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Report Produced: 02/23/2026 18:21 PM

Report Question ID Question Discussion Answer Year
20130134

Reportability--Heme & Lymphoid Neoplasms: According to the hematopoietic database, systemic mastocytosis is reportable; does that include INDOLENT systemic mastocytosis (which is not listed in the list of alternative names)?

For cases diagnosed 2018 and forward, indolent systemic mastocytosis is not reportable (9741/1). Smoldering systemic mastocytosis is reportable (9741/3).

 2013
20130047 Date of diagnosis--Heme & Lymphoid Neoplasms: What is the diagnosis date for a patient with a mild thrombocytosis diagnosed in 2008, that was subsequently treated with Anagrelide in 11/2010 following an increase in platelet count, and later in 3/2011 was found to have positive JAK2 study physician refers to as essential thrombocythemia? See Discussion. In 2008, patient diagnosed with mild thrombocytosis. The patient opted to be followed clinically with observation. In November 2010, a CBC showed an increased platelet count to 600,000. Anagrelide was started. The patient would never agree to a bone marrow biopsy. However, in 3/2011 a JAK2 study was performed and read as positive. Following the positive Jak2 study, physician stated the diagnosis was essential thrombocytosis and started the patient on a different drug.

Code the diagnosis date to 3/2011. It wasn't until 3/2011 that the physician documented a reportable diagnosis of essential thrombocytosis [9962/3].

Mild thrombocytosis is not reportable. Therefore, the case was not reportable in 2008. Although the patient was treated in 2010, there was no documentation of a reportable diagnosis.

2013
20130111 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2008 diagnosis of extralymphatic follicular lymphoma in the breast is subsequently diagnosed in 2011 with ocular follicular lymphoma? See Discussion.

The patient was diagnosed with follicular lymphoma in the breast in 2008. Per notes, there was no evidence of disease again until 2011 when the patient presented with ocular lymphoma. The physician stated this was part of the same disease process as the prior breast diagnosis. The bone marrow was not involved in either case.

Is this a single primary (recurrence) of follicular lymphoma? Or are these multiple primaries because they arise in different extralymphatic sites?

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

Accession a single primary, follicular lymphoma [9690/3] of the breast diagnosed in 2008 per Rule M2.

Accession a single primary when there is a single histology. This is a recurrence of the patient's 2008 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.

2013
20130093 MP/H Rules/Histology--Lung: What histology code is used for an adenocarcinoma in situ/bronchioloalveolar carcinoma (BAC) of the lung? See Discussion.

Classification of lung malignancies has undergone a change. The bronchioloalveolar carcinoma histology is being replaced by adenocarcinoma in situ and minimally invasive adenocarcinoma, using an evaluation of lepidic growth pattern in the tumor.

The final diagnosis is "adenocarcinoma in situ/BAC" and the comment states, "The findings in the current biopsy are most compatible with low grade malignant lesions which, in this sample, shows features of adenocarcinoma in situ (former bronchioloalveolar adenocarcinoma), given the proliferation of pneumocytes is limited to the alveolar lining with no evidence of invasion. However, classification of the lesion depends, per reference guidelines (Travis et al. J THOR ONCOL 2011 6,(2):244-275), on its size and its overall histologic features, to rule out the presence of an invasive component and therefore can only be performed upon examination of it in its entirety, upon resection." The radiation oncologist staged this T1N0M0, stage 1 BAC.

Code the histology to 8140/2 [adenocarcinoma in situ, NOS].

The comment for this case is consistent with information from the CAP protocol, which says, "The diagnosis of bronchioloalveolar carcinoma requires exclusion of stromal, vascular, and pleural invasiona requirement that demands the tumor be evaluated histologically in its entirety. It is therefore recommended that a definitive diagnosis of bronchioloalveolar adenocarcinoma not be made on specimens in which the tumor is incompletely represented."

This tumor was not completely resected. Therefore, code to adenocarcinoma in situ based on the information provided.

2013
20130203 MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are accessioned for a diagnosis of cerebral cavernous malformation disorder (CCM1) and MRI evidence of dozens of cavernous angiomas/malformations throughout the supra and infratentorium? See Discussion.

9/9/11 IMP: Presymptomatic cerebral cavernous malformation disorder (CCM1).

9/9/11 Brain MRI: FINDINGS: Total of 14 foci. 2 largest in rt frontal lobe. In rt frontal lobe, total of 4 foci. Of remaining 10 small foci, 4 are in cerebellum, 1 in rightward pons, 1 in lt temporal lobe, 1 in lt occipital lobe, 1 in rt occipital lobe, 1 in posterior rt temporal lobe, & 1 in lt frontal lobe. Lesions in bilateral occipital lobes & lt temporal lobe are associated w/weighted signal suggestive of hemosiderin & are most c/w additional cavernous malformations. IMPRESSION: Just over a dozen scattered foci of gradient susceptibility throughout supra & infratentorium.

9/13/13 Brain MRI. Clinical diagnosis: Cerebral cavernous angiomas. FINDINGS: Approximately a dozen scattered foci. 2 largest in rt frontal lobe. Remaining small foci identified w/in cerebellum, rightward pons, rt occipital lobe, rt temporal lobe, & lt frontal lobe. Many are less conspicuous than in 2011 & a few that were present on prior study are not evident on current exam. This is likely due to differences in technique. IMPRESSION: Redemonstration of numerous scattered foci c/w cavernous malformations.

This case is not reportable as is. The clinical diagnosis on the 9/13/13 MRI was "cerebral cavernous angiomas," but the final impression on the MRI was a re-demonstration of the numerous scattered foci consistent with cavernous malformations seen on the previous 9/9/11 MRI. There was no reportable statement of cavernous angioma. Cavernous malformation is not a reportable neoplasm; it has no valid ICD-O-3 code.

Vascular tumors of the CNS are reportable when they arise in the dura or parenchyma of the CNS. When they arise in blood vessels or bone, they are not reportable. Do not report vascular tumors when there is not enough information to determine whether they arise in the dura or parenchyma or elsewhere.

2013
20130121 Reportability--Heme & Lymphoid Neoplasms: Is "early essential thrombocythemia" reportable? See Discussion. The bone marrow biopsy diagnosis was, "Combined bone marrow morphologic, flow cytometric, immunohistochemical, molecular and cytogenetic findings are most consistent with early or evolving essential thrombocythemia with low level JAK2 V617F mutation documented on molecular testing." The physician is calling this a benign process. Is this reportable as essential thrombocythemia? Are the terms early or evolving ignored? Does the presence of a JAK2 mutation make this reportable? Without JAK2 testing is this case reportable?

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

Yes, this is a reportable case. The histology is coded to 9962/3 [essential thrombocythemia]. The positive JAK2 mutation testing and bone marrow biopsy results taken together support the diagnosis of essential thrombocythemia in this case.

In the Abstractor Notes section of the Heme DB, it indicates that only 50-60 percent of patients with essential thrombocythemia will have a positive JAK2 mutation. A diagnosis of essential thrombocythemia can still be made in the absence of a JAK2 mutation. For example, if the bone marrow biopsy final diagnosis or a physician's clinical diagnosis is essential thrombocythemia, despite a negative JAK2 mutation test, the neoplasm is still reportable.

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
20130137 Histology--Heme & Lymphoid Neoplasms: How is the histology coded for follicular lymphoma, low grade? See Discussion. Pathologists seem to be moving away from identifying follicular B-cell lymphomas as grade 1, grade 2, etc. Instead, the term follicular lymphoma, low grade is being used. Should the histology be coded as follicular lymphoma, NOS even though the Heme DB indicates this code is usually used for death certificate cases?

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

Code the histology to 9690/3 [follicular lymphoma, NOS].

Low grade for follicular lymphoma are not listed in the Heme DB or Manual. Because low grade can mean grade 1 or grade 2, default to follicular lymphoma, NOS [9690/3].

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
20130124 Reportability--Heme & Lymphoid Neoplasms: Is Rosai-Dorfman's syndrome (histiocytosis) a reportable malignant condition? Rosai-Dorfman disease is not reportable. Rosai-Dorfman disease is a rare non-neoplastic disease. This disease can mimic lymphoma and extranodal involvement is frequent. 2013
20130177 MP/H Rules/Histology--Bladder: What rule and histology code apply when a TURB final diagnosis is small cell neuroendocrine carcinoma and high grade urothelial carcinoma? See Discussion.

The patient has a 6 cm tumor arising in posterior-lateral bladder extending to prostate, obliterates seminal vesicle, and invades pelvic wall.

TURB final diagnosis: Small cell neuroendocrine carcinoma. High grade urothelial carcinoma involves 10% of tumor.

Following the current MP/H single tumor rules, it appears Rule H8 applies. Per Rule H8, code the numerically higher code of 8120. By following this rule, it does not seem the histology code fairly represents this tumor.

There is currently no rule in the urinary site MP/H Rules for this combination of histologies. The best option is to code the histology to 8045/3 [mixed small cell carcinoma], a combination of small cell with other types of carcinoma. The presence of small cell carcinoma drives the treatment decisions for this case.

This issue will be addressed in the next revision of the MP/H Rules.

2013
20130212 Reportability--Heme & Lymphoid Neoplasms: Is a case reportable in which the pathology report is negative for plasmacytoma but a subsequent physician's clinical diagnosis is plasmacytoma?

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

This case is reportable if the patient was treated for plasmacytoma. When the physician calls the case plasmacytoma and treats the patient accordingly, report the case.

See Case Reportability Instructions #6: Report the case when there is a clinical diagnosis (physician's statement) of a reportable hematopoietic or lymphoid neoplasm.

Note 1: The clinical diagnosis may be a final diagnosis found within the medical record or recorded on a scan (CT, MRI for example)

Note 2: Report the case even if the diagnostic tests are equivocal. A number of hematopoietic neoplasms are "diagnoses of exclusion" in which the diagnostic tests are equivocal and the physician makes the clinical diagnosis based on the equivocal tests and the clinical picture. See the Heme DB for definitive diagnostic methods for the specific neoplasm being abstracted.

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