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Report Produced: 09/20/2025 20:52 PM

Report Question ID Question Discussion Answer Year
20091003 MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion. Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules.

For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS].

Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites.

In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma.

 2009
20091117 MP/H Rules/Histology--Breast: How is histology to be coded for a breast primary described as "tubular carcinoma (well differentiated invasive ductal carcinoma)"? See Discussion.

How are terms that are modified by parentheses to be interpreted? Do terms in parentheses modify the stated diagnosis and thus have priority over the stated diagnosis? Or would rule H17 apply and histology would be coded as duct and other carcinoma? For this case, the wording of the diagnosis and use of parentheses seem to indicate that tubular is a type of ductal carcinoma. Tubular is not listed as a specific duct carcinoma in the MP/H rules histology tables for breast.

For cases diagnosed 2007 or later, code the histology as tubular carcinoma [8211/3]. This is not a case of tubular AND infiltrating duct. The histology is stated to be tubular. Tubular is not a specific type of duct carcinoma. 2009
20091063 CS Lymph Nodes--Head and Neck: How is this field coded when a positive neck FNA is followed by a neck dissection that contains one of seventeen positive lymph nodes? See Discussion. The primary site is the right tongue. The patient underwent FNA of a right neck mass that was positive for squamous cell carcinoma. Subsequent right modified radical neck dissection showed one out of seventeen nodes positive for metastatic carcinoma. For head and neck primaries, the CS LN codes 10-19 represent a single positive ipsilateral regional node. Codes 20-29 represent multiple positive ipsilateral nodes.

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.If the neck dissection included the area of the positive FNA, count only the positive nodes from the dissection. Avoid double-counting a positive node for both an FNA and a dissection.

In the unlikely event that the dissection did not include the area of the positive FNA, add one positive node to the count from the dissection.

This instruction supersedes previous instructions.

 2009
20091126 MP/H Rules/Multiple primaries--Vagina: How many primaries should be abstracted for a patient with a complex history of multiple occurrences of vaginal intraepithelial neoplasia (VAIN III) between 2001 and 2008 and invasive squamous cell carcinoma (SCCA) of the vagina diagnosed in 2006 and again in 2008? See Discussion. Patient had VAIN III in March of 2001. She had a partial vaginectomy and then continues to have laser surgery in 2002, 2003, 2005 and 2006 for recurrences. In 12/2006 she is diagnosed with SCCA of the vagina with microinvasion (new primary). Then in 2/2008 she has VAIN III again -- new primary according to rule M10 (more than 1 year later). An invasive SCCA of the vagina is again diagnosed in 9/2008. Is this another new primary per rule M15 (invasive after in situ)? Every instance in 2008 is called a recurrence, but we disregard that statement.

There are two primaries according to the information provided.

1. VAIN III March 2001.

2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ

For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease.

 2009
20091054

First course treatment--Liver: Is planned therapy second course therapy if it is administered after documented progression of disease? See Discussion.

A patient with hepatocellular carcinoma of the liver is waiting for a planned liver transplant. During the waiting period, a CT showed an increase in the liver nodule. The physician performed a bridging chemoembolization. Later on, the patient received a liver transplant. Is the liver transplant still first course treatment? Is the chemoembolization part of first course therapy? Per the SEER manual, first course therapy ends when the treatment plan is completed.

In this case, neither the chemoembolization nor the liver transplant is part of the first course of therapy. The documented treatment plan was changed after disease progression. Chemoembolization was not part of the original treatment plan. First course therapy ends at this point.

 2009
20091124 CS Eval--Lung: How is the CS Reg Nodes Eval field to be coded when the FNA of a paratracheal lymph node is positive for adenocarcinoma and the patient subsequently undergoes neoadjuvant chemoradiation therapy followed by an excision of multiple lymph node fragments that show adenocarcinoma? See Discussion. The CSv1 scheme for lung shows that code 1 under CS Reg Nodes Eval is a path staging basis. However, the definition for code 1 also states that no regional lymph nodes were removed for examination. Would we use code 1 because the case represents path staging basis? If we select code 5 because regional lymph nodes were dissected, the staging basis would be clinical. If we select code 6, the staging basis would be y.

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.

Use code "6" for the CS LN evaluation field. As explained on page 113 in the 2007 SEER Manual, when post-operative disease is more extensive despite neoadjuvant therapy, this can be coded in the evaluation field. In this case, only an FNA was done on lymph nodes pre-operatively, but actual lymph nodes were removed and documented in the post-neoadjuvant excision of the lymph nodes which documented that they are histologically positive -- proving that the neoadjuvant therapy did not work.

 2009
20091045 CS Tumor Size/CS Site Specific Factor--Breast: When tumor size is unknown, but it is known that both in situ and invasive components are present, how should CS Tumor Size and SSF6 be coded? See Discussion. We coded CS Tumor Size 990 and SSF 6 to 060 for a case in which no tumor size was mentioned and the breast core biopsy identified microinvasive infiltrating lobular carcinoma and lobular carcinoma insitu. The lumpectomy identified no residual tumor. SEER edit 218 states we must have CS Tumor Size as 999 if the CS SSF 6 is 060. Yet the tumor size code of 990 (Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm) would more accurately reflect this case. Even in a situation where there was microinvasion described as less than 1mm, the edit will not allow one to code CS Tumor Size to 990 with the CS SSF 6 as 060. Should these types of cases have CS Tumor Size coded 999 or should the edit be adjusted to allow for this combination?

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 tumor size 990 [Microinvasion; microscopic focus or foci only, no size given; described as less than 1 mm] and CS SSF6 050 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated AND proportions of in situ and invasive not known].

This combination of codes captures the information available for this case.

 2009
20091084 Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? Are there priority rules for coding subsite for sites other than Head and Neck? See Discussion. The path report for a hemicolectomy says, " Specimen: left colon..." and the microscopic says, "...received in formalin designated left colon..." The Operative procedure report says, "Postoperative diagnosis - splenic flexure tumor." The text of this report says, "Mobilizing the splenic flexure mass was incredibly difficult..." and then goes on to describe exactly how and where it was resected. The discharge summary says adenosquamous carcinoma of the splenic flexure. SINQ20051010 says to use the pathology report first, but this was written before the new MP/H rules.

Use the operative report information to code primary site in this case. It is more accurate.

The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her.

The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69.

 2009
20091015 MP/H Rules/Histology--Gallbladder: What histology is coded for a tumor described as "90% high grade neuroendocrine ca, large cell type; and 10% low grade adenocarcinoma, conventional type"?

For cases diagnosed 2007 or later:

MP/H Rule H17 for Other Sites applies. Code the histology 8140 [adenocarcinoma].

The ICD-O-3 code for large cell neuroendocrine carcinoma is 8013 and the code for adenocarcinoma is 8140.

 2009
20091017

Primary site--Esophagus: How is primary site coded for a tumor arising in a segment of the esophagus that was reconstructed using a segment of the colon? See Discussion.

A patient had a ruptured esophagus 25 years ago and had a segment of colon removed and transplanted to serve as esophagus. In 2007, the patient was diagnosed with carcinoma in a polyp by endoscopic biopsy of the transplanted 'esophagus'. What is the primary site code? Is this the same site schema to be used for Collaborative staging and surgery coding?

Code the primary site esophagus, NOS [C159]. Use the surgery codes and collaborative staging schema for esophagus. Document the unusual nature of this case in text fields.

2009