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| Report | Question ID | Question | Discussion | Answer | Cancer Site Category | Data Item Category | Year |
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20061137 | Reportability/Grade, Differentiation: Does the term "grade 0" refer to differentiation or does its use as a modifying phrase in the final diagnosis of "grade 0 immature teratoma" impact reportability? |
Regarding the term "grade 0" for an immature teratoma, determine whether the pathologist is using that term to describe the primary tumor or its implants. The term can be used to describe both situations. An immature teratoma (IT) may have grade 0 (benign) implants. Grade 0 implants may affect the prognosis and treatment, but the primary tumor (IT) would still be malignant and therefore reportable. If grade 0 pertains to the primary tumor (as opposed to implants) it is benign, and therefore not reportable. |
N/A | N/A | 2006 | |
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20071131 | Cell indicator--Lymphoma: If the primary site for a lymphoma is stated to be the lymph nodes but there is no biopsy of a lymph node, can the immunophenotype designation for a lymphoma be coded based on a bone marrow or liver biopsy indicating "diffuse large B-cell lymphoma"? | For cases diagnosed prior to 1/1/2010: The cell indicator or immunophenotype designation for lymphomas may be coded from pathology reports on tissue from bone marrow or liver when there is no tissue from the primary site. Code information on cell type from any available source. See the Appendix C of the 2007 SEER manual, Coding Guidelines for Lymphomas, pages C-1055 to C-1056 for more information about coding this field for lymphomas. For cases diagnosed 1/1/10 and later, 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. |
Lymphoma | N/A | 2007 | |
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20160048 | Reportability--Kidney: Is renal cell neoplasm of oncocytosis reportable based on the pathology from a nephrectomy? See Discussion. |
The pathology diagnosis reads: Diagnosis Right Kidney, Laparoscopic Nephrectomy:
-Renal Cell Neoplasm of Oncocytosis (pT1a, pNX See Comment and Template).
-Surgical margins free of tumor.
Kidney, right, nephrectomy:
Tumor histologic type: Renal cell neoplasms of oncocytosis (see Note)
Sarcomatoid features (%) Not identified
Tumor size: 4 cm (greatest dimension largest tumor)
Other dimensions: 2.7 x 2.5 cm
Macroscopic extent of tumor: Limited to kidney
Focality: Multifocal
Number of tumors: 11 grossly visible, range 0.2 4 cm
Fuhrman grade: 2 of 4
Microscopic extent of tumor:
Perinephric fat invasion: Not identified
Renal sinus invasion: Not identified
Other: N/A
Renal vein involvement: Not identified
Adrenal gland present: No
Involved by tumor: N/A
Direct invasion or metastasis: N/A
Cancer at resection margin: Not identified
Location(s): N/A
Pathologic findings in nonneoplastic kidney: Multiple collections of oncocytic cells
Hilar lymph nodes present: No
Number of involved/number present: N/A
"Thank you for sending this fascinating case. In reviewing the H&E-stained slides, we recognize that multiple lesions of varying sizes are present within the specimen, some with features of oncocytoma, some with those of chromophobe RCC, and yet others with features of both. The immunohistochemical studies for CK7 performed at your institution serve to highlight this point with "mass #1" showing focal single cell staining typical of oncocytoma and "mass #2" showing a patchy and confluent staining pattern typical of chromophobe RCC. This second mass was also positive with special stain for Hales colloidal iron. As mentioned, the morphology varies somewhat in each tumor, however, every single mass is comprised of cells with eosinophilic (pink to bright red) cytopolasm. Some tumors show more tightly nested or sheet like growth, others are more tubular or microcystic. Another important feature, present on slides of renal cortex are microscopic tumorlets seemingly emanating from eosinophilic tubules. This finding, along with the presence of numerous oncocytic neoplasms is supportive of the above diagnosis. The absence of clinical features to suggest Birt-Hogg-Dube syndrome is noted. Although these tumors are not recognized in the current classification of renal tumors, we regard these neoplasms as being a distinct entity, unrelated to both oncocytoma and chromophobe renal cell carcinoma, and have applied the designation "renal tumor of oncocytosis" to such lesions (Gobbo S, et al. Renal cell neoplasms of oncocytosis have distinct morphologic, immunohistochemical, and cytogenetic profiles. Am J Surg Patholl 34:620-626, 2010). We concur that the expected behavior in these cases is one of indolence." |
Do not report Renal cell neoplasms of oncocytosis. According to our expert pathologist consultant, these neoplasms do not behave "in a malignant fashion." They are not currently classified as malignant and are not reportable to cancer registries. |
Kidney, renal pelvis | N/A | 2016 |
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20110030 | Reportability--Heme & Lymphoid Neoplasms: If and when did Langerhans cell histiocytosis (LCH) become a reportable neoplasm? See Discussion. | Per the Histiocytosis Association of America, "Over the years, cancer treatments have been used in patients with histiocytosis. Consequently, hematologists and oncologists, who treat cancer, also treat children with Langerhans cell histiocytosis. However, the disease is not cancer." | Updated May 2026 All variants of Langerhans cell histiocytosis were reportable to all agencies as 9751/3 for cases diagnosed 2010-2020.
Starting in 2021, 9751/3 is for Langerhans Cell Histiocytosis, disseminated (multifocal, multiorgan, multisystem) disease. Langerhans Cell Histiocytosis, limited to a single organ/system, or not designated as single, or multiple (includes LCH, NOS), is coded as 9751/1 and is reportable for CNS sites only.
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Heme & Lymphoid Neoplasms | N/A | 2011 |
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20150055 | Multiple primaries--Heme & Lymphoid Neoplasms: Is this 2 primaries? In 2011, a patient had a spinal mass biopsied positive for DLBCL and follicular lymphoma. The heme rules make this one primary coded as DLBCL. Patient had 2 rounds of chemo, but in 2014, he had a recurrent tumor in the same location. The 2014 biopsy was follicular lymphoma. Is this a new primary -- conversion of acute to chronic after treatment? Or is it the same, since FL was diagnosed in the original specimen? |
Rule M13 applies, abstract as two primaries. Since both DLBCL and FL were present in 2011, rule M2 does not fit -- not a single histology. Rule M13 reflects the situation in this case much better: an acute neoplasm which was treated and a chronic neoplasm diagnosed later. |
Heme & Lymphoid Neoplasms | N/A | 2015 | |
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20150061 | Reportability--Vulva: Is this reportable? We have begun to see the following diagnosis on biopsies of the vulva with the statement below. The diagnosis is being given as simply VULVAR INTRAEPITHELIAL NEOPLASIA, no grade is noted. See discussion. |
The note explains: The International Society for the Study of Vulvovaginal Disease (ISSVD) in 2004 revised its classification of VIN by eliminating VIN 1 and combining VIN 2 and VIN 3 into a single category (see table below). Classification of VIN (usual type) ISSVD [International Society for the Study of Vulvovaginal Disease]1986 classification 2004 classification VIN 1 VIN2 VIN3 VIN Note: VIN 2 and VIN 3 combined into single [non-graded] category, VIN Reference: Scurry J and Wilkinson EJ. Review of terminology of precursors of vulvar squamous cell carcinoma. Journal of lower genital tract disease, 2006; 10(3): 161-169 |
Vulvar intraepithelial neoplasia with no grade specified is not reportable. Reportability instructions have not changed. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf |
N/A | N/A | 2015 |
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20120061 | MP/H Rules/Multiple Primaries--Ovary: How many primaries are accessioned and which multiple primary rule applies for a patient diagnosed with a carcinosarcoma of the left ovary and a serous carcinoma of the right ovary? See Discussion. |
The patient underwent a debulking surgery showing a 20.5 cm carcinosarcoma with focal areas of high grade serous carcinoma and extensive high grade stromal sarcoma in the left ovary. The right ovary showed only a high grade serous carcinoma with extensive involvement of the ovarian parenchyma but no sarcomatous elements. While carcinosarcoma is composed of both epithelial and non-epithelial elements, does the presence of a purely epithelial tumor in the contralateral ovary indicate these are separate primaries per rule M8? |
For cases diagnosed 2007 or later, accession two primaries, carcinosarcoma [8980/3] of the left ovary and serous carcinoma [8441/3] of the right ovary. The steps used to arrive at this decision are: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). After determining the histology of each tumor (8980/3 and 8441/3), go to the Other Sites MP rules because ovary does not have site specific rules developed Start at the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within a module. Stop at the first rule that applies to the case you are processing. Review Table 1 (Paired Organs and Sites with Laterality) to determine whether ovary is a paired site. To locate Table 1, go to Other Site under the Terms & Definitions section of the manual. Ovary is listed as a paired site. Accession multiple primaries when there are tumors on both sides (right and left) of a site listed in Table 1 (Paired Organs and Sites with Laterality). Carcinosarcoma [8980/3] is not an epithelial tumor of the ovary within the range of 8000-8799 and, therefore, Rule M7 does not apply. |
Ovary | N/A | 2012 |
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20031211 | EOD-Extension--Thyroid: Is this field coded as involvement of the thyroid capsule if the thyroidectomy path specimen reveals papillary thyroid ca "tumor present within capsular blood vessels?" |
For cases diagnosed 1998-2003: Tumor present within the blood vessels of the thyroid capsule is localized (extension code 30). The tumor has not penetrated the capsule itself if it is contained within the blood vessels. Keep in mind that tumor size determines the extent of disease for thyroid extension codes 10, 20, 30 and 40. |
Thyroid | N/A | 2003 | |
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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. |
Lung | N/A | 2009 |
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20160010 | Grade--Head & Neck: How should grade be coded for a tonsillar primary (or other solid tumor) with resection pathology final diagnosis of poorly differentiated SCC with histologic grade: G2-3 of 3. See discussion. |
We are seeing multiple head and neck cases with unclear or multiple grade assignments. Another example is alveolar mucosa SCC with histologic grade stated as: Moderately differentiated (G2 of 3). Grade Coding for Solid Tumor instruction 5.b. is not clear regarding this situation. Does a statement of differentiation take priority? Should we disregard the differentiation statement and code using the 3-grade systems? |
Use the three-grade system table in instruction #7.b to code grade for the situations you describe. Use the Grade Coding Instructions in order. Instruction #7.b (three-grade system) comes before instruction #8 (terminology).
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Head & Neck | N/A | 2016 |
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