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Report Produced: 02/21/2026 21:47 PM

Report Question ID Question Discussion Answer Year
20130092

Reportability--Head & Neck: What are the correct site and histology codes if a glomus tympanicum tumor of the middle ear is reportable?

Glomus tympanicum tumors of the middle ear are not reportable. The 2005 WHO Classification of Head and Neck Tumors classified these tumors as a borderline [/1] behavior and recorded them in the ICD-O-3 with histology code 8690 [glomus jugulare tumor, NOS].

According to WHO, "the distinction between jugular and tympanic paragangliomas can easily be made in the patient by modern imaging methods ... the jugular neoplasm is identified as arising from the jugular bulb region ... while the tympanic neoplasm is confined to the middle ear." Benign and borderline neoplasms of the middle ear [C301] are not reportable. The middle ear is not a reportable CNS site for benign and borderline tumors.

 2013
20130210

Primary site--Heme & Lymphoid Neoplasms: Does Rule PH27 apply meaning that primary site is coded to C809 or would it be more appropriate to code to C269 GI Tract NOS since all disease involves the GI tract and this is more specific?

Extranodal lymphoma first diagnosed in the stomach (fundus and antrum) which upon further investigation also involved the small bowel (MALT Lymphoma) in the absence of lymph node findings. MD staged this IIE. Initial thought was Gastric, but PET/CT indicated abnormal uptake involving loop of distended small bowel in the pelvis.

Assign C269 for Gastrointestinal tract, NOS. Apply Rule PH24, code to the organ when only an organ is involved. This rule can be used for NOS sites such as GI tract, NOS.

Based on the information provided, this lymphoma is confined to the GI tract -- stomach and small bowel.

2013
20130065 Histology--Heme & Lymphoid Neoplasms: Should the higher histology code associated with grade 1 follicular lymphoma [9695/3] be used rather than grade 2 follicular lymphoma [9691/3] in cases of follicular lymphoma grade 1-2? Code histology to 9691/3 [follicular lymphoma, grade 2], histology. For follicular lymphoma, when there is a grade such as 1-2 indicated, take the histology associated with the higher grade disease process, even though the lower grade histology code is higher. 2013
20130180 Histology--Pancreas: What is the difference between pancreatic endocrine neoplasm (PanNETs) [8240/3] and the new ICD-O-3 terms pancreatic endocrine tumor, benign [8150/0] and pancreatic endocrine tumor, malignant [8150/3]? See Discussion. SEER Inquiry 20120035 discusses the reportability of pancreatic endocrine neoplasm (PanNETs) tumors.

The difference is that 8150 is for islet cell tumors. The preferred name was changed by WHO/IARC to reflect the current language used by pathologists to describe islet cell tumors [8150].

The 8240 histology code added the neuroendocrine tumor, grade 1, low or well differentiated terms to the carcinoid ICD-O name.

Islet cell tumors are more aggressive than the pancreatic NET tumors. Treatment and prognosis are determined by the histologic type. While the histology code 8150 is not new, the histology name has been updated.

2013
20130157

Primary Site--Heme & Lymphoid Neoplasms: What primary site code should be assigned and what rule justifies that code?

Scenario: Pleural effusion, underwent thoracentesis. Pleural fluid unexpectedly showed Large B-Cell Lymphoma. Extensive workup including CT & PET was done and all findings were within normal limits. No evidence of lymphoma was seen and no palpable adenopathy was found. The only indication of lymphoma was the malignant pleural effusion.

Code to pleura, C384.

Per the Hematopoietic database, Diffuse Large B-Cell Lymphoma can originate in the pleural cavity.

2013
20130172 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what is the histology for each if a bone marrow diagnosis reveals co-existent systemic mastocytosis and a lymphoplasmacytic neoplasm? See Discussion.

11/7/12 Peripheral blood flow cytometry: small population of clonal CD5- CD10- B-cells consistent with a B-cell lymphoproliferative process.

1/16/13 Bone marrow final diagnosis: co-existent systemic mastocytosis and lymphoplasmacytic neoplasm.

B-cell component of lymphoplasmacytic neoplasm constitutes 20% of bone marrow cellularity and the plasma cell component approximately 20%. The differential diagnosis includes marginal zone lymphoma with plasmacytic differentiation and lymphoplasmacytic lymphoma.

Flow cytometry: kappa monotypic B-cells and plasma cells.

Comment: Co-existence of systemic mastocytosis and mature B-cell lymphoma meets the criteria for Systemic mastocytosis with Associated Clonal Hematological Non-Mast Cell Lineage Disease (SM-AHNMD).

From our physician's progress note: KIT-D816V-positive, CD117+/CD25+ /SM-AHNMD(40% of the nucleated cells as spindled mast cells) but also seemingly two distinct lymphoid neoplasms, a CD5-negative/CD10-negative B-cell lymphoproliferative neoplasm consistent with occupying another 20% of the nucleated marrow space, together with an IgG-kappa-restricted (non-reportable diagnosis) occupying another 20% of the nucleated marrow space (and an accompanying 2.0 g/dl M-spike without hypercalcemia or anemia).

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

Under the Alternate Names section of the Heme DB, systemic mastocytosis with Associated Clonal Hematological Non-Mast Cell Lineage Disease (SM-AHNMD) is a synonym for systemic mastocytosis. Per Rule M2, this is one primary. Abstract a single primary when there is a single histology. Code the histology to 9741/3 [systemic mastocytosis].

Per the pathology report, the two diagnoses of systemic mastocytosis and mantle cell lymphoma meet the criteria for SM-AHNMD. The B-cell lymphoma is a symptom/marker of the AHNMD. In systemic mastocytosis with AHNMD, a myeloid or lymphatic malignancy is diagnosed with the SM. The prognosis is usually dominated by the non-mast cell malignancy.

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
20130131 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded, and which PH rule applies, when chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) is diagnosed simultaneously by biopsies of both lymph node(s) and the bone marrow?

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 when CLL/SLL [9823/3] involves the bone marrow.

In the later stages of CLL/SLL, there may be involvement of bone marrow AND lymph node(s), lymph node region(s), organ(s), or tissue(s). As long as the peripheral blood and/or bone marrow are involved, the primary site is bone marrow.

WHO states that the diagnostic criteria for CLL versus SLL is not clearly defined. According to WHO guidelines, it is better to code to CLL/SLL and code the primary site to bone marrow when the marrow is involved and to lymph nodes, organ, or tissue when there is no bone marrow involvement.

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
20130032 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for plasma cell myeloma with radiologic evidence of multiple lytic lesions? See Discussion.

Patient complained of pain in the right side and back right upper flank area. CT shows an anterior mediastinal mass and abnormal appearance of skeleton. CXR: Age indeterminate T8 compression fracture. CT chest: abnormal appearance of skeleton. Correlate clinically for myeloma or mets. Acute T5 or T8 compression fractures. Anterior mediastinal mass which may represent thymoma, lymph nodes or metastases. 03/22/12 Metastatic Series: Nonspecific hypodensities in pelvis, left hip and right acromion. Possibility of myeloma can't be totally excluded. Bone marrow right post iliac crest core biopsy, clot section and aspirate: plasma cell myeloma.

Should the primary site be coded to the bone marrow because the diagnosis of plasma cell myeloma was supported by radiologic evidence of multiple lytic lesions? The bone marrow biopsy confirmed the radiology reports.

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 the Heme DB and Rule PH30. The Primary Site(s) section in the Heme DB indicates the primary site for plasma cell myeloma is C421 [bone marrow].

The Primary Site Coding Instructions in the Heme Manual (Rule 1) states that when a specific code is listed under the Primary Site(s) section of the Heme DB it is the only primary site code that can be assigned for that leukemia, myelodysplastic syndrome or myeloproliferative syndrome. Applying the PH Rules will result in the same answer for primary site, bone marrow [C421].

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
20130170

MP/H Rules/Histology--Breast: What is the histology code for "invasive carcinoma of the breast, no special type" as the final diagnosis on a pathology report? See Discussion.

Recently pathology reports for breast primaries are no longer listing invasive ductal carcinoma as the histology on many cases if the treating physician calls the cancer an invasive ductal carcinoma. The pathology report (final diagnosis and synopsis) state this is invasive carcinoma, no special type.

Upon inquiry to the pathology department, the response received stated, In 2012, the WHO got rid of ductal carcinoma as a specific type. So what would have been called Invasive ductal carcinoma, Not Otherwise Specified (NOS), is now being called Invasive carcinoma, No Special Type (NST). In the new WHO classification, lobular, tubular, cribriform, mucinous, etc. are the special types. But ductal is gone.

Is this a change in terminology? Should these cases be coded as 8500/3 [ductal carcinoma, NOS] or 8010/3 [carcinoma, NOS]?

Code the histology to ductal carcinoma, NOS [8500/3] for a pathology report with a final diagnosis of "invasive carcinoma, no special type." Do not code the histology to carcinoma, NOS [8010/3].

The 4th Edition of the WHO Classification of Tumors of the Breast refers to invasive ductal carcinoma as invasive carcinoma, no special type. The ICD-O-3 code remains the same as invasive duct carcinoma [8500/3]. The next revision to the MP/H Solid Tumor Rules will clarify this issue.

2013
20130072

MP/H Rules/Multiple primaries--Lung: How many primaries are accessioned when the right lower lobe lung has two adenocarcinomas, both with lepidic pattern, if the tumor board staged these tumors as separate primaries? See Discussion.

Per pathology report

  • Lung, right lower lobe, wedge excision (A): Invasive moderately differentiated adenocarcinoma with focal lepidic pattern (pT1a, pN0).
  • Right lower lobe, completion lobectomy (F): Separate focus of well differentiated adenocarcinoma with lepidic pattern (<4mm) (see comment).
  • COMMENT: The block F7 shows a microscopic focus of adenocarcinoma with lepidic growth pattern. This most likely represents a separate primary tumor since the stapled margins were all negative for involvement. This focus measures less than 0.4 cm.
  • Tumor focality: Most likely two separate primary tumor nodules. Histologic type: adenocarcinoma, mixed type (NOS and lepidic type).

The tumor board has staged this as two separate primaries and is treating it as such. They are not considering the second focus metastatic even though it is the same histology. Lepidic is not in the ICD-O-3. Is lepidic a new term for histology?

For cases diagnosed 2007 and later, accession a single primary, adenocarcinoma [8140/3] of the right lower lobe lung. 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 Lung MP rules because site specific rules have been developed for this primary.

Step 2: Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. Stop at rule M12. Accession a single primary when the patient has two tumors in the same lung with the same histology.

Keep in mind that physicians follow different "rules" to determine the number of primaries. Even though the physicians consider this case to represent two primaries, the MP/H rules instruct you to accession one primary.

We have received quite a few questions about the term lepidic. Below is the general definition of lepidic that will be added to the next MP/H revision.

"Lepidic" is a growth pattern meaning that tumor cells are growing along the alveolar septa. It is characteristic of bronchioloalveolar carcinoma (BAC), but not diagnostic of it. The diagnosis of BAC also requires no stromal, vascular, or pleural invasion. Lepidic growth may be seen in other adenocarcinomas, including metastases to lung from other sites. It is not a type/subtype of adenocarcinoma. For lepidic lung neoplasms, code the histology indicated, for example BAC.

 2013