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Report Produced: 02/10/2026 05:17 AM

Report Question ID Question Discussion Answer Year
20130079

Reportability--Heme & Lymphoid Neoplasms: Is plasma cell dyscrasia reportable and synonymous with multiple myeloma? See Discussion.

Bone marrow biopsy and aspirate: Plasma cell dyscrasia with IgG kappa expression with FISH (+) for the following abnormalities: 3 copies of 1q21 (25/30 plasma cells) and an extra CCND1 signal (25/34 plasma cells) which is indicative of the presence of other chromosome 11 abnormalities possibly trisomy 11, a change known to occur in plasma cell neoplasms. Flow cytometry: A monoclonal plasma cell population is present, co-expressing cIgG, cKappa, CD56, & CD117 (up to 14% of analyzed cells).

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

Plasma cell dyscrasia and multiple myeloma are not synonymous terms. Plasma cell dyscrasia is not listed in the Alternate Names section of the Heme DB for plasma cell myeloma (multiple myeloma). Plasma cell dyscrasia is listed in the Alternate Names section of the Heme DB for MGUS [9765/1], which is not a reportable disease.

Plasma cell dyscrasia (PCD) is not reportable. PCD is a diverse group of neoplastic diseases that produces a serum M component (monoclonal immunoglobulin).

Usually these patients have a plasma cell morphology such as multiple myeloma or heavy chain disease. However, the registrar cannot diagnose multiple myeloma or heavy chain disease (or any other plasma cell neoplasm). There must be a physician statement and/or a positive biopsy to confirm a reportable diagnosis.

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
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
20130083 Ambiguous terminology/Histology--Heme & Lymphoid Neoplasms: How is the histology coded if an FNA reveals high grade B-cell lymphoma, compatible with diffuse large B-cell lymphoma, and the treating physician states this is diffuse large B-cell lymphoma? See Discussion.

The FNA showed high grade B-cell lymphoma, morphologically compatible with diffuse large B cell lymphoma. Special studies state: Tumor cells are positive for Vimentin, CD45, and CD20, focally weakly positive for CD43; negative for Myeloperoxidase, CD99, AE1/AE3, CK7, CK20, S100, CD3, cyclin D1, CD34, CD5 and TTF1. The cellular findings and immunophenotype are compatible with large B-cell lymphoma.

The treating physician refers to this disease process and is treating the patient for diffuse large B-cell lymphoma. Should the histology be coded as B-cell lymphoma, NOS (9591/3) because both the FNA and the immunophenotyping use ambiguous terminology? Does the physician reference to the disease process as diffuse large B-cell lymphoma, Stage II-AE impact the histology used?

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

Code the histology to diffuse large B-cell lymphoma [9680/3] because the physician states this is a DLBCL and is treating the patient accordingly. Although the pathology report was only compatible with DLBCL, there was a subsequent clinical diagnosis that confirmed a diagnosis of DLBCL. In addition, the patient was treated for DLBCL.

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
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
20130009 Grade--Pancreas: Can the grade be coded when a biopsy is taken from the part of a primary tumor that has contiguously extended into an adjacent organ or structure? See Discussion. The grade rule states to code grade from tissue removed from the primary tumor only, never from a metastatic site or a site of recurrence. There is no mention of whether the grade can be coded if only the contiguous site of involvement is biopsied when a single tumor directly extends to an adjacent tissue or organ. For example, is grade coded to 2 when a pancreatic tumor extends into the duodenum, and the duodenal biopsy confirms moderately differentiated adenocarcinoma consistent with a pancreatic primary? Or does the primary organ/site have to be biopsied in order to be able to code grade?

For one tumor involving a contiguous site, when there is no tissue specimen available from the primary site, you may code the grade based on the tissue from the tumor in the contiguous site.

This instruction is included in the upcoming grade instruction document.

 2013
20130140 Reportability/Ambiguous terminology--Heme & Lymphoid Neoplasms: Is a peripheral blood sample with an immunophenotype that is "characteristic of B-cell chronic lymphocytic leukemia" reportable?

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.

2013
20130115 Histology--Heme & Lymphoid Neoplasms: How is histology coded when the biopsy final diagnosis is "low grade B-cell lymphoma of unclear subtype (splenic marginal zone lymphoma?)" and the hematologist clinically diagnoses this as splenic marginal zone lymphoma? See Discussion.

This patient has massive splenomegaly. The biopsy final diagnosis was "low grade B lymphoma of unclear subtype (splenic marginal zone lymphoma?)." The pathologist's comment states, "Because of the clinical context (lymphocytosis and splenomegaly) a splenic marginal zone lymphoma is a possibility." There are no other histologic diagnoses. All the flow cytometry reports are as unclear as the biopsy.

The hematologist, after seeing the pathology report, states, "The bone marrow biopsy shows a significant infiltration by mature lymphocytes; their markers strongly suggest a marginal zone lymphoma, probably of splenic origin The final diagnosis is a splenic marginal zone lymphoma."

Should the clinical diagnosis of splenic marginal zone lymphoma [9689/3] be coded when a clinical diagnosis is not listed as a definitive diagnostic method for this neoplasm? Or should the histology be coded as low grade B-cell lymphoma [9591/3]? The clinicians will expect the case to be coded as a splenic marginal zone lymphoma when there's no doubt about the diagnosis.

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

Code the histology to 9689/3 [splenic marginal zone lymphoma] per Rule PH29 and Case Reportability Instruction #6 in the Heme Manual. Case Reportability Instruction #6 indicates, "Report the case when there is a (physician's statement) of reportable hematopoietic or lymphoid neoplasm."

The pathology gave an NOS diagnosis, low grade B-cell lymphoma [9591/3]. The physician clinically stated this was a splenic marginal zone lymphoma [9689/3]. Rule PH 29 states to code the specific histology when the diagnosis is one non-specific histology AND one specific histology AND the Heme DB MP Calculator indicates they are the same primary. Per the Multiple Primaries Calculator, these two histologies indicate the same 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.

2013
20130062 Date of diagnosis--Heme & Lymphoid Neoplasms: Should the diagnosis date be coded to the date of the flow cytometry on the peripheral blood or the date of the bone marrow biopsy for a diagnosis of chronic lymphocytic leukemia/low grade B-cell lymphoma? See Discussion. Is a flow cytometry on peripheral blood alone diagnostic of a hematopoietic malignancy (CLL)? If not, when the diagnosis is verified by a subsequent histologic diagnosis (bone marrow biopsy) would the diagnosis date be the date of the peripheral blood flow cytometry or the date of the bone marrow biopsy? The Class of Case depends on this diagnosis date.

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

Code the diagnosis date to the date of the peripheral blood flow cytometry because this is a procedure used to diagnose CLL. Per both the Abstractor Notes and the Definitive Diagnostic Methods sections in the Heme DB, CLL is diagnosed by flow cytometry (immunophenotyping).

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
20130183

Reportability--Heme & Lymphoid Neoplasms: Is a peripheral blood finding consistent with involvement by monoclonal, lambda-restricted mature B cell population with co-expression of CD5 and CD23 reportable if, immunophenotypically, the case is consistent with a chronic lymphocytic leukemia/small lymphocytic lymphoma? See Discussion.

Peripheral blood: Final diagnosis: Leukocytosis absolute lymphocytosis monoclonal, lambda restricted B-cell population w/co-expression of CD5 and CD23 absolute increase in CD4=helper T cells. See comment.

Comment: Peripheral blood findings are consistent with involvement by monoclonal, lambda-restricted mature B cell population with co-expression of CD5 and CD23, which is immunophenotypically consistent with a chronic lymphocytic leukemia/small lymphocytic lymphoma immunophenotype. However, the absolute monoclonal population is only 3.02k/ul.

According to WHO criteria, in the absence of extramedullary tissue involvement, the monoclonal lymphocyte population must be greater than or equal to 5.0 k/ul. Therefore, in the absence of clinical evidence of extramedullary tissue involvement, the diagnosis is most consistent with a monoclonal B cell lymphocytosis. Review of initial analysis reveals well-defined groups of cells within lymphocyte, monocyte and granulocyte gates as defined by CD45 and sid-scatter characteristics (%'s are listed). Overall, peripheral blood findings are consistent with involvement by monoclonal, lambada-restricted B cell population with a chronic lymphocytic leukemia/small lymphocytic lymphoma immunophenotype.

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

This case is reportable. Code histology to 9823/3 [CLL/SLL].

Ambiguous terminology is used to accession cases (determine reportability) because it has been used for over 30 years to do so. Any deviation from using ambiguous terminology to determine case reportability would cause the reporting of incidence counts to vary. In this case, there was a reportable, ambiguous terminology diagnosis on peripheral blood that is "consistent with" involvement by chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) immunophenotype.

The ambiguous terminology "consistent with" in the flow cytometry report is acceptable to determine reportability. Given that it is the only reportable histology mentioned in the scenario, it is also used to code histology. The instruction "Do not code histology based on ambiguous terminology" is intended to be used when there is a reportable NOS histology and reportable more specific histology stated in the diagnosis. Ambiguous terminology cannot be used to report the more specific diagnosis in cases of Heme & Lymphoid neoplasms.

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
20130078

Ambiguous terminology/Reportability--Heme & Lymphoid Neoplasms: Is a physician diagnosis of "appears to be a myeloproliferative disorder" reportable if the patient has no treatment and the physician elects to follow the patient with CBC's?.

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.

 2013