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Report Produced: 09/12/2025 16:21 PM

Report Question ID Question Discussion Answer Year
20031051 Histology (Pre-2007)/Sarcoma: What code is used to represent the histology "Ewing's Sarcoma/Primitive Neuroectodermal Tumor (PNET)"? See Description. A comment on one path report states "some authors consider both Ewing's & PNET to be the same biologic entity given that they share the same translocation between chromosomes 11 & 22." The pathologists at our children's hospital agree with this statement and contend that the two should have the same histologic code.

For tumors diagnosed prior to 2007:

Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.

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.

 2003
20031196 EOD-Pathological Extension--Prostate: How is this field coded when biopsy findings differ from prostatectomy findings? See Description. Needle biopsy of prostate clearly states cancer arising in the apex. Clinical extension would then be 33. After prostatectomy, the path report states only one lobe involved with cancer and the apex was negative for cancer. Would the pathological extension then be coded to a 20 to truly reflect the surgical findings? For cases diagnosed 1998-2003: Combine the information from the needle biopsy and the prostatectomy and code the pathologic EOD to 34 [Extending to the prostatic apex]. The case example above is very similar to Example 4 on page 2 of the Prostate EOD Coding Guidelines. 2003
20031162 Multiple Primaries/Histology--Hematopoietic, NOS/Lymphoma: How many primaries are represented and what are the histologies for "B-cell lymphoma with immunophenotypic findings consistent with hairy cell leukemia" found on a bone marrow biopsy? See Description. Pathologist completed AJCC lymphoma staging form indicating this case should be abstracted as a lymphoma.

For cases diagnosed prior to 1/1/2010:Abstract as one primary, 9591/3 [B-cell lymphoma, NOS]. The bone marrow diagnosis indicates that the main/definite diagnosis is B-cell lymphoma, with a lesser indication of hairy cell leukemia. Both of these are mature B-cell neoplasms according to the WHO histological classification.

For cases diagnosed 2010 forward, 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.

 2003
20031032 Diagnostic Confirmation--Hematopoietic, NOS: How should diagnostic confirmation of Hematopoietic diseases be coded in the absence of positive bone marrow? See Description.

Case 1. Patient admitted 9-12-02 with diagnosis of essential thrombocythemia. Per the H&P, patient obviously has had this since January 2001. Per the clinical history: patient with elevated platelets. Path diagnosis of bone marrow biopsy done 9-20-02 showed mildly increased megakaryocytes. 10-31-02 clinical sign-out diagnosis was: essential thrombocythemia.

Case 2. Patient admitted for evaluation of erythrocytosis. Assessment: Increased hematocrit only. It is most likely that patient has polycythemia vera. I think it is reasonable to initiate phlebotomy treatment.

Code 1, Positive histology, includes diagnostic hematologic findings and peripheral blood smears when these are the basis for diagnosis.

When the clinician makes a specific diagnosis and the blood work is not diagnostic, code diagnostic confirmation as 8 [Clinical diagnosis only]. The clinician is putting together all evidence, including the blood work and using his/her professional experience to diagnose the case.

Case 1. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only]. Megakaryocytes are the immature form of thrombocytes, but mildly increased megakaryocytes are not diagnostic of essential thrombocythemia.

Case 2. The diagnosis is not based on microscopic findings. Assign code 8 [Clinical diagnosis only].

 2003
20031006 EOD/Surgery of Primary Site--Melanoma: If a melanoma primary site is other than skin, vulva, penis, or scrotum should these fields be coded using melanoma schemes? See discussion. Should a melanoma of the cervix be coded using the melanoma or the cervix schemes for these fields? For cases diagnosed 1998-2003: Use the EOD and surgery code schemes for cervix uteri. The EOD scheme for melanoma excludes melanoma of the cervix uteri. The surgery code scheme for skin excludes cervix uteri. 2003
20031131

Multiple Primaries (Pre-2007): Would osteosarcoma of the right arm diagnosed four years after malignant fibrous histiocytoma, also in the right arm, be a second primary when the physician states, "the patient's disease progressed to sarcoma after radiation was administered?"

For tumors diagnosed prior to 2007:

The osteosarcoma is a second primary. The first three digits of the histology codes are different: 8830 [Malignant fibrous histiocytoma] and 918_ or 919_ [Osteosarcoma]. In addition, the diagnoses are four years apart. According to SEER rules, these are separate primaries.

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.

 2003
20031067 Primary Site/Histology (Pre-2007)/Sarcoma: How do you code these fields for a vulvar tumor diagnosed by FISH analysis as "extra-osseous Ewing sarcoma?" See Description. A literature search relates soft tissue malignancy described as "extra-osseous Ewing sarcoma/PNET." Neither are compatible with site.

For tumors diagnosed prior to 2007:

Code histology as 9260/3 [Ewing sarcoma]. ICD-O-3 does not have a code for extra-osseous Ewing sarcoma (EOE). Ignore the topography code listed in ICD-O and use the code for the primary site (vulva).

Site codes associated with morphology codes in the ICD-O are the most common sites and are not intended to limit coding only to those sites.

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.

 2003
20031100

Date of diagnosis: Can a positive VMA:HVA test be used as a date of diagnosis for neuroblastoma? See Description.

Rubin's Clinical Oncology states: Both the catecholamines and their metabolites are used as markers for neuroblastoma, with vanillylmandelic acid (VMA) and homovanillic acid (HVA) being the most commonly used. While their absolute values are not of prognostic significance, a higher VMA:HVA ratio suggests a better prognosis for patients with disseminated disease.

Updated answer July 2024

No. Do not code the neuroblastoma diagnosis date from only the date of an elevated urine catecholamine test (VMA or HVA). Neuroblastoma diagnosis should be made on the basis of tissue biopsy or bone marrow aspiration along with elevated urinary catecholamines. Elevated urinary catecholamines alone are not diagnostic of neuroblastoma.

 2003
20031092

Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: How is the histology of invasive small cell carcinoma of lobular histogenesis coded?

Could high grade ductal carcinoma in situ, comedo type be a recurrence of ductal carcinoma diagnosed 18 years earlier?

Is "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" one or two primaries? See Description.

 A patient was diagnosed in 1984 with 1st breast primary, histology was ductal carcinoma, T1N0, LIQ left breast. In 2002 a mass was found on mammogram, MRM with axillary sampling performed. Histology was invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type, nuclear grade 3/3, T2N1, UOQ left breast. Is the ductal carcinoma in situ recurrent disease from the 1st primary? Does it go with the lobular histogenesis, i.e., lobular carcinoma and DCIS histology code 8522/3 or is the ductal in situ a 3rd primary?

For tumors diagnosed prior to 2007:

According to our pathologist consultant:

Invasive small cell carcinoma of lobular histogenesis appears to be an unusual histology for a breast primary. Code it as such 8041 [Small cell carcinoma, NOS].

The 2002 lesion is most likely a new primary since the previous lesion was 18 years ago, in a different quadrant, and invasive. A comedo DCIS would probably not be asymtomatic for 18 years; an unlikely "recurrence" of an earlier ducal carcinoma.

Code "invasive small cell carcinoma of lobular histogenesis, high grade ductal carcinoma in situ, comedo type" as two primaries. Code the small cell as a separate primary (8041/3), and the DCIS separately (8501/2).

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.

 2003
20031057 Grade, Differentiation--Bladder: How is this field coded for a five grade system? See Description. Example: Invasive, high grade transitional cell carcinoma (Grade 4-5/5) For this example, code grade as 4 based on the term "High grade." If "high grade" was not stated, the grade would be coded as 9, not determined. There is no SEER translation between the ICD-O grades and a five grade system for bladder. None of the pathololgist experts we querried knew of a five grade system for bladder. 2003