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Report Produced: 02/26/2026 09:32 AM

Report Question ID Question Discussion Answer Year
20081001

CS Tumor Size: Can an 'ulcerated mass' be used to code CS tumor size? See Discussion.

The CS Manual (p. 26, 4.a.) states do not code the size of the polyp, ulcer or cyst. However it states that a 'cystic mass' can be used to code TS if it is the only size given. Scopes Text: 'ulcerated' mass based at anal verge & ext 3-4 cm up into rectum.

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.Do not code CS Tumor size using the size of an ulcerated mass.

Answer from:

  • I & R System

  • American College of Surgeons

    		•  2008
    		20081049 Histology--Pancreas: What is the correct code for "non-secretory pancreatic endocrine tumor" with positive lymph nodes on excision indicating a malignant tumor? Pathologist indicated it was not an exocrine tumor.

    Code as islet cell carcinoma [8150/3].

    There are several cell types in the islets, and each produces a different hormone. The custom has been to name the tumors by their hormone production e.g. insulinoma, glucagonoma, etc. Occasional tumors do not produce any hormone (at least one that can be determined or measured). These tumors are called non-functioning endocrine tumors. Most of the endocrine tumors in the pancreas are islet cell tumors.

    		 2008
    		20081056 MP/H Rules--Lung: In reference to lung, SINQ 20071028 states "'nodule' is not an equivalent term for tumor, mass, lesion, or neoplasm." However, slide 5 for the MPH lung section of "Beyond the Basics" states "we use the words 'mass, nodule and lesion' interchangeably." Which is it?

    For cases diagnosed 2007 or later:

    For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.

    This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.

    		 2008
    		20081117 Histology--Brain and CNS: How is histology to be coded for a pituicytoma WHO grade I, of the pituitary?

    Assign code 9380/1 [glioma, borderline].

    According to our pathologist consultant, the term pituicytoma is restricted to low-grade glial neoplasms of the neurohypophysis or infundibulum. The best category currently available for these is glioma.

    		 2008
    		20081066 Multiplicity Counter/Type of Multiple Tumors--Breast: How should these fields be coded when path shows a 1.2 cm infiltrating carcinoma with lobular features and several foci of infiltrating lobular carcinoma [7 foci described as multifocal], 1 large focus, and numerous foci of LCIS and CIS with lobular and ductal features? Should we count the foci or separate tumor nodules, ignore them, or code unknown values for these fields? See Discussion.

    Scenario: 10/17/07: Right axilla soft tissue bx - infiltrating mammary ca with lobular features arising within apparent breast tissue present within axilla. Tumor size 1.2 cm. 11/3/07: Right breast, reexcision lumpectomy - Several foci of infiltrating lobular CA. (2) foci & (5) foci within specimen (multifocal). (1) large focus also present. No lymphovascular invasion identified. Numerous foci LCIS. Pleomorphic LCIS & CIS with lobular and ductal features. Margins free of invasion however margins diffusely involved with LCIS.

    When do you count foci or separate tumor nodules, when do you ignore them, and when do you code unknown values for these fields? Coding instruction 3b states, "When the tumor is multifocal or multicentric and the foci of tumor are not measured, code as 99." Instruction 4b states, "Use code 01 when there is a single tumor with separate foci of tumor." Finally, instruction 6b states, "Use code 99 when the tumor is described as multifocal or multicentric and the number of tumors is not given," which seems to imply that if we know the number of tumors, we would code that number.

    Multiplicity Counter: Use instruction 4b. Since there is one measured tumor and the foci were not measured, code the multiplicity counter 01 [One tumor only].

    Type of Multiple Tumors: Code Type of multiple tumors 00 [Single tumor].

    		 2008
    		20081017 Ambiguous terminology/Reportability--Leukemia: Is a 'suspicious peripheral blood smear' the same as a suspicious cytology? See Discussion. The final diagnosis on the path report for a peripheral blood smear is stated to be "suspicious for malignancy." The microscopic description states that the "lymphoid population raises the concern of chronic lymphocytic leukemia." Nothing further was done. Is this a reportable case? If so, should it be coded as a leukemia or a malignancy NOS?

    For cases diagnosed prior to 1/1/2010:Do not accession a leukemia case based only on a "suspicious" peripheral blood smear. If a confirmed diagnosis, clinical confirmation or further information becomes available later, accession the case at that time.

    For cases diagnosed 1/1/10 and later, 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.

    		 2008
    		20081031

    MP/H Rules--Breast: How many primaries are abstracted if a mastectomy specimen reveals two separate invasive tumors:

    #1: Invasive apocrine carcinoma, poorly differentiated, 1.2cm, (9 o'clock). -Apocrine ductal carcinoma in situ (DCIS), high-grade with comedo necrosis; 2.0cm (9:30 o'clock).

    #2: Invasive ductal carcinoma, well-differentiated, 1.0cm (12:30 o'clock). -Minor component of DCIS, low-grade? See Discussion.

    		 In the MP/H Rules, Table 1 lists apocrine as a type of intraductal carcinoma. Apocrine does not appear in Table 2, the list of specific duct carcinomas. If Apocrine is a type of ductal carcinoma, then Rule M11 would make this a single primary. If it is a single primary, what is the histology?

    For cases diagnosed 2007 or later:

    Using rule M11, there is one primary in the left breast. Apocrine is a specific duct carcinoma. To make this more clear, apocrine will be added to Table 2 in a future revision.

    To code the histology, go to the multiple tumors module and start with rule H20. Stop at rule H29 and code the histology with the numerically higher ICD-O-3 code, 8500/3.

    		 2008
    		20081132 MP/H Rules--Breast: What is the histology code for a breast tumor that is ductal ca with focal squamous differentiation? See Discussion. SINQ 20021062 states for cases Dx'd prior to 2007, use 8570. Is 8570 also used when the squamous differentiation is focal? For cases diagnosed 2007 or later, use rule H14 and code the histology 8500 [duct carcinoma]. Ignore histologies described as "focal," "focus," or "foci." This instruction will be added to the histology rules in the upcoming revision of the MP/H manual. 2008
    		20081040 Reportability/Histology--Hematopoietic: If a JAK2 positive myeloproliferative disorder is reportable, how should histology be coded?

    Please discuss the significance of JAK2 point mutation.

    Example: Bone marrow biopsy showed hypercellular marrow with increased megakaryocytes associated with JAK2 point mutation consistent with myeloproliferative syndrome. Path comment: While the morphologic changes would be compatible with a myeloproliferative syndrome, they are not specific for this as similar findings can be seen in reactive conditions. However, a molecular diagnostic test demonstrated a positive JAK2 point mutation which would support the diagnosis of myeloproliferative syndrome. In summary, the combined histologic and molecular diagnostic findings support a myeloproliferative syndrome. The differential diagnosis would be between polycythemia vera and essential thrombocythemia. Subsequent clinical diagnosis: polycythemia vera.

    For cases diagnosed prior to 1/1/2010:Follow the instructions in the SEER manual on pages 1-4 to determine reportability.

    Code the histology using all information available for the case. If the clinician reviews the case and states a particular histology based on his/her review, code that histology.

    The clinician has access to all of the information available for this case. He/she uses his/her expertise to form a clinical diagnosis.

    For cases diagnosed 1/1/10 and later, 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.

    		 2008
    		20081059

    Reportability/Histology--Head and Neck: Is a right cerebellopontine (CP) angle endolymphatic sac papillary tumor (ELST) reportable? If so, what is the histology code?

    Revised December 2015

    ELST is reportable. Code histology to adenocarcinoma (8140/3). Code primary site to inner ear (C301).

    Endolymphatic sac tumors are rare non-metastasizing adenocarcinomas that originate in the endolymphatic sac of the inner ear (C301). They are slow growing and widely invade, and in later stages often destroy, the petrous bone. The WHO Classification assigns ICD-O-3 code 8140/3.

    		2008