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Report Produced: 09/13/2025 05:16 AM

Report Question ID Question Discussion Answer Year
20041064 CS Tumor Size/CS Extension/CS TS/Ext-Eval--Breast: How do you code these fields when the tumor size and extension differ pre and post treatment with neoadjuvant Arimidex? See Discussion. Clinically on PE 3 cm mass attached to skin with dimpling and erythema overlying the mass. Ultrasound: 2-3 cm breast mass with overlying skin thickened by US evaluation, suggesting dermal invasion. Neoadjuvant Arimidex followed by MRM. Path: 4.5 cm ductal carcinoma (no DCIS), no invasion of skin.

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.Record the larger tumor size and the farthest extension documented.

Code CS Tumor Size/Extension Evaluation to 6 [Surgical resection performed, WITH pre-surgical systemic treatment...; tumor size/extension based on pathologic evidence].

Code CS Tumor Size for the example to 045 [4.5 cm].

Code CS Extension to 20 [Local skin involvement ...] based on clinical description provided.

 2004
20041054 CS Extension--Prostate: For a tumor that is clinically inapparent, but a biopsy from the prostatic apex is positive, is this field coded to 15 [Tumor identified by needle biopsy, e.g., for elevated PSA (clinically inapparent)]?

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.

Yes. Code CS Extension-Clinical Extension to 15 [Tumor identified by needle biopsy, e.g., for elevated PSA (clinically inapparent)] for clinically inapparent prostate cancer with positive apex biopsy.

 2004
20041069

Reportability--Brain and CNS: Is a meningioma invading the bone malignant and, therefore, SEER reportable if diagnosed prior to 2004? See Discussion.

1. Meningothelial meningioma with prominent nuclear pleomorphism, infiltration into dura, calvarium, temporalis skeletal muscle.

Microscopic: Multifocal infiltration by meningothelial tumor...extensive infiltration of trabecular spaces, extension through inner and outer calvarial layers by meningioma...mitotic activity in tumor noted but below the 4 per 10 high power field threshold for diagnosis of atypical meningioma.

2. Aggressive (invasive) transitional type meningioma, neuroimaging and histology imply extensive invasive meningioma involving bone and paraspinal soft tissues. Microscopy:...invaded bone...focal EMA positivity diagnostic of invasive transitional type meningioma... tumor invades bone.

The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant."

The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal.

 2004
20041076 CS Extension--Colon: What is the difference between codes 46 [Adherent to other organs or structures, but no microscopic tumor found in adhesion(s)] and 57 [Adherent to other organs or structures, NOS]? See Discussion.

Code 46 reads "Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)".

Would these examples be coded to 46?

Example 1: 7/04 Op findings: mass was adherent to duodenum without obvious invasion. Path: margins negative (no mention of duodenum). Case staged to pT3.

Example 2: Op findings: large mass involving cecum adherent to peritoneum & retroperitoneum. Path: invasion of pericolic soft tissue; margins negative (no metion of peritoneum & retroperitoneum). Case staged to pT3.

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 46: Attached to other organ (on imaging or surgical observation); pathology says no invasion of the other organ. Code 57: Attached to other organ; pathology is positive for invasion of other organ, or pathology does not specify whether there is invasion of the other organ.

Example 1: Code extension to 46 [Adherent to other organs or sturcture, but no microscopic tumor found in adhesion(s)]. The tumor was attached to the duodenum, but not invading

Example 2: Code extension to 46 [Adherent to other organs or structure, but no microscopic tumor found in adhesion(s)]. The tumor was attached to peritoneum & retroperitoneum, but not invading based on negative margins and no peritoneum or retroperitoneum specimen submitted to pathologist.

 2004
20041050 Surgery of Primary Site--Rectum: How do you code a procedure described as a "transanal resection, debulking of a large rectal mass"? See Discussion. Patient is not a surgical candidate due to "other medical conditions". Colonoscopy done for anemia and rectal bleeding. At the colonoscopy a "Transanal Resection Debulking of large rectal mass" is performed. Two specimens are sent to the lab. The first is labeled "rectal mass" and is a 2.0 cm diameter spherical fragment of tissue. The second is labeled "transanal debulking rectal mass" and is described as multiple, irregular shaped fragments of tan, rubbery tissue measuring 5.0 x 5.0 x 3.0 cm. Final path diagnosis: Debulking of rectal mass: Adenocarcinoma greater than 2 cm in size, resection margins positive for tumor. For cases diagnosed 1998-2002, code Surgery of Primary Site to 20 [Local tumor excision, NOS]. Because the procedure was performed via colonoscopy and apparently did not involve proctectomy, the best choice is a local excision. 2004
20041038 Reportability--Bladder: Is "low grade papillary urothelial neoplasm with no evidence of invasion" reportable to SEER? "Neoplasm" means "new growth," not malignancy. A low grade papillary urothelial NEOPLASM with no evidence of invasion [8130/1] is not reportable to SEER. However, a low grade papillary urothelial CARCINOMA with no evidence of invasion [8130/2] is reportable. 2004
20041047 Multiple primaries (Pre-2007)/EOD-Extension--Fallopian Tube: How many primaries are coded when endometrioid adenocarcinoma involves bilateral fallopian tubes? See Discussion. The pathologist states "because of the intimate association with the luminal line of the fallopian tube it is felt that this represents synchronous primaries rather than mets." The SEER Code Manual only lists ovary, retinoblastomas, and Wilms Tumors under the bilateral code stated to be a single primary.

For tumors diagnosed prior to 2007:

Complete two abstracts, one for left fallopian tube and one for right fallopian tube. This case has been determined to be two primaries by the pathologist. Bilateral involvement of paired sites (other than ovary, retinoblastoma and Wilms tumor) with the same histology within two months requires a determination of whether there are one or two primaries. The pathologist in the case above has made this determination.

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.

 2004
20041036

Surgery of Primary Site/Surgery codes, NOS--Colon: What tissue specimens are included under this field's code 41 [Subtotal colectomy/hemicolectomy plus resection of contiguous organ; example: small bowel, bladder]? See Discussion.

How is site specific surgery coded for the following two cases?

Example 1. A right hemicolectomy normally includes a portion of ileum.

Example 2. Subtotal colectomy with bilateral oophorectomy.

Code 40 includes a right hemicolectomy. A right hemicolectomy normally includes a small portion of the terminal ileum removed with the ileocecal valve. Assign code 41 when resection of CONTIGUOUS organs goes beyond what would normally be removed as part of a subtotal colectomy/hemicolectomy. Record non-contiguous organ resection in Surgical Procedure of Other Site.

Example 1: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy].

Example 2: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy]. Surgical Procedure of Other Site -- 2 [Non-primary surgical procedure to other regional sites].

Addendum July 2021

For coding Surgical Procedure of Other Site, see the instructions for determining regional vs distant sites in the 2021 SEER manual under Coding Instructions #6 and #7 on pages 184-185. Do not use Summary Stage to determine regional vs distant for this data item.

 2004
20041091 Primary Site/Summary Stage 2000/EOD-Extension--Lymphoma: How are these fields coded when a CT Impression states: Large retroperitoneal/abdominal mass resulting in extra-hepatic biliary obstruction & bilateral urinary tract obstruction & encasement of major vessels most c/w lymphoma? See Discussion.

CT findings state: Very lg sft tiss mass encasing pancreatic head & portion of body, splenic & portal veins, celiac axis, sup mesenteric artery & bilateral renal veins. Two components to this mass: 1) retroperitoneal mass encasing great vessels and 2) peritoneal component 10.8cm size, displaces bowel & other structures & encases vessels.

If the physician stated "this is bulky disease" would that change the EOD?

For tumors diagnosed 1998-2003:

Based on the information provided:

The topography code for this lymphoma is C772 [Intra-abdominal lymph nodes].

Code SEER Summary Stage 2000 to 5 [Regional NOS].

Code EOD Extension to 20. More than one lymph node region below the diaphragm is involved (retroperitoneal and peritoneal). The organs mentioned are not involved by the lymphoma. The bulk of the masses is causing obstruction by displacing and/or encasing organs.

A physician description of "bulky disease" would not change the EOD for this case.

 2004
20041042 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Kidney: How many primaries, with what histology(ies) should be coded when nephrectomy pathology specimen shows separate tumors of "renal cell carcinoma [clear cell type]" and "renal cell carcinoma [granular cell type]"?

For tumors diagnosed prior to 2007:

Abstract two primaries. This is an example of two tumors with different histologic types in the same site. The right kidney has two separate tumors.

8310/3 [renal cell carcinoma (clear cell type)]

8320/3 [renal cell carcinoma (granular cell type)]

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.

 2004