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Report Produced: 12/24/2025 23:08 PM

Report Question ID Question Discussion Answer Year
20051131

Recurrence/Multiple Primaries (Pre-2007)/Primary Site--Breast: Is a malignancy that occurs in 2005 in a mastectomy scar years following an original diagnosis of breast cancer in 1971 a recurrence (not reportable) or a new primary (breast or chest wall, NOS)? See Discussion.

The patient had a right mastectomy for breast carcinoma in 1971. In 2005, she came in with a mass in the right axilla and a right chest wall mass in the mastectomy scar. Excision of the axillary mass and biopsy of the chest wall mass revealed invasive adenocarcinoma with a similar histologic pattern. The axilla specimen contained no benign breast tissue. IHC stains exhibit strongly positive for ER, mildly positive for PR and negative for HER2/neu. The pathologist says "Although these findings are consistent with recurrent breast carcinoma, they are not specific for such. Recurrence after 34 yrs. is most unusual."

For tumors diagnosed prior to 2007:

The 2005 diagnosis is a new primary. The 1971 site differs from the 2005 site and there are more than two months between the two. Without further information, assign topography code C761 [chest wall]. The pattern of spread, including regional extension, is different for a primary of the chest wall compared to a primary in the breast. Coding the primary site to C761 will group this case with similar cases.

If further information can be obtained, look for old records that describe the extent of the 1971 mastectomy. It is possible that there was breast tissue left on the chest wall. Residual breast tissue is often present following mastectomy (simple, modified, or even radical). New carcinoma can develop in the remaining breast tissue.

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.

 2005
20051053 Reportability/Multiple Primaries (Pre-2007)/Histology--Anus: How many primaries exist if an 11/7/03 anal lesion presents with poorly differentiated adenocarcinoma with signet ring features and extensive mucin production and the 1/9/04 wide excision has adenocarcinoma and Paget disease (intraepidermal adenocarcinoma) extends to skin margin?

For tumors diagnosed prior to 2007:

This is a single primary: the adenocarcinoma with the Paget representing intraepithelial extension of the process. Tumor cells can invade from their place in the epithelium into the underlying stroma either at the primary site, or at their extension site (skin).

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.

 2005
20051058 Primary Site/Histology (Pre-2007)--Rectum: How are rectal biopsies with the histology of "poorly differentiated carcinoma with mixed basaloid and squamous features" coded if, per the SEER site/histology validation table, the histology 8094/3 [basosquamous carcinoma] histology cannot be coded to the rectum for the primary site?

For tumors diagnosed prior to 2007:

Code primary site C209 [rectum] and histology 8094/3 [basosquamous carcinoma]. As of 6/9/2003, this is no longer an impossible site/histology combination.

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.

 2005
20051118 CS Tumor Size--Rectum: Should the tumor size be coded to 080 from the colonoscopy size or 075 from the CT scan size? See Discussion. 6/29/04 Colonoscopy with biopsy: near obstructing circumferential friable mass extending from 8 to 16cm above anal verge. 6/30/04 CT Scan Abdomen/Pelvis: 7.5X7.2cm large rectal mass. The patient had radiation with concurrent 5-FU. Surgery is done after treatment.

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 tumor size as 080 (8cm). Code the largest pretreatment size recorded when there is preoperative systemic treatment.

 2005
20051087 CS Site Specific Factor 3--Prostate: When a prostatectomy specimen shows tumor focally penetrating through the capsule into periprostatic striated muscle tissue, is the involvement coded to 041 [periprostatic tissue] or 052 [skeletal muscle, NOS]?

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 code 052 [Levator muscle, Skeletal muscle, NOS, Ureter]. The description for this case states periprostatic "striated" muscle tissue. According to our pathologist consultant, "striated muscle in this context is skeletal muscle and the term is being used to differentiate the muscle from smooth (non-striated) muscle." Smooth muscle involvement would be most likely be coded 050 [Extension to bladder neck...] because smooth muscle in a prostatectomy or TURP specimen is usually from the urinary bladder neck.

 2005
20051034 Date Therapy Initiated/Reason no treatment--Lymphoma: Is the date of the lymph node biopsy used as the date of treatment if the lymph node biopsy is the first treatment or the only treatment performed? Is the reason for no surgery coded to 0 [Surgery of the primary site was performed]?

For cases diagnosed prior to January 1, 2008, enter the date of the lymph node biopsy (excisional biopsy or biopsy NOS) as the Date Therapy Initiated for a lymphoma when the biopsy is the first or only therapy performed.

Code Reason for No Surgery of Primary Site as 0 [Surgery of the primary site was performed] and the biopsy of a lymph node is coded to 25 in Surgery to Primary Site.

Do not code a fine needle aspiration or core needle biopsy in Surgery of Primary Site.

 2005
20051003 CS Tumor Size/CS Eval--Breast: How are these fields coded when there is a clinical size recorded but the tumor size is not specified on the pathology report associated with a subsequent resection? See Discussion. 4/8/04 excisional biopsy of 1.5 cm palpable mass. Path: gives a specimen size only and states that there is a nodular firm area that correlates with the clustered microcalcification on radiograph. No pathologic tumor size is given. Would the size be coded to the clinical size of 1.5 cm? The patient did have surgery but the only size available is a clinical one. Because the size is clinical, is the CS Eval field coded to 0 [No surgical resection done. Evaluation based on PE...]?

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.

Clinical size can be coded when the patient has had surgery. For the case above, code the tumor size as 015 [1.5 cm] using the clinical information. The CS Tumor Size/Extent Eval field refers to both tumor size and extension. In this case, record the eval field as 0 or 1 (which ever is appropriate). The tumor size sets the T category unless the resection shows skin or chest wall or dermal lymphatic involvement.

 2005
20051045 CS Lymph Nodes--Breast: Are small isolated tumor emboli occasionally found in lymph node capsular or pericapsular lymphatics sufficient to code as a lymph node metastasis?

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 "small isolated tumor emboli" in the pericapsular lymphatics detected by H&E that are less than 0.2 mm as 05 [Regional lymph node(s) with ITC's detected on routine H & E stains].

 2005
20051007 CS Tumor Size--Breast: How is this field coded for a 1.5 cm clinically palpable tumor that appeared to be a cyst with a papilloma when the partial mastectomy Path Micro stated the lesion was an "intraductal papilloma with focal noninvasive papillary carcinoma"? See Discussion. Should the size be coded to 999 [unknown] because the noninvasive papillary carcinoma is described only as "focal" and is not measured and it is not known how much of the tumor is benign and how much is in situ. Or would the size be coded to the size of the palpable mass, 1.5 cm?

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 as 999 [unknown]. Size of the focal noninvasive papillary carcinoma is not stated.

 2005
20051019 CS Lymph Nodes--Breast: How is this field to be coded if the pathologist staged the case pN1a and the lymph node is stated to be negative on H&E, is .3 cm on IHC stain for pancytokeratin but on review of smears shows no malignant cells?

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 Lymph Nodes as negative [00]. The positive stain for pancytokeratin is contradicted by the statement "malignant cells are not identified." See also sinq 20010055.

 2005