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Report Produced: 04/30/2026 09:52 AM

Report Question ID Question Discussion Answer Year
20031146 EOD-Size of Primary Tumor--Breast: How do we code this field when there is a difference between the size of the tumor mentioned in the gross (i.e., macroscopic description) and the comment sections of a pathology report? See Description. Path Macro Summary states size as 1.5 cm. The path comment states "largest area of tumor seen is 1.5 cm. However, 8 of the nearly contiguous sections are involved with an estimated 2.4 cm area of involvement." For cases diagnosed 1998-2003: Code the size of the largest area of tumor from the path macro summary. For the example provided, code the size as 015 [1.5 cm]. In this case, the additional sections of tumor described in the path comment do not seem to represent pieces of one larger tumor. The 2.4 cm estimated area of involvement was determined by adding together noncontiguous tumor sections. According to the CAP protocol for breast, Note J "When 2 or more distinct invasive tumors are present, each is separately measured...they are not combined into a single larger size." 2003
20031141 Priorities/EOD-Lymph Nodes--Breast: Which part of the pathology report takes precedence when there is a discrepancy between the final path diagnosis and the CAP summary? See Description. For example, breast primary: Final path states "14/18 nodes (+) for tumor & separate matted aggregate of axillary nodes (+) for tumor. Subpectoral lymph node (+) for mets ca. Path Gross states "18 separate lymph nodes identified...many (+) for tumor grossly. Aggregate of matted lymph nodes within axillary tissue (+) for tumor. Multiple separate lymph nodes submitted." CAP Micro Summary lists "20/16 nodes examined/positive." What is correct number of nodes positive & nodes examined in this case? For cases diagnosed 1998-2003: The final pathology diagnosis has highest priority. The CAP summary is second priority. However, you always use the best information available. If the final path diagnosis is vague or unclear, information from the CAP summary can be used. In the case example, the total lymph node count from the final path diagnosis is unclear and the CAP summary provides clarification. Code the number of lymph nodes positive as 16 and the number examined 20. Subpectoral lymph nodes are regional nodes for breast primaries. 2003
20031023 Grade, Differentiation: Can differentiation be coded from the pathology report for a biopsy from tissue involved by local recurrence? Code grade from original primary site. Do not code grade from a local recurrence. 2003
20031119 EOD-Extension/EOD-Lymph Nodes--Colon: For this primary, under which field are satellite tumor nodules in mesenteric adipose tissue coded? See Description.

Sigmoid colon, low anterior resection: Invasive adenocarcinoma, 5.5 cm greastest dimension, moderately differentiated. Tumor invades through muscularis propria, into mesenteric adipose tissue. No penetration of visceral peritoneum. Proximal, distal, and radial margins free of tumor. Satellite tumor nodule present within mesenteric adipose tissue, 1.5 cm diameter, located 2.8 cm from main bowel wall tumor. Ten lymph nodes identified, with no evidence of metastatic tumor.

Comment: The satellite tumor nodule present within the mesenteric adipose tissue has an infiltrating, irregular contoured appearance and does not appear to represent a previously replaced lymph node. This appears to be a local metastasis with histologic features most commonly associated with venous invasion (see AJCC Cancer Staging Handbook, Sixth Edition, 2002, page 131 for current staging terminology).

 For cases diagnosed 1998-2003: For EOD, each grossly detectable nodule in the regional mesenteric fat is counted as one regional lymph node. 2003
20031145 EOD-Extension--Head & Neck: Is this field coded 10 [Invasive tumor confined to one of the following subsites: interior wall, one lateral wall, posterior wall] or 30 [Localized, NOS] for tonsillar primary when there is no mention of involvement of surrounding structures? See Description. Site is stated to be "left tonsil" and was coded to site C099. "The lesion is admixed in tonsillar tissue." No surrounding structures are stated to be involved. Is it logical to assume that since code C099 includes the palantine tonsils and the palatine tonsils are on the lateral wall and since no other areas are stated to be involved that extension code 10 [confined to one lateral wall] would be more appropriate than code 30 [localized NOS]? For cases diagnosed 1998-2003: Code EOD-extension for the case example to 10 [Invasive tumor confined to one of the following subsites: anterior wall, one lateral wall, posterior wall]. The tonsil lies in a pocket on the wall (tonsillar fossa), so you know it is confined to the wall. 2003
20031148 EOD-Systemic Symptoms at Diagnosis--Lymphoma: Would the description, "three days of typical cold symptoms including congestion, sneezing, chills and advanced difficulty breathing and some fever" qualify as B-Symptoms?

For cases diagnosed 1998-2003:

Use the following criteria to determine whether or not certain clinical findings qualify as "B" symptoms.

1. Fevers. Unexplained fever with temperature above 38 degrees C.

2. Night sweats. Drenching sweats that require change of bedclothes.

3. Weight loss. Unexplained weight loss of more than 10% of the usual body weight in the 6 months prior to diagnosis.

Pruritus alone does not qualify for B classification, nor does alcohol intolerance, fatigue, or a short, febrile illness associated with suspected infections.

The clinical description in the example above does not meet the criteria for B symptoms. Generally, the symptoms in the B category have to occur over an extended period of 7 to 30 days. In this case the fever is explained by "typical cold symptoms" and in addition, three days of fever is not a long enough period.

 2003
20031059 EOD-Pathologic Review of Number of Lymph Nodes Positive and Examined: How are nodes positive/examined coded for a positive FNA of a lymph node followed by a subsequent lymph node dissection? See Description.

A breast cancer patient had a FNA of an axillary lymph node positive for metastases. A modified radical mastectomy with lymph node dissection showed six lymph nodes negative for metastases.

Example 1: Patient received neoadjuvant chemotherapy prior to mastectomy and lymph node dissection.

Example 2: Patient received no neoadjuvant therapy.

 For cases diagnosed 1998-2003, the number of Regional Nodes Positive and Examined include all nodes examined by the pathologist, unless there is disease progression. In other words, these fields are cumulative. An FNA alone, positive for regional lymph node metastasis is coded as 97 for number positive and 95 for number examined. 1 & 2. Assuming there has been no disease progression, include all nodes positive and all nodes examined from both the FNA and the lymph node dissection in the counts. Case example: Code number of regional nodes positive as 01, number examined as 07. 2003
20031089 Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description. The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized."

For tumors diagnosed prior to 2007:

Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell carcinoma.

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
20031088

First-Course of Cancer-Directed Therapy Fields/Hematopoietic, NOS: How do you code treatment for a myelodysplastic syndrome when a patient is admitted to receive a "second transfusion 7 months after diagnosis"?

The first course of treatment for these hematopoietic primaries lasts until there is a treatment change. For the case you cite the second transfusion (7 months after diagnosis) would be first course treatment. Code the Other Cancer-Directed Therapy Field to 1 [Other cancer-directed therapy].

 2003
20031054 Grade, Differentiation: Is grade always coded to 4 for a diagnosis of Ewing's sarcoma?

Do not code the ICD-O-3 grade for Ewing sarcoma unless documented in the record.

In the TNM system, grade is required to place Ewing sarcoma into a stage group. For TNM staging purposes, Ewing sarcoma is classified as G4. Do not apply TNM rules to ICD-O coding.

 2003