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For cases diagnosed 2007 or later:

Code histology to 8244/3 [composite carcinoid]. Rule H9 applies: Code 8244 [composite carcinoid] when the diagnosis is adenocarcinoma and carcinoid tumor. WHO describes these tumors as "mixed adenoneuroendocrine carcinoma (MANEC)." They have components of adenocarcinoma mixed with high-grade neuroendocrine carcinoma (NEC), which can be either small cell or large cell.

The next version of the MP/H rules for colon will make this clear by adding a note regarding this issue to Rule H9.

This tumor in 2010 represents a recurrence; it is not a new primary. This second tumor would be coded as a new primary ONLY if the pathology report states that it originated in breast tissue that was still present on the chest wall. When there is no mention of breast tissue in a subsequent resection, the later occurring tumor is regional metastases to the chest wall (i.e., a recurrence of the original tumor).

In turn, this means that there was at least a focus of invasion present in the original tumor that was not identified by the pathologist. The behavior code on the original abstract must be changed from a /2 to a /3 and the stage must be changed from in situ to localized.

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

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

Langerhans cell histiocytosis (LCH) [9751/3] is reportable to all agencies starting for cases diagnosed 1/1/2010 and later. See Appendix D: New Histology Terms and Codes.

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.

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.

For cases diagnosed 2007 or later: The 2011 diagnosis of adenocarcinoma, NOS in the left lower lobe lung is a separate primary.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. For a lung primary, use the Lung Multiple Primary rules to determine the number of primaries.

The 2010 right lung bi-lobectomy showed two separate tumors that were determined to be two primaries: clear cell adenocarcinoma [8310/3] and adenocarcinoma, NOS [8140/3]. The histology of the new left lung mass is adenocarcinoma, NOS [8140/3].

Start at Rule M3 using the MULTIPLE TUMORS module because this patient has more than one tumor. The rules are intended to be reviewed in consecutive order within the module (i.e., from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient has two tumors in each lung with ICD-O-3 histology codes that are different at the second (xxxx) digit. Abstract the LLL adenocarcinoma as a new primary [C343, 8140/3].

The patient has two tumors in each lung. The right lung showed adenocarcinoma and clear cell adenocarcinoma. The two tumors in the left lung were both adenocarcinomas. Clear cell adenocarcinoma [8310] on the right is different at the second digit from adenocarcinoma [8140] on the left. Rule M12 cannot be applied to this case, because Rule M7 is the first rule that applies to this case when processing the rules in consecutive order.

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

Myelodysplastic disorder is a synonym for myelodysplastic syndrome (MDS). If no further workup is done or no additional information can be found, code the histology of myelodysplastic disorder to 9989/3 [MDS] for cases diagnosed 1/1/2010 and later.

Refer to the Abstractor Notes section in the Heme DB, Abstractor Notes for MDS. Myelodysplastic (disorder) syndrome is a NOS term. Usually when this diagnosis is made, the physician will conduct further tests to determine a more specific disease in the Myeloproliferative Neoplasms group. Other specific histologies include: refractory anemia with unilineage dysplasia, refractory anemia with ring sideroblasts, refractory cytopenia with multilineage dysplasia, refractory anemia with excess blasts, myelodysplastic syndrome with del(5q), childhood myelodysplastic syndrome. If a more specific disease is diagnosed, code to that specific neoplasm.

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.

Code the primary site to main bronchus [C340].

Primary small cell carcinoma in the thymus/mediastinum is rare. A bronchial lesion with extension into the mediastinum is much more likely. In a case like this, it is difficult to be sure exactly where the tumor arose, however, it is recommended the default site be the main bronchus when there is no information to the contrary.

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

Ambiguous terms are not used to code a specific histology. This includes ambiguous terminology used as a result of immunophenotyping or genetic studies. However, a definitive clinical diagnosis can be used to code a more specific histology.

In this example, the histology is coded to non-Hodgkin lymphoma, NOS [9591/3] because the pathology final diagnosis was non-Hodgkin lymphoma, NOS even though it was followed by further genetic and immunohistochemistry studies that were "compatible with" (ambiguous terminology) follicular lymphoma.

However, if there was a subsequent non-ambiguous clinical diagnosis, the histology would be coded to the more specific diagnosis. For example, if the pathology final diagnosis was non-Hodgkin lymphoma, NOS, and there was a subsequent clinical diagnosis of follicular lymphoma or the patient was treated for follicular lymphoma, then the histology should be coded to 9690/3 [follicular lymphoma, NOS]. Document either of these in a text field to support the histology code chosen. Follicular lymphoma is a specific type of non-Hodgkin lymphoma. If you do have a confirmed diagnosis of follicular lymphoma, code that specific cell type per rule PH29.

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.

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

Accession a single primary per Rule M3. Code histology to 9891/3 [acute monocytic leukemia] diagnosed in 2009 and primary site to C421 [bone marrow].

Per Rule M3 a single primary is reported when a sarcoma is diagnosed simultaneously or after a leukemia of the same lineage. Histology 9891/3 [acute monocytic leukemia] is listed as one of the histologies in the "same lineage." Myeloid sarcoma (9930/3) diagnosed simultaneously with or after acute myeloid leukemia (9861/3) or another leukemia of the myeloid lineage (9840/3, 9865/3-9867/3, 9869/3-9874/3, 9891/3, 9895/3-9898/3, 9910/3, 9911/3 and 9931/3).

NOTE: Under the Alternate Names section of the Heme DB, granulocytic sarcoma is a synonym for myeloid sarcoma.

Per PH10, code the primary site C421 [bone marrow] and code the histology acute myeloid leukemia, NOS (9861/3) or any of the specific AML histologies (9840/3, 9865/3-9867/3, 9869/3-9874/3, 9891/3, 9895/3-9898/3, 9910/3, 9911/3 and 9931/3) when the diagnosis is myeloid sarcoma (9930/3) AND there is a simultaneous or previous diagnosis of acute myeloid leukemia.

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.