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Report Produced: 02/15/2026 01:17 AM

Report Question ID Question Discussion Answer Year
20130030

Histology--Heme & Lymphoid Neoplasms: How is histology coded for a patient diagnosed with diffuse large B-cell lymphoma, immunoblastic [9684/3] in 2009 and a recurrence in 2010 at another facility was referred to as plasmablastic lymphoma [9735/3]? See Discussion.

Which code is correct for the merged record? Is code 9735/3 [plasmablastic lymphoma] correct because code 9684/3 [DLBCL, immunoblastic] is now obsolete?

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

This case was originally diagnosed in 2009, prior to the development of Hematopoietic Database. Therefore it is necessary to use the ICD-O-3 to code histology to 9684/3 [diffuse large B-cell lymphoma, immunoblastic]. Use the original histology diagnosed for the merged record because DLBCL, immunoblastic, and plasmablastic lymphoma are the same primary. Do not change the histology to code 9735/3 [plasmablastic lymphoma].

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
20130128 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient has a history of chronic myelomonocytic leukemia and a 12/08/2011 subsequent biopsy of the left leg that confirms leukemia cutis? See Discussion. Patient with a history of chronic myelomonocytic leukemia has been undergoing treatment with Dacogen for three years. On 12/8/11 the patient had a biopsy of the left leg that confirmed a diagnosis of leukemia cutis. How is the leukemia cutis coded?

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

Accession a single primary, chronic myelomonocytic leukemia [9945/3], per Rule M2. Accession a single primary when there is a single histology.

This is not a new primary. Leukemia cutis is the infiltration of neoplastic leukocytes into the skin from the existing leukemia. This is an advanced phase of the leukemia and has a poor prognosis.

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
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
20130016 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is diagnosed with small lymphocytic lymphoma in 1996, received chemotherapy on and off for 15 years due to relapses, and was subsequently diagnosed with diffuse large B-cell lymphoma in 2012?

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

Per Rule M10, this case should be accessioned as two primaries. According to Rule M10, one is to abstract as multiple primaries when a neoplasm is originally diagnosed as a chronic neoplasm AND there is a second diagnosis of an acute neoplasm more than 21 days after the chronic diagnosis.

The histology for the 1996 chronic neoplasm is coded to 9670/3 [small lymphocytic lymphoma]. The histology for the 2012 acute neoplasm is 9680/3 [diffuse large B-cell lymphoma].

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
20130199

MP/H Rules/Multiple primaries--Breast: Does breast Rule M10, 'Tumors that are lobular (8520) and intraductal or duct are a single primary" apply if you have two tumors in the same breast, one ductal and the other tubulolobular (8524) or are they separate primaries per Rule M12?

Apply Rule M10 to this case. Tubulolobular is now classified as a variant of lobular. Code to lobular, NOS (8520) because Tubulolobular does not have a specific ICD-O-3 code.

 2013
20130221 MP/H Rules/Multiple primaries--Prostate: How many primaries are accessioned for a diagnosis of metastatic small cell neuroendocrine carcinoma of the prostate following a previous diagnosis of adenocarcinoma of the prostate? See Discussion.

Would a second prostate primary with histology coded to 8041/3 [small cell carcinoma] be accessioned for the following examples? Or are these metastases despite the different histologies?

Example 1: Prostate adenocarcinoma diagnosed in 2001, no treatment given. Metastatic small cell neuroendocrine carcinoma diagnosed 03/2012 on liver biopsy with a physician's statement in 4/2012 that the prostate is likely the cause of the metastasis to the liver.

Example 2: Prostate adenocarcinoma diagnosed in 2006, treated with TURP. Bone marrow biopsy in 5/2012 shows involvement by metastatic small cell carcinoma with morphologic and immunophenotypic features that argue against prostatic adenocarcinoma. The oncologist assessment states, "The patient has Stage 4 small cell carcinoma of the prostate and the bone marrow biopsy path shows metastatic small cell carcinoma (likely prostate in origin)."

Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619], followed by small cell (neuroendocrine) carcinoma [8041/3] of the prostate [C619] for each of the examples given per Rule M10.

In each case, the second histology (because it is not adenocarcinoma) is a new prostate primary. Small cell carcinoma and small cell neuroendocrine carcinoma are not adenocarcinomas. As a result they are not covered by Rule M3.

2013
20130125 Reportability--Heme & Lymphoid Neoplasms: Is self-healing Langerhans cell histiocytosis (LCH) of the skin reportable?

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

This is a reportable primary. Langerhans cell histiocytosis (LCH) [9751/3] is a reportable neoplasm.

The term "self-healing" means that the neoplasm regressed without treatment. This is a known phenomenon.

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
20130109

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2004 diagnosis of acute myeloid leukemia is followed by a 2013 diagnosis of myeloid sarcoma? See Discussion.

Patient was diagnosed in 2004 with acute myeloid leukemia [9861/3] and treated with chemotherapy and transplant. Now the patient has a biopsy of an umbilical mass that is positive for myeloid sarcoma (granulocytic sarcoma) [9930/3].

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

Accession a single primary, acute myeloid leukemia [9861/3] diagnosed in 2004 per Rule M3.

When there is a myeloid sarcoma diagnosed simultaneously or after a leukemia of the same lineage, it is a single primary. The myeloid sarcoma is actually caused by the AML progressing. The myeloid cells in the bone marrow or blood literally "seep out" and implant in the tissue.

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
20130019 Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded when a patient has a lymph node biopsy and peripheral blood that are positive for B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma but refuses a bone marrow biopsy?

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. Note 1 for Rule PH5 states CLL always has peripheral blood involvement. If the peripheral blood is positive for CLL/SLL and no bone marrow biopsy is done, code the primary site to C421 [bone marrow].

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
20130052 Histology--Heme & Lymphoid Neoplasms: How is the histology coded if a biopsy final diagnosis is diffuse large B-cell lymphoma but the physician's final diagnosis favored anaplastic large cell lymphoma? See Discussion. Patient has diffuse intrathoracic, intraabdominal and pelvic lymphadenopathy. An inguinal lymph node biopsy showed diffuse large B-cell lymphoma. The physician's final diagnosis favored anaplastic large cell lymphoma, but wanted to confirm this with FISH. The patient clinically deteriorated so the FISH studies were not done. Which histology is coded?

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.

2013