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Report Produced: 09/11/2025 21:25 PM

Report Question ID Question Discussion Answer Year
20120055 Surgery of Primary Site--Kidney, renal pelvis: How do you code a laparoscopic renal mass core biopsy followed by cryoablation of the tumor? See Discussion. The note under the local tumor destruction codes states "No specimen sent to pathology from this surgical event 10-15." The patient had a pathologic specimen submitted from his core biopsy, but this was not a tumor excision or excisional biopsy [codes 20, 26-27]. Is the correct surgery code 13 [cryosurgery] because the tumor was only ablated and not excised, or surgery code 23 [any combination of 20 or 26-27 with cryosurgery] because a pathology specimen was submitted? Code for Surgery of Primary Site to 13 [Cryosurgery]. While the core biopsy provided a pathology specimen, it is not coded as surgery of the primary site. 2012
20120017

Reportability: Is a low-grade neuroendocrine neoplasm with gastrin expression found in a periportal lymph node reportable if the clinical impression is compatible with a gastrinoma? See Discussion.

SINQ 20110095 states that "low-grade neuroendocrine neoplasm/carcinoid tumor with expression of gastrin" is reportable. However, in this case "carcinoid tumor" is not mentioned. Is this case reportable if the expression "carcinoid tumor" is missing in the diagnosis of the pathology report? Also, does the fact that the gastrinoma was found in a lymph node affect reportability?

This is a reportable case. Code the histology as malignant gastrinoma [8153/3].

Gastrinomas are usually malignant. This one is apparently present in a metastatic site (periportal lymph node) which confirms the malignancy.

 2012
20120004 Grade--Heme & Lymphoid Neoplasms: How is grade coded for a malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant?

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

Code grade to 6 [B-cell] for the histology malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant [9680/3]. Under the Definition section for histology code 9680/3 it states there are morphologic variants of the disease: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.

Rule G3 in the Heme Manual confirms the grade listed in the Heme DB under its Grade section for the histology 9680/3. While the patient presented with a variant of DLBCL that is T-cell/histiocyte rich, it is still a B-cell phenotype. The grade is coded accordingly.

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.

2012
20120027 MP/H Rules/Histology--Colon: How is histology coded if a patient has two frank invasive adenocarcinomas in one segment of the colon and multiple tubular adenomas and hyperplastic polyps throughout the entire colon without a diagnosis of familial polyposis [FAP]? See Discussion.

Does Rule H19 apply which indicates the histology is coded to 8221 [adenocarcinoma in multiple adenomatous polyps] because there are multiple polyps (number not specified) throughout the colon? Does tumor have to arise in at least one of the adenomas in order to apply Rule H19?

Or, does Rule H22 apply which indicates the histology is coded to 8140 [adenocarcinoma, NOS] because the adenocarcinomas are both frank invasive adenocarcinomas and not adenocarcinoma arising in an adenoma?

Code the histology as adenocarcinoma, NOS [8140/3].

For cases diagnosed 2007 or later, the steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Colon Histology rules to determine the histology code for this case. The Module you use depends on the behavior and number of tumors identified in the primary site.

Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module Rule H15. The rules are intended to be reviewed in consecutive order from Rule H15 to Rule H24. Stop at the first rule that applies to the case you are processing. Code the histology when only one histologic type is identified. In this case, the only histology present was adenocarcinoma, NOS [8140/3].

Rules H17 through H21 do not apply in this case because there is no malignancy arising in any of the adenomas or polyps scattered throughout the colon.

2012
20120068 Histology--Heme & Lymphoid Neoplasms: What is the correct histology code for a diagnosis of mature B cell leukemia/lymphoma diagnosed only on a peripheral blood smear?

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

Code the histology to 9591/3 [B-cell lymphoma, NOS].

After searching the Heme DB for the term , no B-cell leukemia/lymphoma NOS code is found. However, the diagnosis of B-cell lymphoblastic leukemia/lymphoma is found. This case scenario does not specify that this is a lymphoblastic leukemia/lymphoma; therefore, the histology code 9811/3 [B-cell lymphoblastic leukemia/lymphoma, NOS] cannot be applied.

A subsequent search of the Heme DB for the term returns "Non-Hodgkin lymphoma, NOS" [9591/3]. Under the Alternative Names section of the Heme DB, B-cell lymphoma, NOS, is a synonym for Non-Hodgkin lymphoma, NOS. Therefore, the B-cell lymphoma NOS code [9591/3] is the most appropriate histology code to use for this case.

This will be added to the next revision of the Heme DB and Manual.

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.

2012
20120082

MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if the patient has two tumors in the left breast, one that is ductal carcinoma with mucinous differentiation and the other is ductal carcinoma, NOS? See Discussion.

The final diagnosis from the left mastectomy was multifocal invasive ductal carcinoma (mpT1cN0) with associated intermediate grade ductal carcinoma in situ located between the invasive foci.

Larger 2:00 focus: moderately differentiated ductal carcinoma with mucinous differentiation (1.4 cm).

Smaller 3:00 focus: moderately to poorly differentiated ductal carcinoma (1.2 cm).

The histologies of the invasive foci should be coded 8523/3 and 8500/3 respectively. To determine the number of primaries, does rule M11 apply which indicates this should be a single primary even though ductal with mucinous differentiation is not in Tables 1 or 2? Or does rule M12 apply because there is a difference in the third digit of histology and thus means this should be reported as a multiple primary case?

For cases diagnosed 2007 or later, accession two primaries, ductal carcinoma with mucinous differentiation [8523/3] and ductal carcinoma, NOS [8500/3]. The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Breast MP rules because site specific rules have been developed for this primary.

Start at the MULTIPLE TUMORS module, rule M4. The rules are intended to be reviewed in consecutive order within a module. These tumors have ICD-O-3 histology codes that are different that the third (xxx) digit and are, therefore, multiple primaries.

Ductal carcinoma with mucinous differentiation is not a specific type of ductal carcinoma identified in either Table 1 or 2. (To locate Tables 1 and 2, go to Breast under the Terms & Definitions section of the manual.) It is ductal carcinoma mixed with another type of carcinoma (mucinous carcinoma in this case) see Table 3. Rule M11 does not apply.

 2012
20120021

Multiple primaries--Heme & Lymphoid Neoplasms: How are the terms "chronic" and "acute" used to help determine the number of primaries to be abstracted and what rule applies when a diagnosis of diffuse large B-cell lymphoma is followed two years later by a diagnosis of follicular lymphoma, grade 3A of 3? See Discussion.

7/31/08 Biopsy of the left supraclavicular lymph node diagnosed Stage IIIB DLBCL [9680/3]

10/14/10 Biopsy of a right supraclavicular lymph node diagnosed follicular lymphoma, grade 3A or 3 [9698/3].

Which multiple primary rule applies to determine the number of primaries to report? Is Rule M4 ignored? Does Rule M13 apply because follicular lymphoma normally transforms to DLBCL? Is this still a transformation because the follicular lymphoma came AFTER the DLBCL (the "acute" reverted to "chronic")? Or does Rule M15 apply, and the Multiple Primaries Calculator should be used to determine the number of primaries to report?

Are "transformations" the acute phases of the more chronic disease? The Heme Manual and previous training sessions do not make this apparent.

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 per Rule M13. Code the histology for the 7/31/08 diagnosis to 9680/3 [diffuse large B-cell lymphoma] and the code the histology for the 10/14/2010 diagnosis to 9698/3 [follicular lymphoma, grade 3A of 3]. Rule M13 applies to this case because the neoplasm was originally diagnosed in the blast or acute phase (DLBCL) and reverted to a less aggressive or chronic phase (follicular lymphoma) after treatment.

Per the "Transformations to" section in the Heme DB for follicular lymphoma, grade 3 transforms to diffuse large B-cell lymphoma [9680/3]. This means that the follicular lymphoma is the chronic neoplasm and that DLBCL is the acute neoplasm. In this case, the chronic neoplasm was diagnosed after the acute neoplasm was diagnosed and treated (with chemotherapy).

Do not Stop at Rule M4 because diffuse large B-cell lymphoma and follicular lymphoma (both NHL's) were not present in the same node(s) AT THE SAME TIME.

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.

 2012
20120042 Histology--Heme & Lymphoid Neoplasms: How is the histology coded if a pelvic mass biopsy is positive for B-cell non-Hodgkin lymphoma and a mediastinal lymph node biopsy is positive for follicular lymphoma, grade 1? See Discussion.

CT guided core biopsy of pelvic mass is positive for B-cell non-Hodgkin lymphoma. Bone marrow biopsy is negative. Mediastinoscopy with mediastinal and pretracheal nodes biopsy is positive for follicular lymphoma grade 1 of 2. The patient has a PET demonstrating positive extensive metastatic disease with nodes in neck, chest, abdomen/pelvis and bone involvement. Should the histology be coded 9591/3 [NHL, NOS] or 9695/3 [FL, grade 1]? Which rule applies?

The table of contents for the Hematopoietic Manual indicates Module 8 for these histologies, however, Module 8 rules do not seem to apply. Continuing on to Module 9, the first rule that applies is PH30. PH30 states use the Heme DB to determine primary site/histology. The Heme DB indicates these are separate primaries, but both histologies are B-cell lymphomas.

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

Code the histology to 9695/3 [follicular lymphoma, grade 1] per PH29.

Under the Alternate Names section of the Heme DB, B-cell non-Hodgkin lymphoma is synonym for non-Hodgkin lymphoma, NOS and B-cell lymphoma, NOS.

Per PH29, one codes the histology when there is one non-specific histology (NHL, NOS) and one specific histology (FL, grade 1). You are also required to confirm the specific and the non-specific (NOS) histology represent the same primary using the Multiple Primaries Calculator. The calculator indicates these are the same primary.

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.

 2012
20120020

MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a lumpectomy shows a single 6 mm "infiltrating mammary adenocarcinoma, histologic type: ductal (tubular)" tumor, and "peritumoral microscopic foci of solid type ductal carcinoma in situ"? See Discussion.

Per SINQ 20091117, tubular (ductal) carcinoma would be coded to 8211/3 [tubular]. However, in that case the tubular/ductal carcinoma is composed of a single tumor. In this case, the foci of DCIS were specifically stated to be peritumoral, and not a part of the infiltrating tubular carcinoma.

Are these microscopic foci of DCIS a separate primary per Rule M12 and SINQ 20110092 [two primaries are accessioned when one tumor is invasive and another is in situ, and histology codes differ at 1st, 2nd or 3rd numbers]? Does the size of the DCIS matter when there are two distinct histologies? Abstracting a second primary for these microscopic foci seems like over-reporting.

The following answers depend on what this pathologist means by "ductal (tubular)." According to the WHO classification, tubular is not a duct subtype. Check with the pathologist if possible to determine if the intended meaning is "tubular carcinoma" or "duct carcinoma".

If the pathologist uses the expression "ductal (tubular)" as an equivalent of "tubular carcinoma": Accession two primaries, a tubular carcinoma [8211/3] and a ductal carcinoma in situ, solid type [8230/2].

For cases diagnosed 2007 and later, the steps used to arrive at this decision are:

Determine the provisional histologies of these tumors in order to apply the Multiple Primary rules. Open the Multiple Primary and Histology Coding Rules manual. For a breast primary, use the Breast Histology rules to determine the histology codes because there are site specific rules for breast primaries.

Determine the histology of in situ carcinoma, solid type ductal carcinoma in situ. Start at Rule H1. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the more specific histologic term when the diagnosis is intraductal carcinoma and a type of intraductal carcinoma. Solid is a specific type of DCIS. The histology is 8230/2.

Determine the histology of the invasive carcinoma, tubular carcinoma. Start at Rule H10. Code the histology when only one histologic type is identified, Tubular carcinoma was the only type identified. The histology is 8211/3.

Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor. Start at the MULTIPLE TUMORS Module, Rule M4, because the patient has a single invasive tumor and separate foci of DCIS. These tumors have ICD-O-3 histology codes that are different at the third (xxx) number and are, therefore, multiple primaries.

If the pathologist uses the expression "ductal (tubular)" as an equivalent of "duct carcinoma": Accession a single primary, a duct carcinoma [8500/3].

For cases diagnosed 2007 and later, the steps used to arrive at this decision are:

Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS Module, Rule M4 because the patient has a single invasive duct carcinoma and separate foci of solid type ductal carcinoma in situ. Multiple intraductal and/or duct carcinomas are a single primary. Table 1 identifies solid type as a specific type of intraductal carcinoma.

Go to the Breast Histology rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module, Rule H20. Code the invasive histology when both invasive and in situ tumors are present. Code the histology as 8500/3 [duct carcinoma].

 2012
20120060 Primary Site/Reportability: What is the primary site and reportability status of a "pancreatic endocrine neoplasm" that arises in the heterotopic pancreas of the splenic hilum that is stated to be a "well-differentiated endocrine tumor, uncertain behavior per the WHO classification"? See Discussion.

SINQ 20120035 states that well differentiated pancreatic endocrine neoplasms should be reported with histology code 8240/3. However, the pathology report provides the WHO Classification which states "uncertain behavior." Should this tumor still be reported as 8240/3?

If reportable, how is the primary site coded? The tumor arose in heterotopic pancreas (in the splenic hilum), which is pancreatic tissue found outside the usual anatomical location of the pancreas. Per the pathology report, the tumor did not invade the spleen. Should the primary site be coded to C48.1 [mesentery]? The patient is female and the coding schema for "Peritoneum for Females" would apply to the case. However, none of those CS extension codes seem to apply to this localized case.

This case is reportable. Code the primary site to C25.9 [pancreas, NOS] and the histology to 8240/3 [neuroendocrine tumor (NET), Grade 1].

Per the 2012 SEER Manual, code the site in which the primary tumor originated. This neoplasm arose in pancreatic tissue and will behave accordingly, even though this pancreatic tissue is not located in the usual place.

Pancreatic endocrine and neuroendocrine neoplasms are essentially the same thing. However, they are described in two different WHO classifications; the endocrine classification and the digestive system classification. The digestive system classification is more recent, and is preferred by our expert pathologist consultant. The term "neuroendocrine" is to be used now, rather than "endocrine." In the pancreas, "well differentiated endocrine tumor" is synonymous with "neuroendocrine tumor (NET) Grade 1" and is coded 8240/3.

2012