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Report Produced: 04/30/2026 21:50 PM

Report Question ID Question Discussion Answer Year
20041099 First Course Treatment: If a patient makes a blanket refusal of all recommended therapy or refuses all treatment before any therapy was recommended, are only immunotherapy and hematologic/endocrine therapies to be coded as refused (code 87)? Or should all treatment modalities be coded as refused if a patient makes a blanket refusal? Or should none of the treatment modalities be coded as refused because we do not know what would have been recommended? See Discussion. Coding instructions for immunotherapy and for hematologic/endocrine procedures state that Code 87 is to be assigned if either of the following circumstances apply: 1) If the patient made a blanket refusal of all recommended treatment. 2) If the patient refused all treatment before any was recommended. These instructions are not included for other treatment modalities. When the patient refuses treatment, the first course of therapy is no treatment. Code all treatments as refused. 2004
20041023 Histology (Pre-2007)--Lung: Should "moderately differentiated adenocarcinoma of scar type, intermixed with bronchiolo-alveolar carcinoma" be coded to 8250 [bronchiolo-alveolar adenocarcinoma, NOS] or 8255 [adenocarcinoma of mixed subtypes]?

For tumors diagnosed prior to 2007:

Code Histology to 8255 [Adenocarcinoma with mixed subtypes]. This is a single tumor containing both a scar carcinoma and a bronchiolo-alveolar carcinoma--use 8255. The synonym for 8255 is adenocarcinoma combined with other types of carcinoma (not just subtypes).

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.

 2004
20041088 CS Extension/EOD Extension--Renal Pelvis: Primary site is renal pelvis with direct extension to the rt adrenal gland. What is the correct extension code?

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.

Assign CS Extension code 67 [Adrenal gland from renal pelvis] for adrenal extension from renal pelvis -- T4 and regional direct extension.

 2004
20041030 Histology (Pre-2007)--Lung: What is the correct histology code for this case of squamous cell carcinoma with several different variants? See Discussion.

The path report from a left pneumonectomy says: This squamous cell carcinoma had several different variants present including typical non-keratinizing squamous cell, spindled cell squamous cell, clear cell squamous cell and a small cell variant of squamous cell.

I cannot find a combination code that fits; the majority of the tumor is not stated; so do you code the highest specific type mentioned - 8084 - Squamous cell, clear cell type?

For tumors diagnosed prior to 2007:

Assign histology code 8070 [squamous cell carcinoma, NOS]. Squamous cell carcinoma, NOS includes types of squamous cell carcinoma without a specific code. This is a combination squamous tumor that does not have a unique code.

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.

 2004
20041036

Surgery of Primary Site/Surgery codes, NOS--Colon: What tissue specimens are included under this field's code 41 [Subtotal colectomy/hemicolectomy plus resection of contiguous organ; example: small bowel, bladder]? See Discussion.

How is site specific surgery coded for the following two cases?

Example 1. A right hemicolectomy normally includes a portion of ileum.

Example 2. Subtotal colectomy with bilateral oophorectomy.

Code 40 includes a right hemicolectomy. A right hemicolectomy normally includes a small portion of the terminal ileum removed with the ileocecal valve. Assign code 41 when resection of CONTIGUOUS organs goes beyond what would normally be removed as part of a subtotal colectomy/hemicolectomy. Record non-contiguous organ resection in Surgical Procedure of Other Site.

Example 1: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy].

Example 2: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy]. Surgical Procedure of Other Site -- 2 [Non-primary surgical procedure to other regional sites].

Addendum July 2021

For coding Surgical Procedure of Other Site, see the instructions for determining regional vs distant sites in the 2021 SEER manual under Coding Instructions #6 and #7 on pages 184-185. Do not use Summary Stage to determine regional vs distant for this data item.

 2004
20041069

Reportability--Brain and CNS: Is a meningioma invading the bone malignant and, therefore, SEER reportable if diagnosed prior to 2004? See Discussion.

1. Meningothelial meningioma with prominent nuclear pleomorphism, infiltration into dura, calvarium, temporalis skeletal muscle.

Microscopic: Multifocal infiltration by meningothelial tumor...extensive infiltration of trabecular spaces, extension through inner and outer calvarial layers by meningioma...mitotic activity in tumor noted but below the 4 per 10 high power field threshold for diagnosis of atypical meningioma.

2. Aggressive (invasive) transitional type meningioma, neuroimaging and histology imply extensive invasive meningioma involving bone and paraspinal soft tissues. Microscopy:...invaded bone...focal EMA positivity diagnostic of invasive transitional type meningioma... tumor invades bone.

The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant."

The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal.

 2004
20041066

Reportability/Date of Diagnosis--Ovary: Is a patient SEER reportable in 2001 or 2003 if she presented with a diagnosis of papillary serous tumor of low malignant potential [borderline tumor] per the 5/2001 surgery but at the time of the planned second look laparoscopic surgery is stated to have Stage 3A ovarian cancer? See Discussion.

A patient was seen in 5/2001 for large pelvic mass growing from right ovary. After TAH and USO and partial omemtectomy, path diagnosis was papillary serous tumor of low malignant potential (borderline tumor), unruptured. Right ovary and omental implant have identical histologic appearance, except the psammoma body formation and the ovary does not.

Patient does not return for lap as planned in 6-12 months.

In 1/03 she returns to hospital with abdominal pain and has debulking, hemicolectomy and Hartmann's procedure. 1/03 Path report "metastatic papillary serous adenoca." Chart now says "History of stage 3A ovarian cancer."

Yes, this case is reportable in 2003. Malignancy was confirmed in 2003. The diagnosis made in 2001 is not reportable for that year, and was not reviewed or revised according to the information provided.

 2004
20041063 Primary Site/Histology (Pre-2007)--Mediastinum: How do we code these fields for a case described as a "neuroendocrine carcinoma" of the "anterior mediastinum" without failing the SEER "impossible" site/histology combination edit? See Discussion. Two different facilities state that the patient has "neuroendocrine carcinoma of the anterior mediastinum." This coded combination failed SEER edit (SEERIF38). We can not correct it because that edit flag does not appear on our system. Both facilities indicate that the mediastinum is the primary. In addition, there is text to support both the histology and primary site codes.

For tumors diagnosed prior to 2007:

The combination of C381 [anterior mediastinum] and 8246 [neuroendocrine carcinoma] will be removed from the list of "impossible" site/histology combinations. There are rare cases of neuroendocrine carcinoma of the anterior mediastinum. As illustrated in the discussion, verify that the primary site is anterior mediastinum, the histology is neuroendocrine ca, and document those findings in the text.

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.

 2004
20041083 CS Lymph Nodes/CS Reg Nodes Eval -- Rectum: If the rectal tumor is not treated with a resection but on endoscopic ultrasound the patient is stated to have a lymph node above the primary tumor and the physician stages the case clinically as N1, should the CS Lymph Nodes field be coded to 30 [Regional lymph node(s), NOS] or 10[Rectal, NOS]? Should the evaluation field be coded to 0 [No lymph nodes removed. Evidence based on other non-invasive clinical evidence] or 1 [No lymph nodes removed. Evidence based on endoscopic examination.]? See Discussion.

Rectal primary:

5/04 sigmoidoscopy w/bx of rectal mass: adenocarcinoma. 6/04 Endoscopic ultrasound of rectal mass: invasion through wall but no definite invasion of prostate or seminal vesicles; 7.5mm lymph node located above tumor, no other enlarged lymph nodes detected. Patient did not have surgery. Physician staged lymph node involvement to clinical N1.

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.Assign CS Lymph Nodes code 10 [Regional lymph nodes] based on the physician's N1. Assign code 10 because it is the lowest numerical CS code that corresponds to N1 in the scheme for rectum. Use the physician's assignment of TNM when the information in the medical record is incomplete or ambiguous. Code CS Reg Nodes Eval field 0 [No lymph nodes removed] for the case described above because there is no indication that N1 was assigned based on the endoscopic exam. The NI may be based solely on TNM documentation provided by the clinician and you do not know what the clinician used as the basis for the staging.

 2004
20041021 Histology (Pre-2007)--Corpus Uteri: How should this field be coded when the D&C which shows "adenocarcinoma with mucinous and papillary features" and the TAH demonstrates only "endometroid carcinoma"? See Discussion. Should Histology be coded to 8380 [endometroid adenocarcinoma] because it is the most representative sample or to 8323 [mixed cell adenocarcinoma], per the Complex Morphology Coding Guidelines? The instructions in the Guidelines seem to imply that it is most important to represent combination histologies first, with majority (most representative sample) of tumor having a lower priority.

For tumors diagnosed prior to 2007:

Code Histology based on the pathology report from the most representative tissue. For the example above, code Histology to 8380 [Endometroid adenocarcinoma] based on the TAH/BSO pathology report.

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.

 2004