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Welcome to the SEER Inquiry System (SINQ). SINQ is a collection of questions that cancer registrars have had while coding cancer cases. Click Search to look for specific questions or to select questions for a Report.


Recent Questions
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20140080

Behavior--Breast: Is behavior for encapsulated papillary carcinoma (EPC) of the breast coded as noninvasive or invasive?

Final Sep 16 2014
20140079

Laterality: Why is a code 5 for laterality midline only allowed for certain sites of brain and skin? I have a nasal cavity tumor and the path report specifically says "Tumor laterality: midline". What is the correct laterality code here?

Final Sep 10 2014
20140078

Surgery of Primary Site--Bladder: Is any mention of cautery in the gross description of pathology for a TURBT specimen sufficient to code 22 (excisional biopsy with electrocautery), or does there need to be a statement in the operative report that electrocautery was performed? See discussion.

Final Aug 29 2014
20140077

MP/H Rules/Histology/Multiple primaries--GE junction: How is histology coded for a goblet cell carcinoma in the GE junction? See discussion.

Final Aug 18 2014
20140065

Summary Stage 2000--Melanoma: How should Summary Stage 2000 be coded for 2014+ diagnosed melanoma cases with satellite nodules or in transit metastases? See discussion.

Final Jul 24 2014
20140064

Reportability--Testis: Is a mature teratoma of the testis reportable? See discussion.

Final Jul 24 2014
20140063

MP/H Rules--Histology: How is histology coded when a metastatic site is biopsy positive for adenocarcinoma, but the physician clinically states this is cholangiocarcinoma? See discussion.

Final Jul 21 2014
20140062

MP/H Rules/Multiple Primaries--Lung: Does lung MP/H Rule M6 apply to synchronous tumors only, metachronous tumors only, or both? See discussion.

Final Jul 21 2014
20140061

Primary Site/In Situ: How is primary site coded for an in situ carcinoma arising in a mucinous cystadenoma with ovarian stroma (focal) located in the right lobe of the liver? See discussion.

Final Jul 21 2014
20140060

MP/H Rules/Histology--Lung: What is the correct histology code for this lung tumor? FINAL PATHOLOGIC DIAGNOSIS: CT-guided Rotex and Franseen needle biopsies: Positive for malignancy, consistent with adenocarcinoma. Comment: the adenocarcinoma present also shows rare CD56 staining which indicates a neuroendocrine component.

Is this a mixed histology? 8045/3? 8244/3?

Final Jul 21 2014
20140040

Reportability/Primary Site--Lip: Is a right lower lip (NOS) squamous cell carcinoma reportable when the microscopic description states the tumor arises from the epidermis and extends through the dermis? See discussion.

Final Jul 11 2014
20140039

Reportability--Heme & Lymphoid Neoplasms: Is a statement of "JAK-2 positive polycythemia" reportable? See discussion.

Final Jul 11 2014
20140038

MP/H Rules/Multiple Primaries--Urinary: How many primaries are there and which MP rules apply in this scenario? See discussion.

Final Jul 07 2014
20140037

Grade--Prostate: How is Grade coded if hormone therapy is given prior to a prostate biopsy that confirms Gleason score 9 (4+5) adenocarcinoma? See Discussion.

Final Jun 05 2014
20140036

MP/H Rules/Multiple primaries--Prostate: Is duct carcinoma of the prostate the same as an adeno/acinar carcinoma of the prostate? Specifically, does rule M3 apply when there is an adenocarcinoma of the prostate followed by a duct carcinoma of the prostate or a duct carcinoma followed by adenocarcinoma?

Final May 15 2014
20140035

Reportability/MP/H Rules/Histology: Is this kidney tumor diagnosis reportable? If so, what is the correct histology? See discussion.

Final May 05 2014
20140034

Reportability--Ovary: Can you clarify when widely metastatic borderline histologies of the ovary and various other sites are reportable? See discussion.

Final Apr 22 2014
20140033

Reportability/Ambiguous Terminology--Prostate: Can you clarify why a prostate biopsy diagnosis of “highly suspicious for, but not diagnostic of adenocarcinoma, suggest another biopsy” is not reportable while a biopsy diagnosis of “atypical glands suspicious for adenocarcinoma with insufficient atypia to establish a definitive diagnosis of malignancy” is reportable? See discussion.

Final Apr 22 2014
20140021 Reportability--Breast: Is an inflammatory myofibroblastic tumor of the breast with metastasis to the lung reportable? Final Mar 31 2014
20140020 Reportability--Breast: Is ADH/DCIS reportable? Final Dx for left Breast biopsy: Atypical epithelial proliferation (ADH/DCIS). Comment: Sections show small focus of atypical epithelial proliferation with features of atypical duct hyperplasia/low grade duct carcinoma in-situ. Final Mar 18 2014
20140019 Reportability--Breast: Is this reportable as 8520/2? Final Diagnosis: Atypical Lobular Hyperplasia (ALH/LCIS). We are seeing this diagnosis quite often. Final Mar 17 2014
20140016 MP/H Rules/Histology--Bladder: What is the correct histology code for this situation? See discussion. Final Feb 17 2014
20140015 Primary site--Heme & Lymphoid Neoplasms: Is there an instruction missing under Rule PH22 of the 2014 Heme Manual that addresses when it might be appropriate to code primary site to C779 for a Stage II lymphoma? See discussion. Final Feb 10 2014
20140014 First course treatment/Surgery of Primary Site--Anus: Would infrared coagulation be coded as treatment for AIN III of the anus/anal canal? See discussion. Final Feb 10 2014
20140013 Primary site--Brain and CNS: How should primary site be coded for a medulloblastoma described as a "posterior fossa mass” and “centered within the fourth ventricle"? See discussion. Final Feb 10 2014
20140012 MP/H Rules/Histology--Breast: What is the correct histology code for this final diagnosis of a breast tumor: INVASIVE POORLY DIFFERENTIATED DUCTAL CARCINOMA WITH SQUAMOUS DIFFERENTIATION (METAPLASTIC FEATURES)? Final Feb 05 2014
20140011 MP/H Rules/Multiple primaries--Breast: Is the diagnosis of Paget disease two years after a diagnosis of infiltrating duct carcinoma of the same breast a new primary? See discussion. Final Jan 24 2014
20140010 Multiple primaries--Heme & Lymphoid Neoplasms: Is this one primary or two? Follicular lymphoma grade 1 (9695/3) on 8/23/12 from an abdominal lymph node. On 1/6/14 an abdominal lymph node biopsy showed diffuse large b cell lymphoma arising from high grade follicle center cell lymphoma. Patient has been on observation. Final Jan 22 2014
20140009 Primary site: What primary site do I assign to a Squamous Cell Carcinoma of the parapharyngeal space when there is no other info available regarding a more definitive site within the parapharyngeal space? Each physician involved with the case states the primary site is the parapharyngeal space. This is a patient who was diagosed and treated elswhere and was seen at our hospital several months later for a radical neck dissection for suspected lymph node mets. Final Jan 22 2014
20140008 Primary site: If text supports a pancreatobiliary primary with no other information what primary site code would be assigned? C249 biliary tract NOS, or C269 GI tract nos, or C809 unknown? Final Jan 22 2014
20140007 Surgery of Primary Site--Lung: How is surgery coded when a patient undergoes a mediastinoscopy with mediastinal lymph node sampling and then a later upper lobectomy? See discussion. Final Jan 15 2014
20140006 Date Therapy Initiated--Corpus Uteri: How should this field be coded for an endometrial primary when the patient undergoes a hysteroscopic polypectomy on 01/08/2014 (Surgery code 25), followed by a TAH/BSO on 02/07/2014 (Surgery code 50)? See discussion. Final Jan 15 2014
20140005 Primary site--Testis: In the absence of a specific statement that the patient's testicle(s) are descended, should the primary site for a testicular tumor be coded as C621 (Descended Testis) when the mass is palpable on physical exam or demonstrated on scrotal ultrasound? See discussion. Final Jan 15 2014
20140004 Grade--Liver: How should grade be coded for a liver lesion treated with radio frequency ablation (RFA) followed by a transplant showing moderately differentiated hepatocellular carcinoma? See discussion. Final Jan 15 2014
20140003 Surgery of Primary Site/Surgical Procedure of Other Sites--Endometrium: How are these fields coded for an endometrial primary when the patient undergoes a radical tumor cytoreduction including modified radical hysterectomy, BSO, omentectomy, resection of intra-abdominal and intrapelvic implants, and partial cystectomy? See discussion. Final Jan 15 2014
20140002 Reportability--Appendix: Is a pathologic final diagnosis of an appendix with "well-differentiated neuroendocrine tumor (carcinoid)" reportable? See discussion. Final Jan 15 2014
20140001 Grade--Brain and CNS: How should grade be coded for a pineal parenchymal tumor of “intermediate differentiation”? See discussion. Final Jan 10 2014
20130222 MP/H Rules/Histology--Bladder: How is the histology coded for a single bladder tumor showing invasive urothelial carcinoma with extensive divergent differentiation including small cell carcinoma, micropapillary carcinoma, and squamous cell carcinoma features? See Discussion. Final Jun 25 2014
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. Final Jun 25 2014
20130220 Reportability--Thyroid: Is a hyalinizing trabecular neoplasm of the thyroid reportable? See Discussion. Final Jun 25 2014
20130219 Date of diagnosis/Ambiguous terminology--Breast: Can a mammogram BIRADS 4 or 5 assessment be used to assess reportability and can the date of the mammogram be used to code the date of diagnosis? See Discussion. Final Jun 30 2014
20130218 Final Dec 10 2013
20130217 Final Dec 10 2013
20130215 Reportability--Heme & Lymphoid Neoplasms: Is hemophagocytic lymphohistiocytosis synonymous with an EBV-associated lymphoproliferative disorder in children considered reportable? See Discussion. Final Jun 30 2014
20130214 Primary site--Heme & Lymphoid Neoplasms: Does Rule PH20 apply if a patient with lymphoma has bilateral axillary and bilateral inguinal lymph node involvement? Final Jun 30 2014
20130213 Primary site--Heme & Lymphoid Neoplasms: How do you code the primary site for a marginal zone lymphoma involving bilateral axillary lymph nodes and inguinal lymph nodes, bone marrow and bilateral orbits that the physician refers to as a bilateral orbital lymphoma, Stage IV? See Discussion. Final Jun 30 2014
20130212 Reportability--Heme & Lymphoid Neoplasms: Is a case reportable in which the pathology report is negative for plasmacytoma but a subsequent physician’s clinical diagnosis is plasmacytoma? Final Jun 30 2014
20130211 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported if a bone marrow shows low grade mature B cell lymphoma with IgM paraprotein - macroglobulinemia? See Discussion. Final Jun 30 2014
20130209 Multiple primaries--Heme & Lymphoid Neoplasms: Is a new bone marrow diagnosis of acute myelogenous leukemia that follows a 2007 treated diagnosis of a JAK-2 positive polycythemia vera considered a new primary? Final Jun 30 2014
20130208 Histology--Heme & Lymphoid Neoplasms: How is histology coded when a bone marrow shows slightly hypercellular marrow with acute myeloid leukemia, non-M3 type and the flow cytometry is also consistent with acute myeloid leukemia, non-M3 type? Final Jun 30 2014
20130207 Multiple primaries--Heme & Lymphoid Neoplasms: Is a new primary reported for the diagnosis of plasmacytoma associated with a pathological fracture if it follows a diagnosis five years ago of multiple myeloma? See Discussion. Final Jun 30 2014
20130206 Primary site--Heme & Lymphoid Neoplasms: What rule applies to code a primary site for a peripheral blood diagnosis of marginal zone lymphoma that has a positive flow cytometry/FISH analysis when no biopsies are performed, scans show no evidence of disease, exam indicates no lymph nodes are palpable and the physician’s clinical diagnosis "marginal zone lymphoma, unspecified site, stage 1"? See Discussion. Final Jun 30 2014
20130205 MP/H Rules/Multiple primaries--Breast: How many primaries are reported and what is the histology for each in a case of infiltrating duct and lobular carcinoma of the breast (8522) with Paget disease of the same breast? Final Jun 25 2014
20130204 MP/H Rules/Histology--Kidney, renal pelvis: How is histology coded for a tubulocystic renal cell carcinoma? See Discussion. Final Jun 25 2014
20130203 MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are accessioned for a diagnosis of cerebral cavernous malformation disorder (CCM1) and MRI evidence of dozens of cavernous angiomas/malformations throughout the supra and infratentorium? See Discussion. Final Jul 03 2014
20130202 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013? See Discussion. Final Jul 03 2014
20130201 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported for a patient with a 6/5/12 RUL biopsy that is positive for MALT lymphoma and a 6/7/12 cervical lymph node biopsy that is positive for follicular lymphoma? Final Jun 30 2014
20130200 Primary Site--Heme & Lymphoid Neoplasms: What is the primary site for a diffuse large B-cell lymphoma involving the testicles, stomach, rectum and bone marrow, when no lymph nodes are involved? Final Jun 30 2014
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 considered separate primaries per Rule M12? Final Jul 03 2014
20130198 MP/H Rules/Multiple primaries--Rectosigmoid: How many primaries are accessioned for a synchronous diagnosis of neuroendocrine carcinoma and a separate adenocarcinoma arising in a villous adenoma when both arise in the rectosigmoid junction? See Discussion. Final Jul 03 2014
20130197 MP/H Rules/Histology--Urinary System: What is the histology code for a 2007 and later diagnosis of papillary carcinoma of the urinary system organs? See Discussion. Final Jun 25 2014
20130195 Laterality--Heme & Lymphoid Neoplasms: Is laterality coded to 0 [not paired] for all lymphoma cases including paired sites (e.g., breast, lung)? Final Jun 30 2014
20130194 Reportability--Brain and CNS: Are blood vessel tumors arising in CNS sites reportable? See Discussion. Final Jun 25 2014
20130193 Sex: How is sex coded for a transsexual diagnosed with a testicular primary? See Discussion. Final Jun 30 2014
20130192 MP/H Rules/Histology--Pleura: How is histology coded when the pathology report final diagnosis is “malignant neoplasm, compatible with malignant mesothelioma” if the COMMENT section of the pathology report indicates the tumor has a mixed epithelial and sarcomatoid pattern? See Discussion. Final Jun 25 2014
20130191 Systemic/Surgery Sequence--Bladder: How is the systemic treatment/surgery sequence field coded for a 2013 case if the patient has a TURBT followed by multi-agent chemotherapy, and then a cystoprostatectomy followed by post-operative multi-agent chemotherapy? Final Jun 25 2014
20130190 Reportability: Is a thymoma, type B3 malignant and, therefore, reportable? See Discussion. Final Jun 24 2014
20130189 Reportability--Brain and CNS: Are the terms ‘mass’ and ‘lesion’ considered reportable terms for accessioning brain and CNS primaries? See Discussion. Final Jun 25 2014
20130188 Reportability--Heme & Lymphoid Neoplasms: Is plasma cell neoplasm reportable? See Discussion. Final Jul 03 2014
20130187 Reportability: Is a clinically diagnosed Stage III malignant thymoma reportable when the post-neoadjuvant resection showed spindle cell thymoma? See Discussion. Final Jun 25 2014
20130186 Grade: Can the FIGO grade be used to code the morphologic grade? Final Jul 03 2014
20130185 Reportability/Behavior: Is HGSIL (high grade squamous intraepithelial lesion) of the vulva or vagina reportable and is it a synonym for histology code 8077/2 [squamous intraepithelial neoplasia, grade III]? Final Jun 25 2014
20130184 Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable? Final Jun 30 2014
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 considered reportable if, immunophenotypically, the case is consistent with a chronic lymphocytic leukemia/small lymphocytic lymphoma? See Discussion. Final Jul 03 2014
20130182 Primary site--Head and Neck: How is primary site coded if a floor of mouth biopsy reveals microinvasive squamous cell carcinoma but the definitive resection of the tongue and floor of mouth unifocal lesion reveals only in situ squamous cell cancer? See Discussion. Final Jun 30 2014
20130181 Multiple Primaries--Heme & Lymphoid Neoplasms: Should Rule M4 or the Heme DB be used to determine whether diffuse large B-cell lymphoma of the large intestine and peripheral T-cell lymphoma of the bone marrow represents one or two primaries? See Discussion. Final Jul 03 2014
20130180 Histology--Pancreas: What is the difference between pancreatic endocrine neoplasm (PanNETs) [8240/3] and the new ICD-O-3 terms pancreatic endocrine tumor, benign [8150/0] and pancreatic endocrine tumor, malignant [8150/3]? See Discussion. Final Jun 30 2014
20130179 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries and what is the histology for each primary if a diffuse large B-cell lymphoma [9680/3] and a focus of splenic marginal zone lymphoma [9689/3] occur in a splenectomy specimen? See Discussion. Final Jul 03 2014
20130178 Reportability--Heme & Lymphoid Neoplasms: Is refractory iron deficiency anemia reportable? Final Jun 30 2014
20130177 MP/H Rules/Histology--Bladder: What rule and histology code apply when a TURB final diagnosis is small cell neuroendocrine carcinoma and high grade urothelial carcinoma? See Discussion. Final Jul 03 2014
20130176

Reportability--Ovary: Is an adult granulosa cell tumor of the right adnexa reportable if the left adnexa, diaphragm and paratubal tissue are reported to be consistent with metastasis? See discussion.

Final Apr 03 2014
20130174 MP/H Rules/Histology--Breast: Given that the current MP/H rules do not recognize specific types of lobular carcinoma, should the histology for an invasive pleomorphic lobular carcinoma be coded to 8022/3 [pleomorphic carcinoma] or 8520/3 [lobular carcinoma]? See Discussion. Final Jun 30 2014
20130173 Histology/Primary site--Heme & Lymphoid Neoplasms: How is the primary site and histology coded when a bladder biopsy reveals myeloid sarcoma and a simultaneously performed bone marrow biopsy demonstrates acute myeloid leukemia? See Discussion. Final Jun 30 2014
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. Final Jun 30 2014
20130171 Reportability--Heme & Lymphoid Neoplasms: Is "plasma cell neoplasm" a synonym for multiple myeloma and is it reportable? See Discussion. Final Jun 30 2014
20130170 MP/H Rules/Histology--Breast: What is the histology code for invasive carcinoma of the breast, no special type? See Discussion. Final Jul 03 2014
20130168 Date of diagnosis--Heme and Lymphoid Neoplasms: Is the date of diagnosis coded to the date a bone marrow biopsy revealed “plasma cell neoplasm; plasma cells are < 10%” or the date a diagnosis of myeloma was noted in the Discharge Summary? See Discussion. Final Jun 30 2014
20130167 Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported if a 2013 diagnosis of right leg skin nodules, consistent with plasmacytoma/plasma cell myeloma, follows a 3/20/07 biopsy diagnosis of multiple myeloma? Final Jun 30 2014
20130166 Reportability--Heme & Lymphoid Neoplasms: Is “indolent multiple myeloma” reportable and considered synonymous with “indolent/smoldering myeloma”? See Discussion. Final Jun 30 2014
20130165 MP/H Rules/Multiple primaries--Thyroid: How many primaries are reported and what is histology for the papillary carcinomas if a Classical cytomorphology with a follicular architecture is on the right and a Columnar cell cytomorphology with a follicular and papillary architecture is on the left? See Discussion. Final Jun 24 2014
20130163 Multiple primaries--Heme & Lymphoid Neoplasms: Is a diagnosis of "post-essential thrombocythemia myelofibrosis" equivalent to “myelofibrosis as a result of myeloproliferative disease,” which is listed under the Alternate Names section of the Heme DB for primary myelofibrosis [9961/3]? See Discussion. Final Jul 03 2014
20130162 Reportability--Heme & Lymphoid Neoplasms: Is erythrocytosis of an unknown cause a reportable disease? Final Jun 30 2014
20130161 Primary Site--Heme & Lymphoid Neoplasms: Is the primary site coded to C779 or C421 for a bone marrow that is positive for B-cell acute lymphoblastic leukemia, the peripheral blood demonstrates leukemic involvement and the PET scan shows involvement of abdominal lymph nodes, spleen and throughout the bones? See Discussion. Final Jul 03 2014
20130160 Histology--Heme & Lymphoid Neoplasms: Should the histology be coded to a therapy-related myeloid neoplasm when the physician states the diagnosis of acute myeloid leukemia is secondary to treatment with Imuran? See Discussion. Final Jul 03 2014
20130156 Other therapy--Heme and Lymphoid Neoplasms: Based on the hematopoietic manual instructions, is plasmapheresis coded as treatment for Waldenstrom macroglobulinemia? See Discussion. Final Jun 30 2014
20130155 Diagnostic confirmation--Heme & Lymphoid Neoplasms: How do we code diagnostic confirmation if the pathology report states the diagnosis of a skin biopsy is “low-grade B cell lymphoma, most compatible with marginal zone lymphoma,” genetic data includes positive rearrangement for immunoglobulin heavy chain gene favor a diagnosis of “B cell lymphoma,” and the physician’s clinical diagnosis is “cutaneous marginal zone lymphoma”? Final Jul 01 2014
20130152 Primary site/Histology--Brain and CNS: How is the primary site and histology coded for a 2013 diagnosis of squamous cell carcinoma arising in a dermoid cyst of the third ventricle? See Discussion. Final Jun 25 2014
20130151 Primary site--Heme & Lymphoid Neoplasms: What is the primary site when a splenectomy shows “T large granular lymphocytic leukemia” and the peripheral blood flow cytometry is negative? See Discussion. Final Jul 03 2014
20130150 MP/H Rules/Histology--Bladder: What is the histology code histology code for a bladder TUR that demonstrates mixed invasive urothelial and small cell carcinoma? See Discussion. Final Jul 03 2014
20130149 MP/H Rules/Histology--Testis: What is the histology code for a testis primary with embryonal carcinoma (70%), yolk sac tumor (30%), and a focus of seminoma (<1%)? See Discussion. Final Jul 03 2014
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