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Report Produced: 02/13/2026 15:45 PM

Report Question ID Question Discussion Answer Year
20031180 Histology (Pre-2007)--Breast: What code is used to represent the histology "ductal adenocarcinoma with medullary features?"

For tumors diagnosed prior to 2007:

Medullary is a subtype of duct and "with features of" is a term that indicates a majority of tumor. If this is an invasive adenocarcinoma with no in situ component, code to 8510/3 [Medullary adenocarcinoma]. If only one of the components is invasive, code that component.

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
20031179 EOD-Extension--Stomach: How is this field coded for a stomach primary that has metastases to "Sister Mary Joseph's Nodes?"

For cases diagnosed 1998-2003: For a stomach primary, code extension to 70 [Abdominal wall]. Sister Mary Joseph's nodule is a cutaneous umbilical metastasis most commonly from an intra-abdominal primary.

This rare form of cutaneous umbilical metastasis results from spread of tumor within the falciform ligament. The umbilicus is part of the abdominal wall.

 2003
20031177 EOD-Lymph Nodes--Colon: Are deposits of carcinoma in the pericolic fat still coded as lymph nodes when the pathology report states, "there is a high likelihood that these represent foci of venous invasion"? See Description.

Patient underwent resection for adenocarcinoma of the rectum. Path final diagnosis stated: "Regional lymph nodes: met carcinoma in 18 of

43 lymph nodes. Pathologic stage (AJCC/UICC 6th edition): pT3, V2, pN2, pMx. See comment." Path comment: "There are additional macroscopic stellate deposits of carcinoma in the pericolic soft tissue. According to the 6th edition of the AJCC staging manual, these should be designated as "V2," indicating that there is a high likelihood that these represent foci of venous invasion."

For cases diagnosed 1998-2003: Each grossly detectable nodule in the pericolonic fat is counted as one regional lymph node.

When the number of deposits is not mentioned, code Number of Regional Nodes Positive as 97 [Positive nodes but number of positive nodes not specified]. Unless the procedure is documented as a dissection, code Number of Regional Nodes Examined as 98 [Regional lymph nodes surgically removed but number of lymph nodes unknown/not stated and not documented as samping or dissection; nodes examined, but number unknown].

 2003
20031176 EOD-Patholgic Review of Number of Regional Lymph Nodes Examined: How is this field coded when there is no lymph node count in the final pathology diagnosis and the gross description states "four possible lymph nodes are dissected"? See Description. Patient with kidney cancer underwent nephrectomy and lymph node removal. Final path diagnosis was Lymph nodes, pericaval biopsy, lymph nodes with no evidence of carcinoma. Per Gross description: Received in formalin as pericaval lymph node is 2.5 cm piece of fibrofatty tissue, from which four possible lymph nodes are dissected. For cases diagnosed 1998-2003: Code the number of regional lymph nodes examined as 04. This is as accurate as possible for this situation. 2003
20031175

First Course Therapy: Are radio immune labeled antibodies, such as Bexxar [Tositum--I-131] coded as immunotherapy, radiotherapy, or experimental therapy?

Agents such as Bexxar or Zevalin are radioisotopes and coded as radiation. These agents destroy cancer cells with radiation. 2003
20031174 Multiple Primaries (Pre-2007)/Recurrence--Breast: Has SEER established a priority of medical opinions to determine the number of primaries or a time parameter establishing recurrence? When a pathologist and a physician refer to the subsequent reappearence in the same breast as both "recurrence" and "new primary"? See Description.

Example 1. Patient was diagnosed with right breast cancer in 1999 and underwent lumpectomy followed by radiation therapy. In 2001, patient was again found to have right breast cancer and was admitted for mastectomy. The surgeon stated that this was recurrence. The patient's primary care physician stated the patient had a new primary. Is there a priority order if the multiple physicians involved in a patient's care do not agree on the diagnosis?

Example 2. Patient was diagnosed in 1998 with left breast cancer. In 2000, the patient again was diagnosed with left breast cancer. There was no mention of recurrence so case was accessioned as a second primary. In 2003, patient was again admitted for an unrelated disease. In the H&P, the physician stated that the patient had recurrent breast cancer in 2000. Do we remove the second primary from our file based on this statement three years later?

Example 3. Patient was diagnosed with Paget's disease with intraductal carcinoma, left breast, in 1997. In August 2002, patient underwent left mastectomy for DCIS, left breast. In November 2002, patient's oncologist stated that patient had been on Evista for 5 years and had recurrent cancer despite Evista. Do we accession this as one or two primaries?

For tumors diagnosed prior to 2007:

Use the best information available. In general, information from the time closest to the event in question is more accurate than later information. The opinion of the pathologist tends to be the most valuable. Beyond that, SEER has not established a hierarchy of physician opinions.

Be aware that a physician's use of the term "recurrence" does not always mean that the second tumor originated from cells from the first tumor.

Examples 1, 2 & 3. Follow SEER rules for determining multiple primaries. In each case, the diagnoses are more than two months apart. Abstract as two 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
20031173

First Course Treatment/Hormone Therapy--Thyroid: Is hormone replacement therapy such as levothyroxine (Synthroid) for thyroid carcinoma coded as first course of treatment? See Discussion.

Examples:

Patient was admitted for thyroidectomy with a diagnosis of probable thyroid cancer. Patient's history stated that patient received work-up for hypothyroidism and was found to have thyroid nodule. Fine needle aspirate suggested carcinoma. Patient's medications included Cytomel and Synthroid.

Patient was given levothyroxine after thyroidectomy for medullary thyroid carcinoma.

Updated December 2025

Do not code levothyroxine given to treat hypothyroidism or as cancer treatment for medullary carcinoma when given as replacement therapy and not as thyroid stimulating hormone (TSH) suppression therapy. Thyroid hormone therapy is generally coded as treatment for follicular, papillary, and oncocytic thyroid carcinomas.

 2003
20031172 Hormone Therapy--Breast: Should hormonal therapy be coded as administered, when the physician states "Tamioxifen was given as a prescription?" Yes, based on the prescription for Tamoxifen, code Hormone Therapy as administered. 2003
20031171 Reportability: Is pseudomyxoma peritonei always reportable? See Description.

In the ICD-O-3, pseudomyxoma peritonei has a behavior code of 6, indicating that it is malignant. Does this imply that pseudomyxoma peritonei is always a reportable malignancy? In the past, our pathologist consultant told us that pseudomyxoma peritonei is only a reportable malignancy if the underlying tumor is malignant. A benign cystadenoma of the appendix, for example, can rupture causing pseudomyxoma perionei. Does SEER agree with our pathologist consultant?

Example: Patient was found to have psuedomyxoma peritonei. Right hemicolectomy was done. Path reported an appendix with mucinous cystic tumor of undetermined malignant potential. A definite diagnosis of cancer can not be rendered.

Reportability is determined from the behavior of the primary tumor and the behavior of implants. If either are malignant, the case is reportable.

The case example does not seem to be reportable, based on the available information. Cancer diagnosis has not been made according to the pathology report.

 2003
20031170 Terminology, NOS/Recurrence/Multiple Primaries (Pre-2007): Is the term "residual disease" equivalent to "recurrence"? See Description.

Example 1. Patient underwent excision and re-excision of lentigo maligna in 1998. Final path showed close but negative margins. In 1999 a biopsy of a brown patch (over the scar) in the same location was done. Pathology reported residual lentigo maligna. Is the 1999 melanoma a new primary because it was diagnosed more than two months after the first melanoma and there is no mention of recurrence? Or is the term "residual" another way of saying recurrence?

Example 2. In 1999, patient underwent excisonal biopsy of intraductal carcinoma of the right breast, followed by radiation therapy. In 2000, mammogram showed calcifications in right breast. Biopsy was done with path showing residual ductal carcinoma in situ. There is no mention of recurrence. Is this one or two primaries?

For tumors diagnosed prior to 2007:

According to our pathologist consultant, "residual" disease indicates incomplete eradication of the original disease process. Residual means that the disease process was not completely removed/eradicated in the initial therapy. Therefore cells from the original primary were never completely removed or destroyed.

In each example above, this is not a recurrence per se but rather

progression of disease. Do not abstract the latter diagnosis as a new primary.

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