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Report Produced: 09/20/2025 10:04 AM

Report Question ID Question Discussion Answer Year
20081041 MP/H Rules/Histology--Thyroid: How many primaries are to be reported and what histology is to be coded for an anaplastic/undifferentiated thyroid carcinoma with sarcomatoid transformation likely arising in association with a papillary thyroid carcinoma? Thyroid contains one tumor: 12.5 cm in greatest dimension...almost completely replaces entire thryroid gland.

For cases diagnosed 2007 or later:

This is a single primary using rule M2; a single tumor is always a single primary.

The histology code for this case is 8260/3 [Papillary carcinoma of thyroid]. Begin with Histology Coding rule H8. Stop at rule H17 and code the histology with the numerically higher ICD-O-3 code.

 2008
20081141

MP/H Rules--Lung: How do we interpret 'spiculated opacities?' How many primaries do we abstract for this patient? See Discussion.

Patient admitted for CT scan of chest. Impression: A small subpleural spiculated opacity is noted in the left upper lobe measuring 9.7x7.7mm. Right upper lobe spiculated nodular opacity measures 13.9x5.9mm. Right lower lobe scattered faint alveolar nodular opacities are noted. The lungs are otherwise clear. Abnormal soft tissue density mass is noted of the right hilum surrounding the distal main right pulmonary artery. Bronchoscopy/mediastinoscopy done: rare malignant cells present consistent with small cell carcinoma, specimen submitted as brushing of right bronchus intermedius. The tumor in the lymph node is metastatic small cell carcinoma. Patient discharged to hospice; died 5 weeks later.

Do the MP/H rules pertain only to the measured opacities in each lung and not to the RLL scattered faint alveolar nodular opacities? The right side was cytologically confirmed. But if we abstract the left lung, what is the histology...8041 or 8000?

For cases diagnosed 2007 or later:

Because there was cytologic confirmation of cancer, for this case only count the spiculated opacities as tumors. Abstract as a single primary using Rule M1. Note 2 under lung rule M1 applies to this case.

Code the histology as 8041 [small cell carcinoma] per rule H10.

 2008
20081081 Reportability: If a dermatopathologist refers to an atypical fibroxanthoma as a malignant process, but the ICD-O-3 indicates it is a borderline process, is this a reportable case? See Discussion. "Final Diagnosis: Surface of ulcerated histologically malignant spindle cell neoplasm, consistent with atypical fibroxanthoma. Note: An exhaustive immunohistochemical work-up shows no melanocytic, epithelial or vascular differentiation. Atypical fibroxanthoma is a superficial form of a malignant fibrous histiocytoma." The pathologist has the final say on behavior. In this case, the pathologist states that this tumor is malignant in the final diagnosis. Therefore, this case is reportable. 2008
20081075 Race, ethnicity/Spanish surname or origin: SEER Program Manual instructions state, "Portugese, Brazilians and Filipinos are not Spanish; Code non-Spanish (code 0)." How is that determined? Is that based SOLELY on birthplace? See Discussion.

The following are scenarios for which we would like clarification on how to code Spanish Ethnicity.

  • Birthplace Portugal; text states Spanish, south American or European Spanish

  • Birthplace Brazil, last name is on Spanish surname list; pt is married female. Text states "Hispanic female, NOS"

  • Birthplace Brazil or Portugal, text states patient is "Mexican", last name is on Spanish surname list

    • Information about Spanish origin is available for both of these cases; code the race as Hispanic. Use the SEER manual instruction when the only information available is that the patient was born in Portugal, Brazil or the Philippines. In the absence of additional information, do not assume Hispanic. However, if additional information is available stating that the patient is Hispanic, code as Hispanic.

    Spanish Surname or Origin Scenarios

  • 6 [Spanish, NOS; Hispanic, NOS; Latino, NOS]

  • 6 [Spanish, NOS; Hispanic, NOS; Latino, NOS]

  • 1 [Mexican (includes Chicano)]

    		• 2008
    		20081133 MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type? For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types. 2008
    		20081116 CS Extension--Brain and CNS: How is this field coded for a malignant brain tumor that presents as a lesion with significant pressure on the left frontal ventricle and dilation of the right ventricles? See Discussion. CS Extension code 30 includes tumor that invades or encroaches upon the ventricular system. Does significant pressure mean the same thing as encroach?

    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.Do not assign extension code 30 in this case unless there is evidence elsewhere of ventricular system involvement.

    "Significant pressure" is not synonymous with encroachment or involvement. See the list of ambiguous terms for CS staging on page 121 of the 2007 SEER manual.

    		 2008
    		20081052 Histology: What is the histology code for a soft tissue thigh mass that was diagnosed as Ewing sarcoma/PNET, primitive neuroectodermal tumor?

    The histologies stated for this case are Ewing sarcoma (9260) and PNET, primitive neuroectodermal tumor,(9364)*. Use the Other Site Rules, starting with H8. Stop at H17 and assign the higher histology code -- 9364/3 [Peripheral neuroectodermal tumor].

    *The term "PNET" is used for two different tumors. One is primitive neuroectodermal tumor (9473) and pertains to brain tumors per ICD-O-3 review. The other is peripheral primitive neuroectodermal tumor (pNET or PPNET 9364) and pertains to bone or soft tissue tumors. This case is stated to be soft tissue and Ewing sarcoma, so it is 9364 rather than 9473.

    		 2008
    		20081101

    MP/H Rules/Multiple primaries--Lung: If a 1.7 cm LUL lung tumor is not treated surgically, would a 2.1 cm tumor in the same lobe three years later be a new primary? See Discussion.

    In 2004 the patient has a 1.7cm squamous cell carcinoma diagnosed in the LUL of the lung treated with radiation and chemotherapy. In 2007, the patient was diagnosed with a 2.1cm squamous cell carcinoma in the LUL treated with radiation. According to the lung MP/H rules, the 2007 tumor would be a new primary. Given that there was no surgery, would the second tumor be progression of disease or would it be a new primary?

    For cases diagnosed 2007 or later:

    If the tumor diagnosed in 2004 was successfully treated and disappeared, apply the MP/H rules for lung. According to rule M8, the 2004 tumor and the 2007 tumor are multiple primaries. If there was no disease-free interval between tumor occurrences, that is, if the 2007 tumor is still the same tumor that was diagnosed in 2004, the MP/H rules do not apply.

    		 2008
    		20081088 CS Lymph Nodes/CS Mets at Dx: How should these fields be coded for an in situ diagnosis when the patient was diagnosed by biopsy only and there is no information in the chart regarding an evaluation of lymph nodes or metastatic sites? See Discussion.

    In reference to the case below, does it make a difference if the CS T stage is known based on the primary excision but there is no clinical information in the record regarding the nodes or metastasis evaluation.

    This scenario is seen on outpatient records of breast biopsies and melanoma excisions; i.e., punch bx followed by gross excision of the lesion but the medical record contains no clinical information or statement of everything else normal.

    I&R Question 17625 2/16/2006

    A patient was diagnosed with ductal carcinoma in situ by needle core biopsy of the right breast. There was no further information in the chart stating if or where the patient went for staging work-up and treatment. What are the codes for CS Extension, CS Regional Lymph Nodes and CS Distant Mets at Dx?

    I&R Answer: Sufficient tissue must be taken to determine the T category. If this is the case, CS Extension = 00.

    Unless the physician makes the statement that the physical exam is negative, code the CS Regional Lymph Nodes = 99 CS Distant Mets at DX = 99.

    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 CS Lymph Nodes and CS Mets at Dx 00 [None] for an in situ diagnosis with no other information.

    The CS instructions state that CS LN's should be coded 00 for in situ because in situ by definition is non-invasive. The same logic applies to CS mets in the case of in situ. The I&R answer will be revised.

    		 2008
    		20091118 Surgery of Primary Site--Corpus uteri: How are the surgery fields to be coded when patient undergoes hysterectomy and omentectomy for endometrial primary? See Discussion.

    The example for instruction 6 in the 2007 SEER manual on page 179 (for surgery of primary site) states "code an en bloc removal when the patient has a hysterectomy and an omentectomy." There is no Site-Specific Surgery code for corpus uteri that combines hysterectomy with omentectomy. Is the information about removal of the omentum lost or is it documented under Surgical Procedure of Other Site?

    		Use the most appropriate code in the "Surgery of Primary Site field." Do not code the omentectomy in "Surgical Procedure of Other Site" when it is performed with a hysterectomy for an endometrial primary. 2009