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Report Produced: 12/26/2025 16:43 PM

Report Question ID Question Discussion Answer Year
20061010 Multiple Primaries/Histology--Lymphoma: If an oral mucosa, right hard palate biopsy contains a composite lymphoma [low-grade follicular + chronic lymphocytic leukemia], how many tumors should be abstracted and how should the histology field(s) be coded?

For cases diagnosed prior to 1/1/2010:This is one primary. Assign code 9590 [Malignant lymphoma, NOS]. This is a composite lymphoma. Code to lymphoma when there is any solid tumor (in lymph nodes, tissue, etc.) Code to lymphoma, NOS since this is not purely follicular and there is no code for composite lymphoma.

For cases diagnosed 2010 forward, 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.

 2006
20061039 CS Tumor Size/CS Site Specific Factor--Breast: Should the tumor size be coded to 1.5 cm or 2.5 cm and SSF6 coded to 020 or 030 respectively for a tumor with invasive and in situ components described as being a 2.5 cm tumor with a "greater than" 1.5 cm invasive portion? See Discussion. Should tumor size be coded to 1.5 cm and SSF6 coded to 020 [Invasive and in situ components present, size of invasive component stated and coded in CS Tumor Size] or should the tumor size be 2.5 cm with SSF6 coded to 030 [Invasive and in situ components present, size of entire tumor coded in CS Tumor Size because size of invasive component not stated and in situ described as minimal (less than 25%)]?

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 CS tumor size 992 [stated as greater than 1 cm] and SSF6 code 020.

The September 2006 revision to the CS Tumor Size table now lists the 992-995 range codes as "greater than ___ cm."

It is better to code the invasive size than the entire size of the tumor. In the TNM mapping, this would more accurately portray the tumor as T1c rather than T2.

 2006
20061106 Reportability--Hematopoietic, NOS: Is a "Myelodysplasia, refractory macrocytic anemia with multilineage dysplasia" reportable?

For cases diagnosed prior to 1/1/2010:Yes, myelodysplasia, refractory macrocytic anemia with multilineage dysplasia is reportable. This is a type of refractory anemia. Refractory anemia is reportable.

For cases diagnosed 2010 forward, 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.

 2006
20061138 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are to be abstracted and how is the histology field(s) coded when a nipple biopsy demonstrates Paget disease and a separate biopsy in the same breast demonstrates inflammatory breast carcinoma? See Discussion. Should Paget disease be coded as the histology because it has a higher histology code than inflammatory carcinoma?

For tumors diagnosed prior to 2007:

Abstract the inflammatory carcinoma as one primary and the Paget disease as a separate primary. The first three digits of the histology codes for these histologies are different (8530 and 8540). Therefore, these are separate 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.

 2006
20061118 Primary Site--Unknown & Ill-defined Site: What is the primary site code for multiple malignant rhabdoid tumors (extra renal) in a newborn infant?

Search for additional information on the location of the primary in this case. A tissue specimen (biopsy) is required for a diagnosis of rhabdoid. Additionaly, there should be scans describing any tumors located in sites other than the biopsy site. If the biopsy site is not assumed to be a metastatic site and is the only location of tumor, code the site of the biopsy as the primary site.

If it is not possible to obtain further information for this case, code the primary site C809 [Unknown primary site].

According to our pathologist consultant, extra-renal rhabdoid tumors have been described in organ sites (liver, GI tract, thyroid, CNS, skin, to name a few) as well as in the soft tissue. Many of the organ site tumors are multiple/multifocal, so multiple tumors in one organ do not necessarily imply metastatic disease and therefore unknown primary site.

 2006
20061054 First Course Treatment/Chemotherapy: Is adriamycin used in a chemoembolization procedure coded as chemotherapy? Code as chemotherapy only when a chemotherapeutic agent is used, such as adriamycin. Do not automatically code chemoembolization as chemotherapy. 2006
20061071 CS Extension--Lymphoma: In the absence of physician staging, is an "enlarged" spleen seen on CT coded as involvement of the spleen for lymphoma cases?

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 spleen involvement when the only evidence is an enlarged spleen.

When imaging is the only diagnostic tool (no biopsy or splenectomy), spleen involvement is based on the presence of nodules and not on enlargement. Splenic enlargement alone (by physical exam or imaging) is insufficient to support involvement of spleen.

 2006
20061099 CS Extension--Lung: If only a "single" cytology is performed on pericardial fluid and it is negative, can Note 6 B, which states that pleural effusion [code 72] is coded as malignant unless there are "multiple" negative cytologies, be used to infer that the pericardial fluid should also be coded as involvement?

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.

No, do not apply the instructions for pleural effusion to pericardial effusion. Do not code a pericardial effusion proven negative by cytology in CS Extension.

 2006
20061086

Reportability--Melanoma: Is an excisional biopsy of the skin with a diagnosis on the pathology report of "Tumoral melanosis" reportable by itself or must there be a pathologist note, such as "Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma", in order for it to be reportable? See Discussion.

Skin, left upper back, exc Bx: Tumoral melanosis. Note: Unless proven otherwise, tumoral melanosis should be considered as a regressed melanoma.

If reportable, do we report a diagnosis of tumoral melanosis without a similar note?

Tumoral melanosis (TM) alone is not reportable. It is not listed in ICD-O-3. TM can be associated with a regressed melanoma, but it can also occur with other cutaneous tumors. The case is reportable if there is a diagnosis of melanoma.

 2006
20061063 CS Extension--Lung: Do notes 6A and 6B in the 2004 SEER manual offer conflicting instruction for determining the significance of pleural effusion for this primary site? See Discussion.

1. Is note B to be used to modify or change what note A states?

Does note B state -- If a pleural fluid bx(s) is negative; but the fluid is bloody and/or is an exudate, and clinical judgment indicates the effusion is related to tumor -- use code 72?

If a pleural effusion is biopsied should the pathology report state the color of the pleural fluid or is an exudate? (Training issue)

2. Do the following clinical findings impact the clinical evaluation of involvement for a pleural effusion? If yes, why? (Training issue(s))

a. Heart problems?

b. The location of the pleural effusion?

i. Bilateral pleural effusion is noted; tumor in Rt or Lt lung only?

ii. Bilateral pleural effusion is noted; tumor in both lungs?

iii. Pleural effusion is noted on the opposite side from the tumor?

iv. Pleural effusion is on same side as the tumor?

SUPPORTING CS MANUAL DOCUMENTATION

Note 6: Pleural Effusion.

A. Note from SEER manual: Ignore pleural effusion that is negative for tumor. Assume that a pleural effusion is negative if a resection is done.

B. Note from AJCC manual: Most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor.

In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be staged T1, or T2, or T3.

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.

1. Note B does not modify or change note A. Note B is explaining when an effusion should not be used to determine the stage. Pleural effusions are evaluated by cytology, not biopsy.

2. If relevant, the clinician should document the fact in the medical record. Heart problems can cause non-malignant pleural effusions (that are disregarded for staging). Pleural effusion will almost always be around the lower lobes due to gravity, but may envelop an entire lung. Pleural effusions can be unilateral or bilateral regardless of the location of the tumor, but are usually on the side where the tumor is.

 2006