MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned when a pathology specimen reveals one tumor with invasive mucinous carcinoma [8480/3] and a second tumor with in situ ductal carcinoma, solid and cribriform types [8523/2]?
For cases diagnosed 2007 or later, accession two primaries, invasive mucinous carcinoma [8480/3] and in situ ductal carcinoma, solid and cribriform types [8523/2].
The steps used to arrive at this decision are:
Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor (8480/3 and 8523/2).
Start at the MULTIPLE TUMORS module, rule M4. These tumors have ICD-O-3 histology codes that are different at the second (xxx) and third (xxx) number and are, therefore, multiple primaries.
Multiple primaries--Lymphoma: Is a splenectomy done for non-Hodgkin lymphoma diffuse large B-cell of the spleen a composite histology and a single primary if a perihilar lymph node with Hodgkin lymphoma classic type is found at the time of this surgery?
For cases diagnosed prior to 1/1/2010:This is two primaries -- Non-Hodgkin lymphoma (NHL) in the spleen and Hodgkin lymphoma (HD) in a lymph node.
Composite lymphoma is NHL and HD both in a single lymph node.
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.
First course treatment/Other therapy--Skin: How is PUVA [psoralen (P) and long-wave ultraviolet radiation (UVA)] coded when used for skin primaries such as melanoma and mycosis fungoides?
Code PUVA as "Other treatment" with Code 1 - Other. We do not have a code specifically for ultraviolet radiation.
Reportability--Appendix: Are low-grade appendiceal mucinous neoplasms reportable?
For cases diagnosed prior to 1/1/2022
A low-grade appendiceal mucinous neoplasm (LAMN) is not reportable. The WHO classification designates LAMN with the behavior code /1 [uncertain whether benign or malignant].
EOD-Extension--Colon: What code is used to represent this field for a mid-ascending colon primary that invades through muscularis propria and into subserosal fibroadipose tissue that also presents with a "separate serosal nodule" of carcinoma within cecum that is consistent with a tumor implant (cT3, N0, M1)?
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 85 [Metastasis], because the nodule of carcinoma in the cecum is not contiguous with the mid-ascending primary colon tumor.
CS Eval/Surgery of Primary Site--Colon: When the only procedure performed is a polypectomy, if there is NO tumor at the margins, should CS TS/EXT-Eval be coded as 3 and the surgery coded as a polypectomy?
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 eval code 3. A polypectomy with no tumor at the margin meets the criteria for pathologic staging.
Code polypectomy in Surgery of Primary site in this case.
Update to the Current Manual/SEER*RSA--SEER Site-specific Factor 1: The 2024 SEER Manual and SEER*RSA say that Codes 10-51 are hierarchical; use the highest code that applies (10 is highest, 51 is lowest). Should the guidance say that 51 is highest, 10 is lowest since code 10 is a HPV negative p16 test?
Assign the highest code with 51 as the highest and 10 the lowest when there is more than one test performed with differing results.
The SEER Manual will be updated in the 2025 release. SEER*RSA will be updated in a future release, version 3.3 in 2026, as version 3.2 has been updated for 2025.
Primary site--Heme & Lymphoid Neoplasms: What the primary site for a diagnosis of Langerhans cell histiocytosis with multifocal multisystem involvement of the skin, chest, CNS and thyroid, but no evidence of involvement on a bone scan?
Langerhans Cell Histiocytosis (LCH) includes three major groups:
Unifocal: Slowly progressing disease, involves one organ.
Multifocal unisystem: Involves several organs in one system.
Multifocal multisystem: Involves several organs in two or more systems.
When the disease is both multifocal and multisystem, code the primary site to unknown [C809] because there is no way to identify the origin of the neoplasm in this situation.
SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.
Histology (Pre-2007)/Multiple Primaries (Pre-2007)--Breast: What code is used to represent histology for a case with a biopsy specimen that reveals "infiltrating ductal carcinoma with ductal carcinoma in situ, comedo subtype, non-extensive" in one quadrant of the breast and a mastectomy specimen with "invasive pleomorphic lobular carcinoma with lobular carcinoma in situ" in another quadrant of the breast? Paget disease is identified in the nipple section.
For tumors diagnosed prior to 2007:
Code the Histology field to 8522/3 [infiltrating duct and lobular carcinoma]. We are choosing the ductal and lobular combination over the Paget disease and lobular combination because it is more important for analysis purposes.
Be careful in using combination codes to code separate tumors in different locations of the same breast as a single primary. Currently there are only three combination codes for the breast that allow for this situation, 8522 [duct and lobular], 8541 [Paget disease and infiltrating duct] and 8543 [Paget disease and intraductal]. Other histologic type differences that occur as separate tumors in different parts of the same breast are coded as multiple 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.
All Surgical Fields/Radiation Sequence with Surgery--Unknown Primaries: What codes are used to represent these fields for an unknown primary treated with a radical neck dissection followed by radiation therapy?
For unknown primaries treated with a lymph node dissection and diagnosed 1/1/2003 and after, code:
1) Surgery to Primary Site: 98 [All unknown and ill-defined disease sites, WITH or WITHOUT surgical treatment].
2) Scope of Regional Lymph Node Surgery: 9 [Unknown or not applicable].
3) Surgical Procedure of Other Site: 1 [Surgery to other site(s) or node(s), NOS; unknown if regional or distant].
4) Radiation Sequence with Surgery: 3 [Radiation after surgery]. Any planned surgical treatment is used to code radiation/surgery sequence (per CoC I&R).
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