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

Idiopathic thrombocytic purpura (ITP) is not a synonym for refractory thrombocytopenia (RT). ITP is not a reportable disease. See Appendix F.

Under the Alternate Names section in the Heme DB, the only synonym for refractory thrombocytopenia is "RT." ITP is not listed as a synonym for refractory thrombocytopenia.

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 2007 or later, code the histology as lobular carcinoma, in situ [8520/2].

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 Breast Histo rules because site specific rules exist for this primary.

Start at the SINGLE TUMOR: IN SITU CARCINOMA ONLY module, Rule H1. The rules are intended to be reviewed in consecutive order. Stop at the first rule that applies to the case you are processing. Code the histology to lobular carcinoma in situ [8520/2] because this is the only histologic type identified.

Pleomorphic lobular carcinoma is a variant of lobular carcinoma which does not have an ICD-O-3 code. It is still a lobular carcinoma. The identification of the variants of lobular carcinoma was a relatively recent discovery and the information was not available when the 2007 MP/H Rules were written. All of the lobular variants will be included in the next revision of the MP/H Rules.

For tumors diagnosed prior to 2007:

No. This is one primary. Mucosal spread of noninvasive cancer from a hollow organ (bladder) into another hollow organ (prostatic urethra) is coded as a single primary. The prostatic urethra is seldom a primary site. The cancer usually starts in the bladder and spreads to the prostatic urethra via the mucosa. In this case the cancer in the prostatic urethra became invasive. Code primary site as bladder, NOS [C67.9].

For cases diagnosed 1998-2003: Code EOD Extension using the invasive information (prostatic urethra).

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

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] per Rule PH1. Code the histology as 9680/3 [DLBCL], the histology of the accompanying lymphoma, when the diagnosis is PTLD and any 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.

Per the WHO Tumors of Endocrine Organs, for thyroid primaries/cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult (1cm or less in diameter) and was found incidentally. WHO does not recognize the code 8341 and classifies papillary microcarcinoma of the thyroid as a variant of papillary thyroid and thereby should be coded to 8260. If the primary is thyroid and the pathology states papillary microcarcinoma or micropapillary carcinoma, code 8260 is correct. This information will be included in the upcoming revisions to the MP/H manual.                        

The following statement "Any mention of the terms including fixed, matted, mass in the hilum, mediastinum, retroperitoneum, and/or mesentery, palpable, enlarged, shotty, lymphadenopathy are all regarded as involvement for lymphomas when determining appropriate code," is included in EOD Primary Tumor and is applicable to Summary Stage 2018.

The statement will be added as note 4 to the Lymphoma Summary Stage chapter. This will be included in the 2019 update (estimated release January 2019).

Yes, code Crooke cell adenoma to 8272/0 pituitary adenoma. According to the WHO classification, it is a variant of adrenocorticotropic hormone (ACTH) producing adenoma (8272/0).

Assign laterality code 9 for midline nasal cavity tumor. We will investigate this issue further.

Search for additional information on the location of the primary in this case. A tissue specimen (biopsy) is required for a diagnosis of rhabdoid. Additionaly, there should be scans describing any tumors located in sites other than the biopsy site. If the biopsy site is not assumed to be a metastatic site and is the only location of tumor, code the site of the biopsy as the primary site.

If it is not possible to obtain further information for this case, code the primary site C809 [Unknown primary site].

According to our pathologist consultant, extra-renal rhabdoid tumors have been described in organ sites (liver, GI tract, thyroid, CNS, skin, to name a few) as well as in the soft tissue. Many of the organ site tumors are multiple/multifocal, so multiple tumors in one organ do not necessarily imply metastatic disease and therefore unknown primary site.

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

This case should be accessioned as a single primary lymphoma of bilateral orbits per Rule M2. Abstract a single primary when there is a single histology. Both orbits showed the same histology. Note 1 for Rule M2 states bilateral involvement of lymph nodes and/or organs is a single 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.