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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20021115 | EOD-Lymph Nodes--Testis: In coding lymph node involvement for a testicular primary, should we use code 5 (Size not stated) when there is not a pathologic size of the lymph node provided? See discussion. | Should Note 1 in the testis EOD be changed to "Metastases in lymph nodes are now measured by the size of the lymph node as stated in pathology report"? The SEER EOD-88, 3rd Edition, states that "when size of regional lymph nodes is required, code from the pathology report." | For cases diagnosed 1998-2003:
For testis cases only, "metastasis in lymph nodes" is measured by the size of the lymph node or the lymph node mass. It is acceptable to code the size of this metastasis from a CT scan or other imaging when a pathology specimen is not available for testicular primaries. |
N/A | N/A | 2002 |
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20091128 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a patient was diagnosed with breast carcinoma in 2001 and was subsequently diagnosed with a mammary carcinoma in a chest wall mass in 2008? See Discussion. |
Patient was diagnosed with invasive lobular carcinoma of the right breast in April 2001. Following modified radical mastectomy in May 2001, the patient was disease free. In December 2008 the patient was diagnosed with a right chest wall mass, invasive poorly differentiated mammary carcinoma with lobular origin. If this is a new primary in 2008, would we code the primary site to breast or chest wall? Please see I&R answers 25924, 22163 and 26155 with similar case scenarios that give two different answers. One response indicates coding this type of scenario as new primary to chest wall and the other two responses indicate this should not be a new primary because the chest wall is a metastatic site. The pathology report does not state that this is metastatic and it is unknown if there is breast tissue left behind at the chest wall. |
For cases diagnosed 2007 or later, this case is a single primary. The chest wall (NOS) is a metastatic site for breast cancer. There is no mention of residual breast tissue, so the 2008 diagnosis cannot be a new primary. "Chest wall" is an ambiguous term. It can mean the internal chest wall or the external chest wall. When the path report states that the "recurrence" is in residual breast tissue, this is most likely the external chest wall and the residual breast tissue is part of the breast not removed by the MRM. In contrast, skin or the chest wall, NOS, are regional metastases. |
Breast | N/A | 2009 |
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20000512 | EOD-Extension/EOD-Lymph Nodes--Kaposi Sarcoma: What code is used to represent this field for a Kaposi sarcoma with no skin lesions but positive lymph node and bone marrow biopsies? | Code the EOD-Extension field to 13 [Visceral (e.g., pulmonary, gastrointestinal tract, spleen, other)], because of the positive bone marrow. Code the EOD-Lymph Nodes field to 3 [Both clinically enlarged palpable lymph nodes (adenopathy) and pathologically positive lymph nodes], for the pathologically positive node.
Note: Potential revision of the extension scheme will be referred to SEER Medical Advisory Group (SMAG). |
Sarcoma | N/A | 2000 | |
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20000437 | EOD-Extension--Lymphoma: Should "bilateral" inguinal lymph node involvement by lymphoma be two chains for the purpose of coding EOD? |
Yes. Bilateral inguinal lymph nodes are coded as two chains/regions. |
Lymphoma | N/A | 2000 | |
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20210053 | Reportability/Heme & Lymphoid Neoplasms: Is ALK positive (ALK+) histiocytosis involving the bone marrow and kidney reportable? See Discussion. |
2021 Bone marrow biopsy showed erythroid hyperplasia, increased histiocytes with hemophagocytosis and Factor XIIIa positive histocytic cells. Moderate cytoplasmic staining for ALK 1, consistent with bone marrow involvement of ALK-positive histiocytosis. A subsequent kidney lesion biopsy was also found to have ALK-positive histiocytosis. The patient was then treated with clofarabine. Patient is 3 years old. 07/2020-Chart indicates patient presented in June with fevers and refusing to walk with pancytopenia, bone marrow biopsy showed no leukemia buthistiocytes. Impression: ALK positive histiocytosis involving BM and kidney. 10/2020 Bone marrow final diagnosis states right and left bone marrow aspirates and biopsies: No morphologic or immunohistochemical evidence of involvement by the patient's previously diagnosed ALK+ histiocytosis (see Comments) - Multiple histiocytic collections with prominent hemosiderin; favor reactive - background normocellular bone marrow with maturing trilineage hematopoiesis. The patient's prior bone marrow samples are reviewed (9/2020 and 7/2020). Similar to the September bone marrow sample, the current marrow shows numerous histiocyte collections with abundant associated hemosiderin deposition. These histiocytes have a stellate/dendritic appearance and lack the atypical features noted in the patient's marrow at diagnosis, favoring a reactive process. This impression is further supported by the lack of immunoreactivity for either Factor XIIIa or ALK1 among these cells. There is no convincing morphologic or immunohistochemical evidence of marrow involvement by the patient's previously diagnosed ALK+ histiocytosis within the sampled material. Of note, the marrow otherwise appears normocellular for the patient's age, indicative of ongoing marrow recovery post therapy. It is not clear whether this would be equivalent to Langerhans cell histiocytosis, disseminated (9751/3) as there is not a statement of Langerhans cell or whether this is just histiocytosis, NOS and not reportable. |
Updated May 2026 Do not report this case of histiocytosis. Based on the information provided, this case is not reportable. For cases diagnosed 2026+, this is reportable as 9750/3. See the Hematopoietic Database. |
Heme & Lymphoid Neoplasms | N/A | 2021 |
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20130106 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a 2009 diagnosed Hodgkin lymphoma, nodular sclerosis type is treated and subsequently presents in 2010 with the same diagnosis? See Discussion. | 2009 diagnosis of Hodgkin lymphoma, nodular sclerosis type involved the superior mediastinal nodes, AP window nodes, bilateral axillary nodes and pulmonary nodules. The patient received chemotherapy and went into remission.
Patient presents in 2010 with Hodgkin lymphoma, nodular sclerosing type in the superior mediastinum.
Does timing play any part in determining if this reported as one or two primaries? There is no timing rule in the Heme Manual. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Accession a single primary, Hodgkin lymphoma, nodular sclerosis type [9663/3] diagnosed in 2009 per Rule M2.
Accession a single primary when there is a single histology. Note 2 for Rule M2 indicates timing is not relevant. This is disease progression or recurrence and not a new primary.
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. |
Heme & Lymphoid Neoplasms | N/A | 2013 |
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20000485 | EOD-Extension--Lung: Should the phrase "some pleural fluid in both posterior gutters" be interpreted as pleural effusion for lung primaries? See discussion. | CT scan: "3 cm mass left upper lobe of lung. Some pleural fluid in both posterior gutters. Large matted hilar lymph nodes, left. Some narrowing left upper bronchus by this adenopathy. Squamous cell ca lung with mets to left hilar lymph nodes, most likely possibility." Would you code extension to 72 [malignant pleural effusion; pleural effusion, NOS]? | For cases diagnosed 1998-2003:
Yes. Code the EOD-Extension field to 72 [malignant pleural effusion, pleural effusion, NOS]. Pleural effusion is mentioned as being present. |
Lung | N/A | 2000 |
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20110145 | MP/H Rules/Recurrence--Skin: If a pathologist does not review the August 2008 slides, how many primaries are accessioned for a patient diagnosed and treated for a dermatofibrosarcoma protuberans of the left upper inner arm in August 2008 who subsequently had a "recurrence" noted in October 2010 located in the scar of the original primary? | Abstract as a single primary: dermatofibrosarcoma protuberans [8832/3] of the left upper inner arm [C446] diagnosed in August 2008.
The rationale for this answer was provided by subject matter experts. The physician specialists for soft tissue and bone replied as follows:
Low-grade sarcomas tend to recur locally. Because this tumor recurred in same area, i.e. scar of prior surgery, and recurred in this period of time, this is a local recurrence. Dermatofibrosarcoma Protuberans is a low grade tumor which can recur many years following tumor excision. |
Skin | N/A | 2011 | |
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20081101 | MP/H Rules/Multiple primaries--Lung: If a 1.7 cm LUL lung tumor is not treated surgically, would a 2.1 cm tumor in the same lobe three years later be a new primary? See Discussion. |
In 2004 the patient has a 1.7cm squamous cell carcinoma diagnosed in the LUL of the lung treated with radiation and chemotherapy. In 2007, the patient was diagnosed with a 2.1cm squamous cell carcinoma in the LUL treated with radiation. According to the lung MP/H rules, the 2007 tumor would be a new primary. Given that there was no surgery, would the second tumor be progression of disease or would it be a new primary? |
For cases diagnosed 2007 or later: If the tumor diagnosed in 2004 was successfully treated and disappeared, apply the MP/H rules for lung. According to rule M8, the 2004 tumor and the 2007 tumor are multiple primaries. If there was no disease-free interval between tumor occurrences, that is, if the 2007 tumor is still the same tumor that was diagnosed in 2004, the MP/H rules do not apply. |
Lung | N/A | 2008 |
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20081110 | MP/H Rules--Breast: Is a ductal carcinoma diagnosed in August, 2008 following a lobular-ductal primary diagnosed in February 2007 a new primary? See Discussion. |
Patient has two right breast tumors excised in February, 2007. One is lobular and the other ductal - abstracted as single primary per rule M10. Patient presents with new right breast tumor in August, 2008. This is a ductal carcinoma stated to be a recurrence. Would we again stop at M10 (single primary) or continue on to M12 and make this a new primary (difference at third number)? |
For cases diagnosed 2007 or later: Stop at rule M10 -- this is the first rule that applies. The 2008 diagnosis is not a new primary. |
Breast | N/A | 2008 |
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