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Report Produced: 02/12/2026 12:42 PM

Report Question ID Question Discussion Answer Year
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
20120091 Reportability/Behavior--Kidney: Is epithelioid angiomyolipoma (AML) of the kidney a reportable malignancy? See Discussion. The addendum final diagnosis on a pathology report for a kidney core needle biopsy included the results of additional stains performed on the tissue. It indicated the morphology was most consistent with epithelioid angiomyolipoma. Further comments in the body of the report indicate these tumors are now considered malignant neoplasms with the capacity to be locally aggressive and they can potentially metastasize. There is no mention of a metastasis in this particular case.

Epithelioid angiomyolipoma (AML) [8860/0] of the kidney is not reportable unless stated to be malignant.

If the pathologist confirms this is a malignancy, apply ICD-O-3 Rule F (Matrix principle) and assign the behavior code /3. If confirmation is received, accession the case using the morphology code 8860/3 [malignant angiomyolipoma].

2012
20120083 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient is diagnosed with follicular lymphoma, grade 3 in 2006 and is subsequently diagnosed with follicular lymphoma, grade 2 in 2011? See Discussion.

June 2006, the patient was diagnosed with follicular lymphoma, grade 3 by cervical lymph node biopsy and bone marrow biopsy. The patient refused treatment but was followed.

May 2007, the patient had another cervical LN biopsy with a diagnosis of follicular lymphoma, grade 2.

July, 2009, a neck mass excision was diagnosed as follicular lymphoma, grade 3.

June 2011, another neck lymph node was excised and diagnosed as follicular lymphoma, grade 2.

According to the MP calculator, FL grade 3 [9698/3] is a separate primary from FL grade 2 [9691/3]. Is the June 2011 diagnosis of FL grade 2 a new primary?

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

This case should be accessioned as a single primary per Rule M15. The histology is coded to 9698/3 [follicular lymphoma, grade 3] diagnosed in 2006. The 2011 diagnosis of follicular lymphoma, grade 2 [9691/3] is not a new primary.

Follicular lymphoma, grade 2 [9691/3] is listed under the Same Primaries section of the Heme DB for 9698/3 [follicular lymphoma, grade 3]. To confirm this, Rule M15 indicates we are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries because none of the rules from 1-14 apply. Per the calculator, these histologies represent 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
20120059 Primary site/Reportability--Breast: Is a "right nipple skin" biopsy that demonstrates squamous cell carcinoma reportable using a primary site of C500? See Discussion. In the 2011 SEER Manual Reportability Examples, example 3, it states a "biopsy-proven squamous cell carcinoma of the nipple" is reportable when the subsequent resection shows "no evidence of residual malignancy in the nipple epidermis." However, this example does not specify the biopsy is from the nipple skin and the ICD-O-3 does not list nipple skin as a synonym for code C500.

Because the site is specifically stated to "skin" of nipple [C44.5], this case is not reportable.

If possible, you may wish to confirm the type of biopsy performed. If the biopsy was done by FNA or needle biopsy, the biopsy tissue should contain a full-thickness of skin and subcutaneous breast (nipple) tissue. If that is the case, this tumor would likely be a reportable squamous cell carcinoma of nipple [C50.0]. If, however, this was a punch biopsy it is more likely a non-reportable squamous cell carcinoma of the skin [C44.5].

2012
20120084 MP/H Rules/Multiple primaries/Histology: How many primaries are accessioned and how is the histology coded if a patient has a 1.2 cm hepatocellular carcinoma and a 7 cm hepatocellular carcinoma, solid, acinar and trabecular type? See Discussion. FINAL Diagnosis: 2 separate lesions of the liver 1)1.2 cm hepatocellular carcinoma and 2) 7 cm hepatocellular carcinoma, solid, acinar, and trabecular type.

For cases diagnosed 2007 or later, accession a single primary, hepatocellular carcinoma [8170/3].

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) and go to the Other Sites MP rules because liver does not have site specific rules developed.

Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. There is one tumor with HCC and another tumor with a specific type of HCC.

Hepatocellular carcinomas vary and often display different architectural patterns such as solid, acinar and trabecular.

 2012
20130125 Reportability--Heme & Lymphoid Neoplasms: Is self-healing Langerhans cell histiocytosis (LCH) of the skin reportable?

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

This is a reportable primary. Langerhans cell histiocytosis (LCH) [9751/3] is a reportable neoplasm.

The term "self-healing" means that the neoplasm regressed without treatment. This is a known phenomenon.

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.

2013
20130192 MP/H Rules/Histology--Pleura: How is histology coded when the pathology report final diagnosis is "malignant neoplasm, compatible with malignant mesothelioma" if the COMMENT section of the pathology report indicates the tumor has a mixed epithelial and sarcomatoid pattern? See Discussion. This case was discussed with a pathologist who feels the correct histology should be biphasic mesothelioma (9053/3) because there are both epithelial and sarcomatoid components to this tumor. However, applying the current MP/H Rules, the histology is coded to 9050/3 (mesothelioma, NOS) because the term "pattern" cannot be used to code a more specific histologic type for invasive tumors. If this truly is a biphasic mesothelioma, that data is lost for researchers because the current MP/H Rules fail to capture this information. Should the term pattern be used to code the more specific histology in this case? Code the histology to malignant mesothelioma, NOS [9050/3]. Apply the MP/H Rules as written until they are revised. The word "pattern" and other terms will be reconsidered for the next iteration of the rules. 2013
20130147 Primary site--Heme & Lymphoid Neoplasms: What the primary site for a diagnosis of Langerhans cell histiocytosis with multifocal multisystem involvement of the skin, chest, CNS and thyroid, but no evidence of involvement on a bone scan?

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

Code the primary site to C809 [unknown].

Langerhans Cell Histiocytosis (LCH) includes three major groups:

  • Unifocal: Slowly progressing disease, involves one organ.

  • Multifocal unisystem: Involves several organs in one system.

  • Multifocal multisystem: Involves several organs in two or more systems.

    • When the disease is both multifocal and multisystem, code the primary site to unknown [C809] because there is no way to identify the origin of the neoplasm in this situation.

    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.

    		2013
    		20130112 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of post-transplant lymphoproliferative disorder (PTLD) diagnosed on an inguinal lymph node biopsy with CT scan evidence of lymphadenopathy in the chest, abdomen and pelvis if the bone marrow is also involved?

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

    Code the primary site to multiple lymph node regions, NOS [C778] per Rule PH21 when multiple lymph node regions, as defined by the ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated

    In the Abstractor Notes section in the Heme DB for PTLD it states PTLD commonly involves lymph nodes, GI tract, lungs and the liver. This patient has extensive lymph node involvement. Rule PH26 states to code the primary site to the bone marrow when ONLY the bone marrow is involved; however, that does not apply in this case.

    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.

    		2013
    		20130019 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when a patient has a lymph node biopsy and peripheral blood that are positive for B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma but refuses a bone marrow biopsy?

    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 PH5. Note 1 for Rule PH5 states CLL always has peripheral blood involvement. If the peripheral blood is positive for CLL/SLL and no bone marrow biopsy is done, code the primary site to C421 [bone marrow].

    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.

    		2013