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Report Produced: 03/04/2026 04:11 AM

Report Question ID Question Discussion Answer Year
20091049 P/H Rules/Multiple Primaries--Lung/Breast: Can we assume that a current tissue specimen is a recurrence of previous primary if a pathologist states that he has compared the current specimen with the slides from the prior tumor and concludes that the current tumor is "similar" to a previous tumor? See Discussion.

The MP/H rule general information section states that we do not accession a second primary unless a pathologist compares the current tumor to the original tumor and states that the current tumor is a recurrence of cancer from the previous primary. In our experience it is rare that a pathologist speaks so bluntly. They frequently hedge somewhat.

Are the following statements worded strongly enough for us to make the assumption that the current tumor is a recurrence of patient's previous cancer?

Example 1: Pathologist states: Patient's prior lung tumor reviewed. The tumor in the current case (left lower lobe) shows similarities to some areas of the patient's prior left lower lobe tumor.

Example 2: Pathologist states: The focus of ductal carcinoma in the mastectomy specimen does resemble the carcinoma in the previous partial mastectomy specimen. (Slides reviewed).

All pathologists do not use words in the same way. Therefore, we will not provide a list of specific words to accept or not to accept in order to determine recurrence. For cases diagnosed 2007 or later, do not base your decision about recurrence on words such as "similar" or "resembles." If the pathologist believes two or more tumors are the same or believes one is a recurrence of another after comparison, accept it. When pathologists believe that two or more tumors are not the same or believe that one is not a recurrence of another, there is usually a strong statement indicating that opinion. 2009
20091046 CS Lymph Nodes/CS Site Specific Factor--Melanoma: When CS Lymph Nodes is coded 13, 14 or 15 (codes used when satellite nodule(s) or in-transit metastases are present), why must CS SSF 3 be coded 000 (No lymph node metastasis)? See Discussion.

3/11/05 Consult - PE: huge exophytic lesion right lower leg (mushroom-type lesion), 6cm. Below that lesion is another ulcerative lesion 2cm. Right upper arm lesion w/ satellite nodule. Note from physician states malignant melanoma on right lower leg metastatic to the left arm/shoulder. No scans done so there is no assessment of the lymph nodes.

We coded CS LNS to 13, which captures the satellite nodule, CS SSF3 = 999 and CS Reg Nodes Eval = 0. SEER Edit 216 requires the SSF3 to be 000. SSF 3 is coded 999 as there is no information about the clinical status of lymph nodes.

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.When CS lymph nodes is coded 13-15, SSF 3 must be coded 000. Follow the instruction in the SSF 3 Note: Use code 000, No lymph node metastases, if ... there are satellite nodules or in-transit metastases, but no regional lymph node metastases, i.e., CS Lymph Nodes is coded 13-15.

For this case, assign CS lymph node code 15 [Satellite nodule(s) or in-transit metastases greater than 2cm from primary tumor WITHOUT regional lymph node involvement or involvement of regional nodes not stated]. The arm lesion is more than 2cm from the leg lesion.

 2009
20091107

CS Extension--Lymphoma: Does peripheral blood involvement affect the stage for lymphoma? See Discussion.

2009 Diagnostic Year

Lymph node bx is positive for Mantle Cell lymphoma. Flow cytometry on lymph node tissue shows CD+ pos B cell lymphoproliferative disorder. IHC findings support Mantle Cell lymphoma. Flow cytometry on peripheral blood shows CD+ B cell lymphoproliferative disorder. Because the lymph node is positive for Mantle Cell lymphoma and the flow cytometry findings are the same on the lymph node tissue and peripheral blood, is the peripheral blood involved (Stage IV disease)?

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. Peripheral blood is not the same as bone marrow involvement which is what would be required for stage IV.

Lymphomas can arise in lymph nodes which are connected by lymphatic vessels. Both lymphatic vessels and blood vessels travel through lymph nodes and malignant cells can travel between the vessels. Cells in peripheral blood do not prove Stage IV.

 2009
20091047 MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"? For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored. 2009
20091130

MP/H Rules/Histology--Breast: What is the correct histology code and MP/H rule used for 1) infiltrating ductal carcinoma, mucinous type and 2) infiltrating ductal carcinoma with features of tubular carcinoma? See Discussion.

There is confusion as to which rule applies. Should the histologies be coded to 8480/3 [mucinous adenocarcinoma] and 8211/3 [tubular adenocarcinoma] respectively per rule H12? Rule H12 states to code the most specific histologic term; "type" and "with features of" are used in the pathologic diagnosis and are both terms that can be used to code the specific histology. Or would the histology be coded 8523 for both examples per rule H17 because neither histologic codes 8480/3 or 8211/3 are included as examples of duct carcinomas, nor are they included in Table 2?

For cases diagnosed 2007 or later, code 8523 [infiltrating duct mixed with other types of carcinoma] for

1. Infiltrating ductal carcinoma, mucinous type and

2. Infiltrating ductal carcinoma with features of tubular carcinoma

The infiltrating ductal types in Rule H12 are listed (8022, 8035, 8501-8508) and do not include mucinous or tubular. We cannot use this rule. The first rule that applies to these single tumors is H17, code to 8523. If you look up 8523 in the numerical morphology section of ICD-O-3, you will see similar examples included in the definition of this code.

2009
20091014

MP/H Rules/Histology--Melanoma: Please clarify what we should code when we see the term 'spitz or spitzoid' in association with melanomas. See Discussion.

Path reports often diagnose "melanoma with spitzoid features." There is no code for this in ICD-O-3. Would it be melanoma NOS with a specific type for MP/H rule H9 (with features of...), or would we stop at H3? Could the matrix principle apply, changing 8770/0 (one of the synonyms is Spitz nevus) to 8770/3 (although no Spitz synonyms are specifically listed under this code)? What if the path report says "melanoma arising in a Spitz nevus"?

For cases diagnosed 2007 - 2020

Assign code 8720/3 [Malignant melanoma] for melanoma with Spitzoid features, Spitzoid variant of nevoid melanoma, melanoma arising in Spitz nevus, or Spitzoid melanoma. The WHO Classification of Tumors groups these with Nevoid melanomas and codes them to 8720/3.

According to WHO, "Nevoid melanoma is a subtype of malignant melanoma of the skin that is distinctive in that the primary lesion mimics many of the architectural features of a common compound or intradermal nevus ... or a Spitz nevus... These lesions are defined not as atypical nevi, but as melanomas because they involve the dermis and have the potential for metastasis."

 2009
20091056 MP/H Rules/Histology--Ovary: How is histology coded for an ovarian tumor diagnosed as an "ovarian clear cell cystadenocarcinoma"? See Discussion. Final diagnosis for a resected ovary is ovarian clear cell cystadenocarcinoma. In applying the MP/H rules, rule H16 does not apply because cystadenocarcinoma is not included in Table 2. As a result rule H17 applies. Thus it appears the histology should be coded 8440. Cystadenocarcinoma is a specific histologic type and it is assigned the numerically higher histology code. This result differs from pre-2007 SINQ entry 20041045 that states: Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies.

For cases diagnosed 2007 or later:

Assign code 8310 [Clear cell adenocarcinoma] according to rule H13. Ignore "cyst" when determining the histologic type for ovarian malignancies. For this case, the only histology is clear cell.

The histologies for the common ovarian epithelial malignancies are serous, mucinous, endometrioid, clear cell, and transitional cell/Brenner. This clarification will be added to the rules in the next revision.

2009
20091018 MP/H Rules/Multiple Primaries/CS Extension: How many primaries are to be accessioned when tumors are present bilaterally in the pleura and fallopian tubes? See Discussion.

For both pleura and fallopian tube, the MP/H rules indicate that bilateral involvement of these sites should be coded as multiple primaries. However, both of these sites have CS extension codes that classify the contralateral disease as regional extension.

Is a case described as a left sided pleural mesothelioma that has right sided pleural disease coded as one or two primaries? How is CS coded?

For cases diagnosed 2007 or later:

For a pleural or fallopian tube primary, if there is tumor(s) on the left and separate tumor(s) on the right and neither is stated to be metastatic from the other, abstract as multiple primaries according to rule M8 for other sites. If both sides are involved, but there is only one tumor, rule M2 for other sites applies and this is a single primary. Code each primary separately in CS.

 2009
20081007 CS Extension--Lung: How is "subpleural extension" coded?

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.Subpleural extension means that the tumor extends to the subpleural space, but the pleura itself is not involved. Assign the appropriate extension code based on the other facts for the case. Do not code pleural involvement.

 2008
20081112 MP/H Rules--Breast: Is a 2008 invasive ductal carcinoma counted as a new primary when it follows a 2005 invasive lobular carcinoma diagnosed in the same breast? See Discussion. The patient has invasive lobular breast carcinoma excised in 2005. She returns in 2008 with a new invasive ductal carcinoma tumor same breast. Following MP/H rules, M10 seems to apply, which states this is still a single primary. Does this mean that this invasive ductal carcinoma is ignored and the patient remains in the registry with only a lobular carcinoma primary?

For cases diagnosed 2007 or later:

Rule M10 applies. The 2008 diagnosis is not a new primary.

The abstract for the 2005 diagnosis should be annotated to include the new information.

 2008