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

There are two reportable primaries for this case -- follicular lymphoma in 2010 and DLBCL in 2012.

First determine the histologies needed to to determine the number of primaries to report. We determined the histologies are follicular lymphoma, grade 1 for 2010 and DLBCL for 2012 as follows:

• Rule M4, a mix of DBLCL and follicular lymphoma, grade 3 is a single primary when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location(s), such as the same lymph node or lymph node region(s), the same organ(s), and/or the same tissue(s). Additionally, the instruction per Rule PH11 indicates one is to code the histology to diffuse large B-cell lymphoma (DLBCL) (9680/3) when DLBCL and any other non-Hodgkin lymphoma (i.e., follicular lymphoma, grade 3) are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow.

Per the Hematopoietic database, follicular lymphoma (all types are chronic) transforms to DLBCL (acute). Per Rule M 10 instructions, "Abstract as multiple primaries when a neoplasm is as a neoplasm there is a of an neoplasm after the chronic diagnosis." Therefore, abstract the DLBCL as a second 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.

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

The histology should be coded as diffuse large B-cell lymphoma [9680/3]. The biopsy pathology report definitively diagnosed DLBCL. The physician's diagnosis cannot be used because it is an ambiguous diagnosis only, "favored anaplastic large cell lymphoma." "Favor" is an ambiguous term.

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, 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.

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.

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, acute myeloid leukemia [9861/3].

MDS diagnosed prior to 1/1/2001 is not a reportable disease process. However, because MDS is currently a reportable disease process, it must be considered when trying to determine whether the AML represents a separate primary.

• If the Heme DB indicates MDS and AML represent different (separate) disease processes, only one primary is reported (i.e., AML) because the 1999 diagnosed MDS is not reportable.

• If the Heme DB indicates MDS and AML represent the same disease process, then no primaries are reported because MDS was not reportable in 1999.

Rule M2 does not apply to this case because more than one histology is mentioned in the scenario. According to the Heme DB, MDS can transform to AML. Rules M8-M13 apply to cases involving transformation. In this case, Rule M10 applies because the patient was diagnosed with a chronic neoplasm (myelodysplastic syndrome) followed greater than 21 days later by an acute neoplasm (AML).

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.

Per the Heme DB, the histology B-cell acute lymphoblastic leukemia is synonymous with B lymphoblastic leukemia/lymphoma, NOS. Per Rule PH8, for a neoplasm that can manifest as either leukemia lymphoma or leukemia lymphoma, one is to code the primary site to the site of origin when lymph node(s) or lymph node region(s), tissue(s) or organs are involved. The Note 4 instruction states it is necessary to go to Module 7 (Rules PH18-PH27) to code the more specific primary site. In this case, use Rule PH22 to code primary site to C779 [lymph nodes, NOS] for the case you describe.

In this case, there is involvement of abdominal lymph nodes, spleen, bone marrow and bone. There is no indication of the primary site. Per the Heme DB, the most frequent sites of involvement for the lymphoma are bone and lymph nodes. This is a Stage IV lymphoma.

The now inactivated SINQ 20120047, stated that based on the sites of involvement, this histology could be coded as either leukemia or lymphoma. If the only involvement is the bone marrow, the site is coded to C421 [bone marrow]. The involvement of peripheral blood does not change the primary site because such involvement is part of the leukemic process.

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 this histology to 9920/3 [therapy-related myeloid neoplasm] when the physician states the acute myeloid leukemia is therapy-related.

Therapy-related AML can result from any systemic therapy for benign or malignant diseases. In this case, AML resulted from immune system-suppressing therapy with Imuran for a benign disease, polymyalgia rheumatica. The drugs that induced the AML do not have to be listed in the SEER*Rx database.

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.

This is a reportable diagnosis of chronic lymphocytic leukemia [9823/3]. The physician is using the terms "characteristic of" in the same manner as he/she would use the terms "diagnostic of."

This case fits with the usual diagnosis of CLL. The peripheral blood is diagnostic for leukemias. There was a specific leukemia noted, B-cell chronic lymphocytic leukemia. CLL (B-cell is the phenotype) is usually diagnosed incidentally by a peripheral smear because it is asymptomatic. However, we recommend looking for further work-up, such as a bone marrow biopsy.

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.

Yes. This is a reportable diagnosis and should be accessioned with the histology coded to 9975/3 [myelodysplastic/myeloproliferative neoplasm, unclassifiable].

The word is a reportable ambiguous term per the Hematopoietic Coding Manual (Case Reportability Instructions, Rule 4).

Myeloproliferative disorder is synonymous with myeloproliferative disease. Myeloproliferative disease is listed as an alternate name for myelodysplastic/myeloproliferative neoplasm, unclassifiable.