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Use Rule M2. Abstract as a single primary when there is a single histology.

When you have questions about how to code the primary site, start with the abstractor notes. If the answer isn't found there go to Module 7 (a specific module to help code primary site for lymphomas).

The abstractor notes for DLBCL in this case do not provide information you can use for this case. Go to Module 7 in the PH rules.

Use Rule PH25 Code the primary site to the organ when lymphoma is present in an organ and that organ’s regional lymph nodes. Code the primary site to colon (organ and regional lymph nodes involved). The fallopian tube is secondary involvement. As is common with lymphomas, there can be more than one organ involved. You can differentiate the primary site from the secondary site(s) because of the large colon mass with regional lymph node involvement.

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

There has been a change in coding practice based on a change in clinical classification of leukemia/lymphomas. In the past, we did, indeed, default to lymphoma when both tissue and bone marrow were involved. The problem was that when only bone marrow was involved, the case was coded to leukemia with a primary site of bone marrow. When lymphoma symptoms developed later, there was a lot of inconsistency in how registries handled these cases. Some coded a new primary "lymphoma;" while others ignored the lymphoma calling it progression.

The clinical world, including the hematopoietic experts in the World Health Organization and the Inter-Lymph Consortium, agreed that for certain neoplasms (CLL/SLL being one of them) it was not useful or practical to code the leukemia and lymphoma separately OR to capture only one of the neoplasms (because these neoplasms almost always progress to lymphoma); so new codes for the leukemia/lymphoma were developed. According to the experts, 9823/3 most accurately portrays the neoplastic process for the neoplasms assigned to a lymphoma/leukemia code.

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.

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

Heparin-induced thrombocytopenia is not reportable.

If the diagnosis is changed to refractory thrombocytopenia, then this case 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.

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

Code the primary site to the sigmoid colon [C187] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ. Based on the information provided, the lymphoma is present only in the sigmoid colon.

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.

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

Code the grade to 6 [B-cell] for all cases of 9811/3 [B lymphoblastic leukemia/lymphoma] per Rule G3 in the Heme Manual.

Acute lymphoblastic leukemia, NOS [9835/3] is an obsolete code and cannot be used for cases diagnosed 2010 and later. The Heme DB indicates the correct histology code is 9811/3 and grade 6 [B-cell] for cases diagnosed 2010 and later.

For cases of acute lymphoblastic lymphoma, NOS [9835/3] diagnosed prior to 2010, use the pathology report information to code the grade. Code the grade as 9 [unknown] if the pathology report does not specify the grade.

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.

Accession a single primary, clear cell adenocarcinoma [8310/3] of the left upper lobe lung [C341] diagnosed on 08/05/2010.

The MP/H Rules do not apply to the 2012 diagnosis because only metastatic sites were examined and there was no re-examination of the original 2010 tumor. Therefore, the disease process in 2012 is assumed to be metastatic from the lung primary diagnosed in 2010.

Code the histology to 8140/2 [adenocarcinoma in situ, NOS].

The comment for this case is consistent with information from the CAP protocol, which says, "The diagnosis of bronchioloalveolar carcinoma requires exclusion of stromal, vascular, and pleural invasiona requirement that demands the tumor be evaluated histologically in its entirety. It is therefore recommended that a definitive diagnosis of bronchioloalveolar adenocarcinoma not be made on specimens in which the tumor is incompletely represented."

This tumor was not completely resected. Therefore, code to adenocarcinoma in situ based on the information provided.

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.

For cases diagnosed 1/1/2010 and later, use the Hematopoietic & Lymphoid Neoplasm Manual for instructions on coding aspirin, blood thinners/anti-clotting medications, and transfusions in the field "Other Treatment."

For cases diagnosed 5/1/2002 12/31/2009, use the instructions in the SEER Manual and the instructions in "Abstracting and Coding Guide for the Hematopoietic Diseases" to code aspirin, blood thinners/anti-clotting medications, and transfusions in the field "Other Treatment."

For cases diagnosed 1/1/2001 04/30/2002 use the instructions in the SEER Manual for collection of aspirin, blood thinners/anti-clotting medications, and transfusions in the field "Other Treatment."

Prior to 1/1/2001, these treatment modalities were not collected.

This case should be accessioned as a single primary. Code the primary site to the colon and rectum [C199] and the histology to adenocarcinoma in familial polyposis coli [8220/3] per MP/H Rule H17.

For cases of familial polyposis, when the rectosigmoid or rectum are involved, assign code C199 [colon and rectum]. When the rectosigmoid or rectum are not involved, assign code C189 [colon, NOS].