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Report Produced: 02/13/2026 05:18 AM

Report Question ID Question Discussion Answer Year
20130113

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient diagnosed and treated for multiple myeloma is subsequently diagnosed with multiple large plasmacytomas involving the scalp and thorax? See Discussion

The patient was diagnosed with multiple myeloma, underwent treatment and subsequently was in remission. The patient later presented with lesions on the scalp and thorax lesions. The final diagnosis on the pathology report for the scalp lesion was multiple myeloma with plasmablastic transformation (high grade). The physician states this is an aggressive, recurrent multiple myeloma with multiple large plasmacytomas involving the scalp and thorax.

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

Accession a single primary, multiple myeloma [9732/3] per Rule M2.

The multiple myeloma is in an advanced stage when plasma cells are being deposited on the scalp and thorax. Clinically, those plasma cells are rightly called plasmacytomas by the physician. However, the patient has a late-stage multiple myeloma causing the plasma cells/plasmacytomas. Note that under the myeloma Recurrence and Metastases section of the Heme DB it indicates that extramedullary involvement (e.g., the scalp and thorax involvement) usually indicates advanced disease. Therefore, this scenario represents a case of a single histology that is accessioned as a single primary per Rule M2.

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
20130184

Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable?

For cases diagnosed prior to 1/1/2022

A low-grade appendiceal mucinous neoplasm (LAMN) is not reportable. The WHO classification designates LAMN with the behavior code /1 [uncertain whether benign or malignant].

 2013
20130007

MP/H Rules/Histology--Colon: What rule applies and how is histology coded if a colon tumor is composed of moderately differentiated adenocarcinoma and neuroendocrine tumor, grade 1 (G1)? See Discussion.

Intestine, large -- moderately differentiated adenocarcinoma

Pathological stage: IIIA (T2 N1a Mx) -- Neuroendocrine tumor, G1

Addendum comment: The results of the immunochemical study are compatible with a neuroendocrine tumor, G1.

For cases diagnosed 2007 or later, the correct histology code is 8244/3 [composite carcinoid]. The steps used to arrive at this decision are:

Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Colon Histology rules because site specific rules have been developed for this primary.

Step 2: Start at the SINGLE TUMOR module, rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H9. Code the histology as 8244/3 [composite carcinoid] when the diagnosis is adenocarcinoma and carcinoid tumor.

Neuroendocrine tumor, grade 1 (G1) is synonymous with carcinoid tumor [8240/3] for the purpose of rule H9.

2013
20130191 Systemic/Surgery Sequence--Bladder: How is the systemic treatment/surgery sequence field coded for a 2013 case if the patient has a TURBT followed by multi-agent chemotherapy, and then a cystoprostatectomy followed by post-operative multi-agent chemotherapy? For cases diagnosed in 2012 and later, code 7 (surgery both before and after systemic therapy) seems like the most appropriate answer. However, previous SINQ entries 20091055 and 20071102 have conflicting answers regarding surgery before and after systemic therapy. Do these SINQ entries apply to a 2013 diagnosis? Would the systemic treatment/surgery sequence be coded 7 because this patient had surgery then chemotherapy followed by more surgery? Should the post-operative systemic treatment be ignored in coding the sequence in this case?

Code the Systemic/Surgery Sequence to 7 [surgery both before and after systemic therapy] for this case.

The answers to SINQ 20091055 and 20071102 do not apply to a case diagnosed in 2013. These answers were posted prior to code 7 becoming effective in 2012.

2013
20130102

Histology--Heme & Lymph Neoplasms: Is follicular lymphoma, high grade synonymous with grade 3 lymphoma [9698/3] or is the "high grade" ignored and the histology coded to follicular lymphoma, NOS [9690]?

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

Code histology to 9698/3 [follicular lymphoma, grade 3].

Follicular lymphoma, high grade is listed under the Alternate Names section of the Heme DB for Follicular lymphoma, grade 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
20130045 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if subsequent to a bone marrow biopsy diagnosis of acute myeloid leukemia there is an oncology consult note that indicates the pathology finding is suggestive of an underlying myelodysplastic syndrome? See Discussion

5/14/12 Bone marrow biopsy: Acute myeloid leukemia (AML).

5/21/12 Oncology consult: AML with 30-40% blasts and evidence of del(20q) and del(5q), is suggestive of an underlying myelodysplastic syndrome (MDS). Hence the patient has secondary AML.

If these are two primaries, how are the diagnosis dates coded?

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

This case is accessioned as a single primary diagnosed on 5/14/12 as acute myeloid leukemia with myelodysplasia-related (e.g., del(5q)) changes [9895/3] per Rule M2. The patient was diagnosed with a single histology, acute myeloid leukemia with myelodysplasia-related changes per the submitted information.

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
20130166

Reportability--Heme & Lymphoid Neoplasms: Is "indolent multiple myeloma" reportable and synonymous with "indolent/smoldering myeloma"? See Discussion.

7/10/12 Diagnosed with monoclonal gammopathy of undetermined significance (MGUS)

7/27/12 Diagnosed with MGUS/smoldering myeloma. There was no intervention at this time.

In about October/November 2012 the diagnosis was reported as smoldering myeloma,.

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

Indolent myeloma [9732/3] and smoldering myeloma [9732/2] are reportable terms synonymous with plasma cell myeloma. Monoclonal gammopathy of undetermined significance (MGUS) [9765/1] is not 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
20130190

Reportability: Is a thymoma, type B3 malignant and, therefore, reportable? See Discussion.

Recent information received from a registrar/pathologist states the WHO classifies well-differentiated thymic carcinoma [8585/3] as a synonym for type B3 thymoma.

For cases diagnosed prior to 2021

Thymoma, type B3 [8585/1] is not reportable. Well-differentiated thymic carcinoma [8585/3] is reportable.

WHO lists well-differentiated thymic carcinoma as a synonym for type B3 thymoma, but indicates the behavior code differs as indicated above.

See the applicable SEER manual for cases diagnosed 2021 and later.

 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
20130101 Reportability--Heme & Lymphoid Neoplasms: Is plasma cell dyscrasia, favor MGUS vs. smoldering myeloma reportable? See Discussion. The pathology report states, "plasma cell dyscrasia, favor MGUS vs. smoldering myeloma." The patient then died of a heart attack and no further information is available. If this is reportable, what histology code applies?

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

This case is not reportable. Neither plasma cell dyscrasia nor MGUS are reportable. Smoldering myeloma was given as a possible diagnosis, but never confirmed.

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