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Report Produced: 02/17/2026 00:42 AM

Report Question ID Question Discussion Answer Year
20091119

MP/H Rules/Multiple primaries--Lung: How many primaries are to be reported for an adenocarcinoma of the lung in the right middle lobe of the lung and bronchioalveolar carcinoma, non-mucinous type in the right upper lobe? See Discussion.

Bilobectomy revealed two tumors, adenocarcinoma in the right middle lobe and bronchioalveoar carcinoma non-mucinous type in the right upper lobe. MP/H rule M10 states that tumors with non-small cell carcinoma (8046) and a more specific non-small cell type (chart 1) are a single primary. Does rule M10 apply to only those cases for which one tumor is stated to be non-small cell, NOS? Or do we use chart 1 to identify specific subtypes? For this case, using chart 1, would we note that bronchioalveolar is a subtype of adenocarcinoma and count this case as a single primary? Most of the MP/H rules schemas have a rule making an adenocarcinoma and a more specific type of adenocarcinoma a single primary. Would we apply rule M10 to this case and count it as a single primary? Or would we move on to rule M11 and count the case as two primaries?

For cases diagnosed 2007 or later, Rule M11 applies. Accession two primaries.

Rule M10 applies only to cases for which one tumor is stated to be "non-small cell carcinoma."

 2009
20091037 MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle?

For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].

According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.

 2009
20091030 MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10?

For cases diagnosed 2007 or later:

The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.

Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.

For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites.

 2009
20091040 MP/H Rules/Histology--Breast: How is histology coded for an "infiltrating papillary carcinoma" of the breast when there is no mention of ductal or adenocarcinoma in the pathology report?

For cases diagnosed 2007 or later, assign histology code 8503 [Papillary adenocarcinoma]. Rule H14 applies.

ICD-O-3 code 8050 does not apply in this case. Refer to the numeric listing in ICD-O-3. 8050 is a squamous cell neoplasm. Papillary carcinoma of the breast is NOT a squamous cell neoplasm. It is a neoplasm of the breast parenchyma - ducts, lobules or connective tissue. 8503 is the correct code in this case.

 2009
20091021

Behavior/Reportability--All sites: Would a GIST tumor stated to be "high risk for malignant behavior" be a reportable GIST? See Discussion.

According to our pathologist and oncologist, the terms "malignant" and "benign" do not apply to GIST. Rather, the term "high risk for malignant behavior" is used. This is based on tumor size: greater than 5 cm and mitotic activity: greater than 5 mitoses/50 hpf.

Do not report the case to SEER if it does not satisfy the criteria for reportability. According to the current reportability criteria, malignant GIST (8936/3) is reportable to SEER. GIST coded to 8936/0 or 8936/1 is not reportable. If your pathologist will not indicate "malignant" or "benign," code 8936/1 applies according to ICD-O-3 and, therefore, these are not reportable to SEER.

 2009
20091101 CS Reg LN Pos/Exam--Melanoma: How should these fields be coded for a case that is an unknown primary site melanoma with liver involvement and a positive axillary lymph node?

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 regional lymph nodes positive 01 [one positive lymph node] and regional lymph nodes examined 01 [one lymph node examined] (assuming the positive node was the only node examined).

If the only lymph node involvement is the positive axillary lymph node, it is reasonable to conclude that this is a regional lymph node. When only one chain of lymph nodes is involved with metastatic melanoma, the metastatic cells had to come from skin with direct drainage to those lymph nodes.

 2009
20091055 Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008.

For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.

2009
20091120

MP/H Rules/Histology--Esophagus: Should the modifying expression "with areas of" be used to code histology? See Discussion.

Patient was found to have two tumors in the esophagus. The large tumor was diagnosed as adenocarcinoma with areas of neuroendocrine differentiation (small cell carcinoma). The smaller tumor was diagnosed as small cell carcinoma. If we accept the "areas of" to be part of the diagnosis, rule H16 indicates that histology for the large tumor would be coded 8045 (combined small cell and adenocarcinoma). If we ignore the "areas of," then histology for the large tumor would be coded to 8140 (adenocarcinoma). Either way, when counting primaries, rule M17 would be applied and the two tumors would be classified as separate primaries. However, it seems that the two tumors are probably the same disease process since they both show small cell carcinoma.

For cases diagnosed 2007 or later, do not use the modifying expression "with areas of" to determine a more specific histology per rule H13 in the MP/H rules.

 2009
20091073 Grade: Can FIGO grade be used to code Grade/Differentiation? See Discussion. SINQ 20020059 says not to use FIGO grade to code differentiation. It also says SEER is evaluating whether the ICD-O-3 sixth digit differentiation codes accurately represent the FIGO grade. For the time being, do not code FIGO grade. What is the result of the evaluation? Any new information regarding FIGO grade?

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.Do not code FIGO grade in the grade field. The conversion from a three-grade system to a four-grade system does not work for FIGO grade three. Since FIGO G3 includes both Poorly differentiated and undifferentiated, it cannot be converted.

FIGO grade may be captured in a CS site specific factor in the future.

 2009
20091028

MP/H Rules/Multiple primaries/Cancer-directed treatment--Lung: Is a 2008 occurrence of non-small cell carcinoma in the left lower lobe following a 1998 occurrence of the same histology in the left lung to be counted as a new primary if the 1998 primary was treated with chemotherapy and/or radiation but not surgery? See Discussion.

1998 diagnosis on non-small cell carcinoma treated with radiation and chemotherapy. In 2008, there is an abnormality in the LLL with brushings/washings positive for non-small cell carcinoma.

According to the MP/H rules, M8 states this would be a new primary. However, in the document titled " Quality Improvement Meeting August 2008," found on the SEER website, it stated that because the patient never had surgery for the initial primary there is no evidence that the patient was ever disease free. Therefore, the occurrence of the latter tumor would not be a new primary (p. 7, "colon"). Does this answer pertain only to surgery or does it apply to any type of treatment?

For cases diagnosed 2007 or later, the 2007 MP/H rules apply if the 2008 diagnosis is a new tumor. Was there any statement that the patient was free of disease (NED) after the chemo and radiation therapy? (A patient can be disease free without surgery). If there is no statement to the contrary, no mention of metastasis from the 1998 diagnosis, and no mention of disease between 1998 and 2008, follow lung rule M8 and abstract the 2008 diagnosis as a new primary.

This lung case differs from the colon case discussed in the document titled "Quality Improvement Meeting August 2008." For the colon case, there was disease in 2003, 2005 and 2007. Based on the information provided, the 2007 diagnosis was not a new tumor because the patient was never free of disease. Therefore, the 2007 diagnosis is not a new primary. The number of reportable primaries was based on disease status over time, and was not based on the type of treatment given for the initial tumor (i.e., surgery or any other treatment modality).

 2009