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Report Produced: 07/29/2025 19:59 PM

Report Question ID Question Discussion Answer Year
20081031

MP/H Rules--Breast: How many primaries are abstracted if a mastectomy specimen reveals two separate invasive tumors:

#1: Invasive apocrine carcinoma, poorly differentiated, 1.2cm, (9 o'clock). -Apocrine ductal carcinoma in situ (DCIS), high-grade with comedo necrosis; 2.0cm (9:30 o'clock).

#2: Invasive ductal carcinoma, well-differentiated, 1.0cm (12:30 o'clock). -Minor component of DCIS, low-grade? See Discussion.

 In the MP/H Rules, Table 1 lists apocrine as a type of intraductal carcinoma. Apocrine does not appear in Table 2, the list of specific duct carcinomas. If Apocrine is a type of ductal carcinoma, then Rule M11 would make this a single primary. If it is a single primary, what is the histology?

For cases diagnosed 2007 or later:

Using rule M11, there is one primary in the left breast. Apocrine is a specific duct carcinoma. To make this more clear, apocrine will be added to Table 2 in a future revision.

To code the histology, go to the multiple tumors module and start with rule H20. Stop at rule H29 and code the histology with the numerically higher ICD-O-3 code, 8500/3.

 2008
20081029 Multiple Primaries--Brain and CNS: Multiple cavernous hemangiomas diagnosed in 1995 are treated with radiation and steroids in 1996. A 1999 MRI states there is no interval change with the lesions in selected location since 1995. How many new primaries should be reported if a 2006 MRI states there are additional cavernous hemangiomas in other parts of the brain? See Discussion.

7-03-97 PE: Past history significant for cavernous hemangiomas. Has had radiation and was on high-dose steroids in early 1996. Patient reports subsequent MRI done and neurologist gave "clean bill of health."

1-26-99 MRI BRAIN. Clinical information: history of intracranial cavernous hemangiomas. Comparison with prior brain MRI in 12/15/95. IMP: Upper medullary, right parieto-occipital, left frontal cavernous hemangiomas without interval change in size as compared to 12/15/95.

1-25-06 MRI BRAIN. Clinical info: history of prior radiation for cavernous angiomas. Comparison made with prior exam on 1/26/99. Impression: Multiple, variable sized cavernous angiomas within medulla, pontomedullary junction, midbrain, & cerebral hemispheres. Dominant lesion centered within posterior pontomedullary junction. FINDINGS: 8mm lesion in posterior pontomedullary junction. 2mm lesion within right paracentral portion of medulla. Several less than 5mm lesions noted within brain stem bilateral. Two, less than 1-2mm, areas within right inferior aspect of right and left cerebellar hemispheres. 1cm lesion centered within white matter within right posterior parietal/occipital region. Several small, less than 1-2mm, lesion within surrounding white matter. 3rd dominant lesion within left frontal lobe equal 6mm. Several 1-2mm foci of susceptibility artifact within subcortical white matter of high right and left cerebral hemispheres consistent with small cavernous angiomas.

Benign and borderline brain and CNS tumors diagnosed January 1, 2004 and later are reportable. Multiple tumors in different brain and CNS sites are separate primaries. Different sites are those with ICD-O-3 topography codes that differ at the first, second, third or fourth character.

There are four reportable primaries in the scenario described above.

  • Brain stem, C717 (medulla, pontomedullary junction, midbrain)

  • Cerebrum, C710 (right cerebral hemisphere)

  • Cerebrum, C710 (left cerebral hemisphere)

  • Parietal/Occipital region, C718

    		• 2008
    		20081028 Multiplicity Counter--Ill-defined sites: How is this field coded for Ill-Defined sites (C760-C768)? Code the number of tumors present if known. If the number of tumors present is not known, code 99 [unknown number of tumors, unknown if multiple tumors]. 2008
    		20081026 MP/H rules/Multiple primaries: Is a 2007 cytology diagnosis of adenocarcinoma in bile duct a new primary for a patient with a 2005 diagnosis of adenocarcinoma of gallbladder? See Discussion.

    A case abstracted for an adenocarcinoma of gallbladder (C23.9) in 2005. In 2007, cytology diagnosis of adenocarcinoma in bile duct(C24.0). Oncologist calls this recurrence. There is no pathologist statement of recurrence.

    Using Other Sites multiple primary rules, rule M10 indicates this is multiple primaries. Sequence 01 dx in 2005 and sequence 02 dx in 2007. Is this correct? There is no statement of a primary tumor; the MP/H rules talk in terms of mass, lesion, tumor in a primary site.

    		 For cases diagnosed 2007 or later, abstract the 2007 bile duct diagnosis as a new primary unless it is described as metastatic. 2008
    		20081025 MP/H Rules/Histology--Anus: What is the correct histology code and MP/H histology rule to use for AIN-3 arising in a polyp? See Discussion.

    Patient has colonoscopy with excision of small 5mm polyp in rectum (no mention of anus or anal canal); path reads out: AIN-3 (anal intraepithelial neoplasm grade 3).

    In coding the histology using the "Other Sites" rules, H2 would be the first rule that applies for this case. However, we lose the fact that the AIN-3 arose in a polyp (H3). Is this how SEER wants these cases coded?

    		 For cases diagnosed 2007 or later, apply rule H2 and assign histology code 8077/2 (squamous intraepithelial neoplasia, grade III). Apply the rules in order, H2 precedes H3. 2008
    		20081024 CS Site Specific Factor--Breast: How is SSF6 coded when CS tumor size is coded from a clinical report, not from pathology? See Discussion. A breast ultrasound displays a 2 cm tumor. Core biopsy diagnosis is lobular carcinoma in situ. No further record for patient. Tumor size coded to 020. Should SSF 6 be coded to 010 "Entire tumor reported as in situ (no invasive component reported)" because it was pathologically confirmed, or to 888 because size was coded based on a clinical exam - the ultrasound?

    This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code SSF6 888 [Clinical tumor size coded]. When the size recorded in CS Tumor Size is not determined pathologically, 888 must be coded in SSF6. Note: The code in SSF 6 pertains to pathologic tumor size. It describes the relationship of invasive and in situ tumor in the tumor size coded.

    		 2008
    		20081023 Histology: Must every word in the ICD-O-3 code definition appear in the diagnosis in order to assign that ICD-O-3 code? See Discussion. Is the diagnosis "Acute myeloid leukemia, M2" coded to Acute myeloid leukemia with maturation, FAB M2, NOS, (9874/3) or to Acute myeloid leukemia, NOS, (9861/3)?

    For cases diagnosed prior to 1/1/2010:The general instructions for assigning histology codes are to code as precisely as possible. Acute myeloid leukemia with maturation is the definition of the FAB M2 category. A pathologist does not need to provide every word in the term associated with an ICD-O code; pathologists don't always talk that way. AML M2 is a very specific diagnosis and should be coded to 9874/3.

    For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

    		2008
    		20081022 CS Extension/CS Mets at Dx--Wilm's Tumor: Is the fact that a Wilm's tumor case is bilateral captured in the CS Extension field or is the CS Mets at Dx field coded to 40?

    This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Code laterality as bilateral, code the greatest extension from either side in CS extension.

    Code CS Mets at diagnosis 00 [None] UNLESS true distant metastases were identified.

    		 2008
    		20081021 Primary Site/Surgery of Other Site--Leukemia: If hairy cell leukemia is diagnosed at splenectomy, and 1 month later a bone marrow confirms the same diagnosis, is the primary site coded to spleen or bone marrow? If the site is bone marrow, is the splenectomy coded to 2 (regional) or 4 (distant) in the surgery field?

    For cases diagnosed prior to 1/1/2010:Primary site:

    Code the primary site to C421 [bone marrow] per primary site coding instructions for leukemia in the 2007 SEER manual, page 70.

    Surgery of other site:

    Since all surgical procedures for hematopoietic diseases are coded in the data item Surgery of Other Site, assign code 1 [Nonprimary surgical procedure performed].

    For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

    		 2008
    		20081019 Multiple Primaries--Lymphoma: How many primaries are abstracted for a patient with a 1995 periaortic lymph node biopsy showing lymphocytic lymphoma, diffuse small cleaved probable intermediate grade B cell positive, followed by stomach biopsies on 6/18/05 showing diffuse large B cell lymphoma and on 6/24/05 showing malignant lymphoma, tumor cells positive for [CD20] B cell respectively?

    For cases diagnosed prior to 1/1/2010:There are two primaries:

  • Lymphocytic lymphoma, diffuse, intermediate in 1995

  • Diffuse large B-cell lymphoma in June, 2005

    • According to the Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9673 [Malignant lymphoma, lymphocytic, diffuse, intermediate] and 9680 [Malignant lymphoma, large B-Cell, diffuse] are separate primaries. Again, according to the table, 9680 [Malignant lymphoma, large B-Cell, diffuse] and 9591 [Malignant lymphoma, non-Hodgkin, NOS] are the same primary.

    For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

    		 2008