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Report Produced: 02/12/2026 16:27 PM

Report Question ID Question Discussion Answer Year
20091113 MP/H Rules/Histology--Breast: How is histology coded when a nipple biopsy shows Paget disease but the mastectomy specimen shows only infiltrating ductal carcinoma in the breast tissue and the nipple is negative for Paget disease? See Discussion. Biopsy of nipple showed Paget disease. Subsequent mastectomy showed two tumors proven to be infiltrating ductal carcinoma. Nipple is negative. Per MP/H rule M9, this is all counted as a single primary. Do we code histology from the most representative specimen and lose the information about the Paget disease? For cases diagnosed 2007 or later, code the histology 8541/3 [Paget disease and infiltrating duct carcinoma]. Paget disease of the nipple and infiltrating duct are separate tumors. For each tumor, take the histology from the most representative specimen. The biopsy is the most representative specimen for the Paget disease. The mastectomy is the most representative specimen for the infiltrating duct. According to the multiple primary rules, tumors that are Paget disease and duct are a single primary (M9). According to the histology rules, assign code 8541/3 (H26). 2009
20091106 Multiple Primaries--Urinary: How many primaries should be coded for an 8/9/07 invasive transitional cell carcinoma of right ureter; 7/9/08 non-invasive urothelial carcinoma of bladder; 11/18/08 non-invasive urothelial carcinoma of left ureter; 6/20/09 invasive urothelial carcinoma of left ureter? One primary. This is a good example of how the field effect occurs in the urinary system. From 2007 to 2008, Rule M8 says bladder and ureter tumors are not new primaries and would be documented as recurrences. Because other urinary sites are involved by 11/08 and by 06/09, do not make second primary of left ureter (Rule M4 does not apply). 2009
20091052 Multiple Primaries--Lymphoma: How many primaries should be reported when a left tonsil biopsy is diagnosed with marginal zone lymphoma (9699) and a cervical lymph node biopsy is diagnosed with marginal zone lymphoma and grade 3 follicular lymphoma (9699 and 9698)?

For cases diagnosed prior to 1/1/2010:

Abstract two primaries: The first is a marginal zone lymphoma of tonsil and the second is a follicular lymphoma of cervical lymph node. According to the Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases (the tri-fold chart), marginal zone lymphoma (9699) and follicular lymphoma (9698) are different primaries.

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.

 2009
20091121 MP/H Rules/Multiple primaries--Brain: Does a patient diagnosed with anaplastic astrocytoma of the left temporal lobe in 2000 followed by a diagnosis of oligoastrocytoma of the right frontal lobe in 2007 have a single primary per rule M7 or multiple primaries per rule M8? See Discussion. MP/H rule M7 states that tumors with ICD-O-3 histologies on the same branch in chart 1 are a single primary. Chart 1 shows that both of the histologies for our sample case are located on the glial branch. However, the glial tumor branch has three secondary branches. Does rule M7 apply to secondary branches? Anaplastic astrocytoma [9402] is classified under the secondary branch for astrocytic tumors. Oligoastrocytoma [9382] is classified under the secondary branch for mixed glioma. Does rule M7 or does rule M8 apply for this case? Does this case represent one or two primaries?

For cases diagnosed 2007 or later, Rule M8 applies. There are two primaries.

Anaplastic astrocytoma and oligoastrocytoma (mixed glioma) are on separate branches in Chart 1. They are both gliomas, but one is a mixed glioma and the other is an astrocytic tumor.

2009
20091009 MP/H Rules/Histology--Kidney: How do you code histology for a renal cell carcinoma when pathologists disagree as to whether or not the tumor is consistent with thyroid-like follicular carcinoma of the kidney? See Discussion. Final diagnosis states 'left radical nephrectomy, renal cell carcinoma.' The CAP Histologic Type is listed as: Unclassified, most consistent with primary thyroid-like follicular carcinoma of the kidney.' Because of the unusual histology it was sent for a consult to a genitourinary pathology specialist. His response was: 'histologic features not typical for any of the known subtypes of renal cell carcinoma and are not consistent with primary thyroid-like follicular carcinoma of the kidney, a distinct renal tumor that we have recently published in the literature.' The tumor was TTF-1 negative, arguing against metastasis from a thyroid primary. For cases diagnosed 2007 or later, assign code 8312 [renal cell carcinoma, NOS]. The diagnosis is renal cell carcinoma, but the specific type is in question. 2009
20091029 MP/H Rules/Histology--Melanoma: How should histology be coded for a melanoma arising in a compound nevus, NOS or a nevus, NOS?

For cases diagnosed 2007 or later, assign code 8720 [Melanoma, NOS] to melanoma arising in a nevus that does not have a specific code or to melanoma arising in a nevus, NOS.

Currently, ICD-O-3 does not have a specific classification for a melanoma arising in a compound nevus.

 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
20091027 MP/H Rules/Multiple primaries--Thyroid: How many primaries should be coded in a patient with a 4/5/08 left thyroid lobectomy diagnosis of follicular carcinoma followed by a 7/25/08 right thyroid lobectomy diagnosis of papillary carcinoma, follicular variant?

For cases diagnosed 2007 or later:

Rule M17 under Other Sites applies. These are separate primaries based on their ICD-O-3 histology codes. Follicular carcinoma is coded 8330. Papillary carcinoma, follicular variant is coded 8340. The histology codes are different at the third number. Rule M6 does not apply because these diagnoses are more than 60 days apart.

 2009
20091043

Multiple primaries--Lymphoma: Should a second primary lymphoma be accessioned if the reporting hospital disagrees with the final diagnosis stated on a review of slides? See Discussion.

Example: Patient had an original diagnosis of small lymphocytic lymphoma (9670/3) of lung in 1986 and later presents with small B-cell non-Hodgkin lymphoma (9670/3) of small bowel in 2008 at Hospital A. Slides sent for review at Hospital B where patient was also seen. Slides there read as low grade B-cell lymphoma most consistent with extranodal marginal B-cell lymphoma of mucosal associated tissue (MALT Lymphoma). Hospital A's pathology report stated that immunostains would exclude mantle cell lymphoma and MALT lymphoma and the original pathology report has not been amended to match the outside path diagnosis. Is this a second primary of MALT lymphoma (9699)?

For cases diagnosed prior to 1/1/2010:The 2008 diagnosis is not a new primary according to the Definitions of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table) using the pathology report diagnosis from the facility where the procedure was performed (Hospital A). Since Hospital A disagreed with the slide review and did not amend their diagnosis based on the slide review, do not use the slide review diagnosis in this case.

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.

 2009
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.

2009