendum indicates, "Genzyme IHC show results consistent with high grade invasive urothelial carcinoma with neuroendocrine features." Two months later a liver biopsy shows poorly differentiated malignant tumor. The path addendum indicates, "Genzyme IHC results show metastatic poorly differentiated carcinoma with neuroendocrine features, favor bladder primary."

Is the latter a second bladder primary with histology code 8246/3 [neuroendocrine carcinoma]?

NOTE: Neuroendocrine is not listed as an urothelial tumor in Table 1 of MP/H Rules.

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 2010 diagnosis is urothelial carcinoma. The presence of "neuroendocrine features" does not change the histologic category.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Urinary MP rules under one of the three formats (i.e., flowchart, matrix or text). The rules are intended to be reviewed in consecutive order within the module. You stop at the first rule that applies to the case you are processing.

Start at the MULTIPLE TUMORS module start at rule M3.

. Bladder tumors with any combination of transitional cell carcinoma and papillary transitional carcinoma are a single primary.

2011
20110107 Primary site/Histology--Heme & Lymphoid Neoplasms: How are these fields coded for a precursor T lymphoblastic leukemia involving the bone marrow and peripheral blood (per pathology) with a clinically noted large mediastinal mass and cervical lymphadenopathy? See Discussion. The patient had a large mediastinal mass and cervical lymphadenopathy, however, no biopsy was performed of either area nor was there a specific statement indicating involvement. The bone marrow biopsy showed 100% cellular marrow with involvement by precursor T lymphoblastic leukemia. The peripheral blood also showed precursor T lymphoblastic leukemia. The discharge summary and office notes state the diagnosis as T-cell acute lymphoblastic leukemia.

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

Code the histology to 9837/3 [adult T cell leukemia/lymphoma] and the primary site to C778 [lymph nodes, multiple regions]. Per Rule PH8, code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. A statement of "mediastinal mass" and lymphadenopathy for lymphoma primaries is equivalent to lymph node involvement. To identify the more specific primary site, you need to move to Rule PH21 that indicates you are to code the primary site as 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.

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
20110035 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when both a lymph node biopsy and peripheral blood are positive for CLL/SLL? See Discussion. Per Module 3, Rules PH5 and PH6 in the Hematopoietic Manual, it states that CLL has peripheral blood involvement and SLL does not.

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] and histology to 9823/3 [CLL/SLL]. Per Rule there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s) but as long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow (C421).

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
20110110

MP/H Rules/Multiple primaries--Head & Neck: If a 1991 neuroesthesioblastoma [9522/3] of the nasal cavity has subsequent recurrences of the same histology but later "recurs" in 2008 with "sarcoma, NOS, high grade" on a biopsy and a "high grade fibrosarcomatous transformation of esthesioneuroblastoma" [8810/3] on resection, should the subsequent tumor be reported as a new primary if the clinician continues to refer to the tumor as a "recurrence"? See Discussion.

Are histologic transformations always recurrences of the original tumor?

Assuming the same primary site for the 2008 lesion, according to the current MP/H rules the high grade fibrosarcoma [8810/3] is a new primary per Head & Neck MPH rule 11 because it is a different histology.

The revised MP/H rules will include tables to define tumors that de-differentiate (transform) and recur with what is seemingly a different histology. Although the rules will be changed in the future, we must use the rules in place at this time for this case.

 2011
20110138

First course treatment--Heme & Lymphoid Neoplasms: What is first course of treatment when a patient received multiple different chemotherapy regimens before a complete remission for diffuse large B-cell lymphoma was achieved?

The patient was initially treated with involved field radiation and R-CHOP. The patient still had residual disease and the treatment was changed to RICE. Following RICE, there was still residual disease and the patient underwent another unspecified chemotherapy treatment. The patient was then transferred to a transplant center for pre-transplant chemotherapy and a bone marrow transplant. The patient achieved a complete response after transplant.

Should the R-CHOP and radiation be the first course treatment in a case like this, or would first course treatment include all chemotherapy and the transplant?

For hard-to-treat diseases such as DLBCL, the treatment plan outlined prior to treatment beginning may indicate, "The first course of treatment will be radiation and R-CHOP. If the R-CHOP does not achieve remission, we will use RICE." In other words, the first course treatment plan includes a second round of chemotherapy if the patient has not achieved a complete response after the R-CHOP and radiation. If the treatment plan was documented like this for the patient, the first course treatment includes R-CHOP, involved field radiation and RICE.

However, if there is no initial treatment plan in the medical record, all treatment provided after the date when "residual disease" or "failed to achieve remission" is documented in the medical record is either second or a subsequent course of therapy.

 2011
20110075 Primary site--Heme & Lymphoid Neoplasms: How do you code primary site for a case of "leukemia cutis" when the bone marrow exam is negative for involvement with leukemia?

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] per Rule PH30 which states to use the to determine the primary site and histology when rules PH1-PH29 do apply. Leukemia cutis is the term for a leukemic infiltration of the epidermis, the dermis or the subcutis. This infiltration is easily identified as cutaneous lesions, but the primary site is still bone marrow. This is a type of "metastasis" or spread of the leukemia cells. The "conventional" definition for leukemia cutis is the infiltration of skin from a bone marrow primary. See the Hematopoietic & Lymphoid Neoplasm Coding Manual Glossary.

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