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Report Produced: 12/25/2025 15:28 PM

Report Question ID Question Discussion Answer Year
20190041

Reportability/Primary Site--Gastrointestinal (GI) Tract: Is a gastrointestinal stromal tumor (GIST) with a single nodule in the small intestine (C17_) and a nodule in the stomach (C16_) reportable per the 2018 SEER Coding Manual reporting instructions for GIST due to the multiple foci or do the multiple foci need to be in the same organ to be reportable? See Discussion.

Example: Small intestine wedge resection with GIST, 1.8 cm in mid small intestine, single nodule. Stomach nodule biopsy: GIST, 0.3 cm. Pathology report comment section indicates the gastric GIST is not staged due to the small size and incidental nature.

Report the GIST in the small intestine. The 2018 SEER Manual says to report GIST when there are multiple foci and to code the primary site to the site where the malignancy originated. Use text fields to record the details, including the stomach nodule.

 2019
20190106

Tumor Size--Esophagus: Can information from the endoscopy procedure that implies a size of 3 cm for Tumor Size--Clinical be used for Esophagus? See Discussion.

1-28-2018 CT Scan: 2.4 cm mass

2-15-2018 Endoscopy: Mass was present 22 to 25 cm. Biopsies were taken with cold forceps for histology; biopsy positive.

For the case you describe, we would record the clinical tumor size stated on the CT report.

The priority order for clinical tumor size is as follows.

1. Biopsy or operative (surgical exploration) report

2. Imaging

3. Physical exam

We do not recommend coding tumor size based on an inferred tumor size from a description such as "Mass was present 22 to 25 cm." Look for an actual measurement of the mass, or a stated tumor size. Use text fields to record details.

 2019
20190032

Summary Stage 2018--Lung: Are ground-glass lung nodules coded as distant for Summary Stage? See Discussion.

Chest x-ray: Multifocal pneumonia in left lung; possibility of masses in left lung not excluded.

Chest CT: 4 large ground-glass masses in LUL (largest 46mm); beginning of Tree-In-Bud appearance in LUL; 2 small ground-glass nodules in right lung.

Lung LUL biopsy: Adenocarcinoma, Solid Predominant.

No further information as patient did not want to discuss treatment options.

Per the AJCC book and CAnswer Forum, multifocal classification should be applied equally whether the lesions are in the same lobe OR in different ipsilateral lobes OR contralateral lobes, cT2b(m), cN0, cM0.

Do not assume that ground glass presentation is consistent with a neoplasm. There are numerous causes of a ground glass lung condition such as sarcoidosis or pulmonary fibrosis. A ground glass lung opacity may also be observed in conditions such as alveolar proteinosis, desquamative pneumonitis, hypersensitive pneumonitis, and drug-induced or radiation-induced lung disease. If an area of ground glass opacity persists in the lung, it is usually classified as an adenocarcinoma, a classification that ranges from premalignant lesions to invasive disease. This is in line with AJCC that states to stage based on the largest tumor determined to be positive for cancer.

To Summary Stage the case example provided, ignore the lesions in the contralateral lung (do not assume that they are malignant). There are multiple lesions in the left lung, but once again, do not assume that those not biopsied are malignant. This leaves us with the lesion confirmed to be malignant, making this a Localized (code 1) tumor.

 2019
20190033

Update to current manual/Neoadjuvant therapy/Pathologic tumor size--Breast: When a patient with invasive breast cancer is started on neoadjuvant therapy and at surgery is found to have only residual in-situ disease, do we record the size of the in-situ tumor for Pathologic Tumor Size? See Discussion.

I understand that we are to record the Clinical Tumor Size in Tumor Size Summary because of the neoadjuvant therapy, but the SEER manual does not address what to record in the Pathologic Tumor Size after neoadjuvant therapy. Would we record 999 or the size of the in-situ tumor in the Pathologic Tumor Size field? Will there ever be a new data item added or changes to this current data item? By recording the Patholigic Tumor Size this way, there currently will not be any way to compare tumor size clinically versus after neoadjuvant therapy and assessing the response.

Note: this is an update to the 2018 SEER manual.

Assign 999 in Pathologic Tumor Size when neoadjuvant therapy has been administered. We can explore the possibility of another data item in the future.

 2019
20190037

Solid Tumor Rules/Multiple Primaries--Breast: How many primaries should be abstracted for simultaneously diagnosed non-contiguous invasive duct carcinoma and mucinous carcinoma? Does rule M12 apply since the two histologies are on different rows of Table 3 of the Breast Solid Tumor Rules? See Discussion.

Core biopsy of left breast at 2:00: Invasive ductal carcinoma, Nottingham score 6/9.

Core biopsy of left breast at 4:00: Invasive mucinous carcinoma (variant of ductal carcinoma), Nottingham score 5/9.

Post neo-adjuvant mastectomy: Main (largest tumor): Invasive ductal carcinoma, upper outer quadrant grade 2. Secondary tumor: mucinous carcinoma, grade 1 at 4:00.

Abstract multiple primaries when separate, non-contiguous tumors are on different rows in Table 3 of the Breast Solid Tumor Rules. Use Rule M14 as each row in the table reflects a distinctly different histology, in this case, invasive ductal carcinoma (8500) and mucinous carcinoma (8480).

 2019
20190035

Reportability/Histology--Vulva/Penis: Are differentiated penile intraepithelial neoplasia (C60._) and differentiated vulvar intraepithelial neoplasia (C51._) reportable for cases diagnosed 2018+? See Discussion.

We previously downloaded the 8/22/2018 ICD-O-3 histology update tables which included the note, not reportable for 2018, for both of these terms (with an updated histology 8071/2). SINQ 20180020 confirms differentiated penile and vulvar intraepithelial neoplasia are NOT reportable for 2018 (as does 20160069). However, when looking at the 8/22/2018 ICD-O-3 histology update table today, the not reportable for 2018 comment has been removed and it appears these two terms are reportable. Which is correct?

Report differentiated vulvar intraepithelial neoplasia and differentiated penile intraepithelial neoplasia (8071/2). The 2018 ICD-O-3 Coding Table errata dated 8/22/2018, lists the summary of changes of 7/20/2018, stating that these were erroneously flagged as not reportable and the flag was changed from not reportable to reportable (N to Y).

We will update SINQ 20180020.

 2019
20190009

First Course Treatment/Surgery of Primary Site--Breast: How is "Goldilocks," also referred to as oncoplastic reconstruction, in the surgery section for breast cancer patients coded?

Code Goldilocks mastectomy in Surgery of Primary Site. Breast surgery code 30 seems to be the best available choice for "Goldilocks" mastectomy. It is essentially a skin-sparing mastectomy with breast reconstruction. The choice between code 30 and codes in the 40-49 range depends on the extent of the breast removal. Review the operative report carefully and assign the code the best reflects the extent of the breast removal.

 2019
20190056

Behavior--Breast: What is the behavior of a solid papillary carcinoma when a pathologist does not indicate it in the pathology report and follow-up with the pathologist to obtain clarification regarding the behavior is not possible? See Discussion.

Example: Mastectomy specimen final diagnosis shows two foci of invasive ductal carcinoma including: Invasive ductal carcinoma, no special type, in association with solid papillary carcinoma (tumor #1, 1 cm, slices 6 and 7) and invasive ductal carcinoma, no special type (tumor #2, 1.2 cm, slices 9 and 10).

Summary Staging outlines, Tumor #1: Histologic Type: Invasive ductal carcinoma, no special type, in association with solid papillary carcinoma. As well as, Tumor #2: Histologic type: Invasive ductal carcinoma, no special type. Additional findings include ductal carcinoma in situ (DCIS): presently approximately 3.3 cm, spanning slices 10-13.

The behavior of the solid papillary carcinoma component will affect the provisional histology of the first tumor (8523/3) per Rule H17 vs. 8500/3 per Rule H7). Based on the response, we can determine whether this represents a single or multiple primaries (single primary per M13 vs. multiple primaries per M14).

Review all sections of the pathology report carefully for any mention of invasion, or lack of invasion, pertaining to the solid papillary carcinoma.

Per WHO 4th Ed Breast: If there is uncertainty that there is invasion, these lesions should be regarded as in situ. The distinction between in situ and invasive disease in solid papillary carcinoma is difficult.

 2019
20190010

Reportability/Histology--Bladder: Is papillary urothelial neoplasm of low malignant potential (PUNLMP) (8130/1) reportable when also referred to as papillary transitional cell carcinoma, grade 1, no invasion (8130/2) previously? See Discussion.

The pathology report reads: Urinary bladder, tumor over right ureteral orifice, biopsy: Urinary bladder mucosa (urothelium) and submucosa (lamina propria), with papillary urothelial neoplasm of low malignant potential (previously known as papillary transitional cell carcinoma, grade 1 of 3), no invasion identified.

This case is not reportable. PUNLMP (8130/1) is the diagnosis stated by the pathologist for this case and PUNLMP is not reportable. The information in parentheses is informational in this case and does not change the pathologist's diagnosis.

According to WHO Classification of Tumors of the Urinary System and Male Genital Organs, 4th edition, there is variation of architectural and cytological features between PUNLMP and papillary urothelial carcinoma, low grade, reflecting grading changes from an older classification system.

 2019
20180104

Reportability--Ambiguous terminology: Are the following terms reportable: almost certainly and until proven otherwise? See Discussion.

Example 1: Physician states patient has an almost certain melanoma. Due to the patient's age, there is no plan to for any treatment or further workup. Almost certain is not listed as a reportable phrase, so typically we would not accession this case.

Example 2: Imaging states a diagnosis of renal cell carcinoma until proven otherwise. No additional workup is available at this facility. This terminology is also not seen on the ambiguous reportable terminology list but we are seeing it more often and wanted confirmation.

Use the ambiguous terminology list as a last resort. Consult with the physician and search for further information to assist with the decision. If no further information can be obtained, use the ambiguous terms list to decide; in this case, the terms are not on the list and these examples would not be reportable.

 2018