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Report Produced: 02/10/2026 21:11 PM

Report Question ID Question Discussion Answer Year
20130124 Reportability--Heme & Lymphoid Neoplasms: Is Rosai-Dorfman's syndrome (histiocytosis) a reportable malignant condition? Rosai-Dorfman disease is not reportable. Rosai-Dorfman disease is a rare non-neoplastic disease. This disease can mimic lymphoma and extranodal involvement is frequent. 2013
20130080 Primary site/Histology--Heme & Lymphoid Neoplasms: How are the primary site and histology coded when a right neck mass and spinal mass both show B-cell lymphoma, favor Burkitt lymphoma? See Discussion.

2/5/11 Right neck swelling. Biopsy of mass B-cell lymphoma, favor Burkitt lymphoma.

7/5/11 Hemi-laminectomy, L2-L5 spinal mass: Malignant lymphoma, B-cell phenotype, favor Burkitt lymphoma.

Should the primary site be C779? Is the correct histology Burkitt lymphoma [9687/3] or malignant lymphoma, diffuse large B-cell [9680/3]?

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

Code the primary site to C779 [lymph nodes] per Rule PH22 and the histology to 9591/3 [B-cell lymphoma, NOS].

Code the primary site to C779 [lymph nodes, NOS] when lymphoma is present in an organ and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. The patient has involvement of a lumbar spine mass and cervical lymph nodes. Cervical lymph nodes are not regional to the lumbar area of the spine.

Do not use ambiguous terminology to code histology for hematopoietic neoplasms. "Favor" is ambiguous terminology. Therefore, the histology must be coded to B-cell lymphoma and not to diagnosis which is "favored" (Burkitt lymphoma). Remember that ambiguous terminology is only used to determine case reportability, not to code histology for hematopoietic 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
20130057 Histology--Heme & Lymphoid Neoplasms: How is the histology coded if the bone marrow biopsy favors lymphoplasmacytoid lymphoma and the physician states the diagnosis is lymphoplasmacytic lymphoma-Waldenstrom's macroglobulinemia? See Discussion.

Bone marrow biopsy: Focal bone marrow involvement with B-cell lymphoproliferative disorder. Comment: This patient has 2 monoclonal proteins in serum, IgM kappa and IgG kappa clones. The marrow does have focal involvement with a small cell lymphoproliferative disorder. A lymphoplasmacytoid lymphoma is favored.

Flow Cytometry: Bone marrow reveals a low level, kappa-bearing-B-lymphoproliferative population that has an immunophenotype compatible with mantle cell lymphoma or related small, mature non-Hodgkin lymphoproliferative disorder.

Physician statement: lymphoplasmacytic lymphoma-Waldenstrom's macroglobulinemia.

Per the Heme DB, the criteria to diagnosis WM is the serum paraprotein IgM. This patient's IgM was 6020 mg/dL. It was described as elevated per the physician. The physician also states the patient's IgG is elevated. According to the Heme DB, when both IgG and IgM are elevated it is indicative of LPL.

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

Code the histology to 9671/3 [lymphoplasmactyic lymphoma (LPL)] per the Heme DB Abstractor Notes and Rule PH17. When IgG and IgM are elevated, code to lymphoplasmacytic lymphoma. Waldenstrom's macroglobulinemia is caused by increased lymphocytes which causes an increase in IgM. LPL has mixed abnormalities, both the lymphocytes and plasma cells are increased which results in an abnormally high IgM and IgG.

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
20130012

MP/H Rules/Multiple primaries--Urinary: If topography codes C681-C689 are not included in Urinary Multiple Primary Rule M8, would a subsequent renal pelvis papillary transitional cell carcinoma be a new primary? See Discussion.

The patient had a papillary transitional cell carcinoma of the bladder and ureter diagnosed in 2010. The primary site was coded to C689 [urinary system, NOS]. The patient was diagnosed with a transitional cell carcinoma of the renal pelvis [C659] in 2012. In applying the MP/H rules to the 2012 diagnosis, rule M8 would be ignored because the primary site of the 2010 primary was coded to C689. The result is that M9 or M10 would be applied which indicates a new primary for the 2012 diagnosis. Should the 2012 renal pelvis carcinoma be a new primary?

For cases diagnosed 2007 or later, accession a single primary, papillary transitional cell carcinoma of the bladder and ureter [C689, urinary system, NOS] diagnosed in 2010. The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Urinary MP Rules because site specific rules exist for this primary.

Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. This patient has urothelial tumors in two or more of the listed sites (bladder, ureter and renal pelvis) diagnosed within 3 years.

When C689 is assigned because tumors of the bladder and tumors of the ureter were determined to be a single primary and the site of origin is not known (as in this example), rule M8 is applied when a subsequent tumor is diagnosed in one of the listed sites. However, if site C689 [urinary system, NOS] was assigned for other unknown urinary primary site situations, rule M8 would not be used.

Rule M8 was written specifically for urothelial tumors in the renal pelvis, ureter, bladder and urethra. Paraurethral gland [C681] and overlapping lesions of urinary organs [C688] do not belong in rule M8.

We will add this issue to the list of possible revisions for the next edition of the MP/H Rules.

 2013
20130005 Reportability--Brain and CNS: Are spinal schwannomas and neurofibromas reportable or non-reportable? The most accurate and most current instruction is to report these spinal tumors when they arise within the spinal dura or spinal nerve roots, or when they are stated to be "intradural" or "of the nerve root." Do not report these tumors when they arise in the peripheral nerves. The peripheral nerves are the portion of nerve extending beyond the spinal dura. 2013
20130014 Reportability--Heme & Lymphoid Neoplasms: Is Castleman disease reportable when diagnosed 2010 and later? When checking Castleman disease in the Hematopoietic Database, the result is a reportable histology code 9738/3. However, per an online search, Castleman disease is a very rare disorder characterized by non-cancerous growths (tumors).

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

Castleman disease, NOS, is not reportable for cases diagnosed 2010 and later. However, when Castleman disease is diagnosed in connection with large B-cell lymphoma [9738/3], it is 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
20130037 Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a "cutaneous diffuse large B-cell lymphoma, leg type" that has been verified as a valid diagnosis with prognostic factors including age and number of lesions on the legs?

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

Code this histology to 9680/3 [diffuse large B-cell lymphoma]. Primary cutaneous DLBCL, leg type, is listed as an Alternate Name for DLBCL per the Heme DB.

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
20130055 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a lymphoma with multifocal bone and epidural involvement but no lymph node involvement if the physician does not clearly state the primary site? See Discussion.

MRI Lumbar spine: Bony metastatic disease most evident at L5, L3 and T10. There is marrow tumor in the posterior elements of T12 and T10. The 14 mm epidural mass represents epidural tumor, likely metastatic, extending into the left intervertebral foramen at T12-L1.

PET scan: Hypermetabolic activity corresponding to epidural mass at the level of T12 and L1 concerning for malignancy. Other small areas of hypermetabolic activity in the left mandible and both femoral necks. There is no hypermetabolic activity corresponding to the areas of abnormal marrow edema in the vertebral bodies which enhanced on MRI scan in the lumbar and lower thoracic spine. No lymph nodes mentioned.

Biopsy epidural mass: Diffuse large B-cell lymphoma with a background of follicular lymphoma, consistent with a large cell transformation. Flow cytometry confirms a mixed large and small cell population of lymphoma (55% large cells).

T12/L1 Bone Biopsy: Bone and marrow with atypical paratrabecular lymphoid infiltrates, suspicious for involvement by follicular lymphoma. Negative for large cell lymphoma.

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

Code the primary site of the diffuse large B-cell lymphoma [9680/3] to C809 [unknown primary site] per Rule PH27. The patient has involvement of multiple bones and an epidural mass with no evidence of nodal involvement. Code the primary site to unknown [C809] when multiple organs are involved without any lymph node involvement, even when there is no statement from the physician regarding primary site.

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
20130118 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of Langerhans cell histiocytosis with extensive bony metastatic disease and lymphadenopathy? See Discussion. Patient was diagnosed with LCH on a biopsy of the right femur. Imaging showed extensive bony metastatic disease, extensive infiltrative perinephritis, encasement of both kidneys, renal hilar, retroperitoneal and periaortic lymphadenopathy. The right femur biopsy pathology report did not state this was metastatic.

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

Code the primary site to C419 [bone, NOS] per Rule PH30.

This patient has widely metastatic disease. Per Rule PH30, one needs to reference the Heme DB to determine the primary site and histology for this case. Per the Abstractor Notes section, Langerhans cell histiocytosis arises in the bone and many times can involve multiple bones, along with other organs and lymph nodes. Although the right femur was biopsied, this does not prove that the primary site is the femur [C402] because the patient has what was described as extensive bony metastatic disease.

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
20130116 Histology/Primary site--Heme & Lymphoid Neoplasms: How are the histology and primary site coded if a pleurocentesis is compatible with plasmablastic plasmacytoma/lymphoma when no further information is available?

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

Code the histology to 9735/3 [plasmablastic lymphoma] and the primary site to C809 [unknown] per Rule PH27.

Code the histology specified when the only histology for the case is preceded by ambiguous terminology. For this case, code the histology to plasmablastic lymphoma because it is the only histology mentioned in the diagnosis.

Per the Heme DB Abstractor Notes section for plasmablastic lymphoma, most patients present with Stage III-IV disease. The positive pleural fluid is likely due to advanced disease. In the absence of any other information for this case, Rule PH27 applies, "Code primary site to unknown primary site C809 when there is no evidence of lymphoma in lymph nodes AND the physician documents in the medical record that he/she suspects that the lymphoma originates in an organ(s) OR multiple organ involvement without any nodal 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