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Report Produced: 02/22/2026 06:13 AM

Report Question ID Question Discussion Answer Year
20130182 Primary site--Head and Neck: How is primary site coded if a floor of mouth biopsy reveals microinvasive squamous cell carcinoma but the definitive resection of the tongue and floor of mouth unifocal lesion reveals only in situ squamous cell cancer? See Discussion.

Patient with overlapping lesion of tongue and floor of mouth. Initial biopsy of floor of mouth reveals microinvasive squamous cell cancer. Definitive resection reveals in situ squamous cell cancer. Pathology report states unifocal tumor. The tumor site on pathology report is documented as involving the tongue and floor of mouth.

Should the primary site be coded to floor of mouth because it is the site of invasive disease? Or is primary site C148 [overlapping sites of lip, oral cavity and pharynx] because invasion should not be used to determine primary site?

Code the primary site to C068 [overlapping lesion of other and unspecified parts of the mouth]. Based on the information provided, this is a tumor described as a "book-leaf" lesion a lesion that overlaps the floor of the mouth and the underside of the tongue. 2013
20130089 MP/H Rules/Histology--Breast: How is the histology coded when a pre-treatment core biopsy showed ductal carcinoma, but the mastectomy specimen following neoadjuvant chemotherapy showed lobular carcinoma? See Discussion. 11/06/2012 Ultrasound-guided biopsy of the left breast and left axilla showed invasive ductal carcinoma. The patient underwent 6 months of chemotherapy. In 05/2013 the patient underwent a mastectomy that showed invasive lobular cancer, pleomorphic type, with 11 axillary lymph nodes negative.

The histology is coded to lobular carcinoma, NOS [8520/3] because the mastectomy (the most representative specimen) showed only lobular carcinoma.

The MP/H Rules state to code the histology from the most representative tumor specimen examined. Although this patient underwent neoadjuvant treatment, there is no indication that the ultrasound-guided biopsy contained more tumor than the mastectomy. The mastectomy is the most representative specimen and should be used to code the histology.

2013
20130010 MP/H Rules/Histology--Skin: How is the histology coded for "infiltrative carcinoma with ductal alterations compatible with squamoid eccrine ductal carcinoma" of the skin?

Code the histology to 8413/3 [eccrine adenocarcinoma]. This is the most specific code available for this diagnosis.

According to our expert pathologist advisor, "The adnexal glands in the skin, sweat (eccrine) glands and apocrine glands, all have ducts which connect the business portion of each gland to the skin surface. Some of the adnexal tumors have features of differentiation which appear to be duct-like, hence the designation 'ductal.'"

In addition, "The 'squamoid' simply indicates some degree of squamous differentiation, but doesn't alter the usefulness of [code 8413/3] because we have no way of coding anything more specific in this case anyway."

2013
20130050 Multiple Primaries/Primary site/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what is the primary site and histology for each if a 6/12/12 left shoulder mass specimen suspicious for large B-cell lymphoma is followed on 7/10/12 with three skin nodules excised from the back with a diagnosis of "composite lymphoma? See Discussion.

6/12/12 Excisional biopsy left shoulder soft tissue mass: Suspicious for large B-cell lymphoma.

7/10/12 Excisional biopsy three skin nodules of back: "Composite lymphoma" - primary cutaneous anaplastic large cell lymphoma (CD3 pos, CD4 pos, CD30 pos, ALK neg with partial loss of CD5) and CONCURRENT cutaneous follicular center lymphoma (CD20 pos, PAX5 pos, BCL-6 pos, partially CD10 pos) and flow cytometry revealed results compatible with involvement by a lymphoproliferative disorder of T-cell lineage.

Per imaging performed, there was no involvement of lymph nodes or other organs.

Is the primary site C449 Skin, NOS and histology 9718/3 [Lymphoma, primary cutaneous anaplastic large cell] be correct?

Code primary site to C445 [skin, back] and histology to 9718/3 [cutaneous anaplastic large cell lymphoma] .

Per Rule M6, abstract a single primary when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location. For this case, there is cutaneous follicular (follicle) center lymphoma (9597/3) and cutaneous anaplastic large cell lymphoma (9718/3).

Per Rule PH22, code the primary site to the site or origin (skin, back) and the histology to the NHL with the numerically highest ICD-O-3 code. In this case, that would be 9718/3.

2013
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
20130213 Primary site--Heme & Lymphoid Neoplasms: How do you code the primary site for a marginal zone lymphoma involving bilateral axillary lymph nodes and inguinal lymph nodes, bone marrow and bilateral orbits that the physician refers to as a bilateral orbital lymphoma, Stage IV? See Discussion.

None of the rules seem to apply when the lymphoma is present in an organ, distant lymph nodes and bone marrow only. No regional nodes are involved.

Does rule PH22 infer that the organ should be coded as the primary site because it has been named by the physician?

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

Per Rule PH24, code primary site to orbit. According to Rule PH24, one is to code the primary site to the organ when lymphoma is present only in an organ. Note 2 under this rule also instructs one to capture the secondary involvement of distant lymph nodes and/or bone marrow in CS extension fields.

If the physician had not confirmed the primary site as orbit, you would have used Rule PH22 when the primary site is not indicated.

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
20130015 Reportability--Heme & Lymphoid Neoplasms: Is essential thrombocytopenia reportable? See Discussion. Many times essential thrombocytopenia has been coded based on blood counts. Sometimes the discharge summary states thrombocytosis (NOS), and the case is coded to essential thrombocytopenia. Are these cases reportable?

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

The following are not alternative names for any reportable disease process:

  • Essential thrombocytopenia

  • Reactive thrombocytosis

  • Thrombocythemia

  • Thrombocytopenia

  • Thrombocytosis

    • The diagnosis of essential thrombocythemia is based on blood counts, but is usually a diagnosis made by excluding other myelodysplastic disorders. The following are reportable disease processes:

    • Essential thrombocythemia (9962/3)

  • Essential thrombocytosis (9962/3)

  • Refractory thrombocytopenia (9992/3)

    • 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
    		20130103 First course treatment--Heme & Lymphoid Neoplasms: Why isn't darbepoietin coded as treatment for hematopoietic diseases?

    Darbepoietin is a synthetic form of erythropoietin. It stimulates erythropoiesis (increases red blood cell levels) and is used to treat anemia, commonly associated with chronic renal failure and cancer chemotherapy.

    Darbepoietin is a support medication; it does not treat cancer. It is used to treat anemia caused by cancer directed chemotherapy treatments. It is not indicated for patients with myeloid cancers; cancers that originate in the bone marrow like leukemia.

    Darbopoietin is an ancillary drug and is not coded as treatment.

    		2013
    		20130085

    Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient was treated in 1999 with Vidaza for myelodysplastic syndrome and had a recent biopsy that demonstrated a transformation to acute myeloid leukemia?

    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.

    		 2013