System Guide
Back to Search Results

Search Results

Display Options
Display Options
Select Fields
Export Results to CSV Create Report 0
+ Add all results to report

Report Produced: 12/30/2025 01:24 AM

Report Question ID Question Discussion Answer Year
20091101 CS Reg LN Pos/Exam--Melanoma: How should these fields be coded for a case that is an unknown primary site melanoma with liver involvement and a positive axillary lymph node?

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.Code regional lymph nodes positive 01 [one positive lymph node] and regional lymph nodes examined 01 [one lymph node examined] (assuming the positive node was the only node examined).

If the only lymph node involvement is the positive axillary lymph node, it is reasonable to conclude that this is a regional lymph node. When only one chain of lymph nodes is involved with metastatic melanoma, the metastatic cells had to come from skin with direct drainage to those lymph nodes.

 2009
20091130

MP/H Rules/Histology--Breast: What is the correct histology code and MP/H rule used for 1) infiltrating ductal carcinoma, mucinous type and 2) infiltrating ductal carcinoma with features of tubular carcinoma? See Discussion.

There is confusion as to which rule applies. Should the histologies be coded to 8480/3 [mucinous adenocarcinoma] and 8211/3 [tubular adenocarcinoma] respectively per rule H12? Rule H12 states to code the most specific histologic term; "type" and "with features of" are used in the pathologic diagnosis and are both terms that can be used to code the specific histology. Or would the histology be coded 8523 for both examples per rule H17 because neither histologic codes 8480/3 or 8211/3 are included as examples of duct carcinomas, nor are they included in Table 2?

For cases diagnosed 2007 or later, code 8523 [infiltrating duct mixed with other types of carcinoma] for

1. Infiltrating ductal carcinoma, mucinous type and

2. Infiltrating ductal carcinoma with features of tubular carcinoma

The infiltrating ductal types in Rule H12 are listed (8022, 8035, 8501-8508) and do not include mucinous or tubular. We cannot use this rule. The first rule that applies to these single tumors is H17, code to 8523. If you look up 8523 in the numerical morphology section of ICD-O-3, you will see similar examples included in the definition of this code.

2009
20091108 MP/H Rules/Multiple Primaries--Lung: How do we apply the MP/H rules if a pathologist states a patient has multiple reportable primaries after he compares an October 2006 RLL lung specimen with a March 2009 RML lung specimen? See Discussion. Patient had a right lung lobectomy (RLL) in Oct. 2006 diagnosed as adenocarcinoma. In March of 2009, two nodules in the right upper lobe were identified. Following a RUL wedge resection, the pathology report indicated: Two foci of M.D. adenocarcinoma with mixed mucinous and micropapillary and solid patterns. COMMENT: The present tumor is compared to the previous adenocarcinoma reviewed in 2006. Although there is some overlap in their appearance, the present tumor shows a much greater component of mucinous adenocarcinoma. Because there is some difference in the appearance, and the nodule is located in a separate lobe, this will be dictated as a separate lung primary.

For cases diagnosed 2007 or later, this is two primaries.

MPH General Instructions tell us a pathologist may decide when there is recurrence when comparing the current tumor to a previous specimen. In this case, the pathologist did the comparison and documented that the second tumor is NOT a recurrence but a new primary.

Histologies described by the terms "pattern" and "component" do not indicate a more specific type when applying the histology rules. The histology for the 2009 diagnosis is adenocarcinoma [8140/3]. Rule H3 applies.

2009
20091114 MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion. Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis. For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis. 2009
20091063 CS Lymph Nodes--Head and Neck: How is this field coded when a positive neck FNA is followed by a neck dissection that contains one of seventeen positive lymph nodes? See Discussion. The primary site is the right tongue. The patient underwent FNA of a right neck mass that was positive for squamous cell carcinoma. Subsequent right modified radical neck dissection showed one out of seventeen nodes positive for metastatic carcinoma. For head and neck primaries, the CS LN codes 10-19 represent a single positive ipsilateral regional node. Codes 20-29 represent multiple positive ipsilateral nodes.

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.If the neck dissection included the area of the positive FNA, count only the positive nodes from the dissection. Avoid double-counting a positive node for both an FNA and a dissection.

In the unlikely event that the dissection did not include the area of the positive FNA, add one positive node to the count from the dissection.

This instruction supersedes previous instructions.

 2009
20081123 Reportability--Brain: Is angiocentric glioma, WHO grade 1 of the right frontal lobe reportable? If so, how is histology to be coded?

Angiocentric glioma is reportable. The best histology code currently available is 9380/1 [glioma, NOS; uncertain behavior].

According to the WHO Classification of Central Nervous System Tumours, Angiocentric glioma has a behavior of /1. WHO defines it as an epilepsy-associated stable or slowly growing cerebral tumour primarily affecting children and young adults; histopathologicaly characterized by an angiocentric pattern of growth, monomorphous bipolar cells and features of ependymal differentiation.

 2008
20081011 Surgery of Primary Site/CS Reg LN Exam/Scope Regional LN Surgery--Rectum: How are these fields coded when a patient develops a non-tumor related complication that requires an additional sigmoid resection that removes 2 additional lymph nodes one week following a low anterior resection that removed 4 lymph nodes? See Discussion. Patient had a low-lying rectal cancer that was biopsied and then treated with radiation and chemo followed by a low anterior resection. Four nodes were removed. There was no residual tumor. The patient returned one week later due to a rectal bleed, thought to be an abscess. During surgical exploration it was found that the anastomosis had broken down and it was decided to do a sigmoid colectomy. Residual disease was not suspected. Two additional nodes were removed.

Surgery of primary site: Assign code 30 [low anterior resection]. Code the most extensive surgery (i.e. the highest surgery code) applicable.

CS Reg LN Exam: Code 04 [four nodes removed].

Scope of regional lymph node surgery: Code 5 [4 or more regional lymph nodes removed].

The sigmoid colectomy was performed for a surgical complication, thus it was not cancer-directed therapy. The regional lymph nodes removed during that procedure were not removed to diagnose cancer or stage the disease, and they were not removed during the initial treatment. Please see SEER manual for instructions for coding Regional Lymph Node Surgery.

 2008
20081035 MP/H Rules/Histology--Breast: What histology code is used for a single tumor, micropapillary carcinoma with components of mixed ductal and lobular carcinoma?

For cases diagnosed 2007 or later, use rule H16 and assign code 8522 [Duct and lobular carcinoma].

Micropapillary is specific duct type (see Table 1).

 2008
20081057 CS Extension--Lung: Chest CT shows segmental atelectasis (CS EXT code 40), but patient had Left Lower Lobe lobectomy/Lymph Node dissection with no involvment outside the lobe (pleura and all margins neg). Do we still code the atelectasis (CS Ext 40) over confined to lung (CS EXT code 10)?

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 40 [Atelectasis/obstructive pneumonitis that extends to the hilar region but does not involve the entire lung (or atelectasis/obstructive pneumonitis, NOS)].

CS extension code 10 does not apply when any condition described in codes 20-80 exists.

 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