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Report Produced: 06/15/2025 19:47 PM

Report Question ID Question Discussion Answer Year
20091001 CS Lymph Nodes/CS Mets at DX--Ovary: Are lymph nodes in the pericolic mesentery of the sigmoid that are removed during ovarian cancer debulking surgery, coded as regional or distant? See Discussion. Debulking surgery found tumor in both ovaries and in lymph nodes of pericolic mesentery, which was removed en bloc with a segment of sigmoid colon (colon had tumor implants involving serosa). Pericolic nodes are not listed as regional for ovary. However Note 2 in the CS manual for Extension states "sigmoid mesentery" is a regional pelvic organ, and that metastatic deposits here should be coded in the extension field, not as distant mets. Should lymph nodes from this same area be coded as regional or distant?

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.

Lymph nodes in the mesentery of the sigmoid colon are regional for an ovarian primary. Code involved sigmoid mesenteric nodes under CS Lymph Nodes.

 2009
20091123

Reportability: Is a tumor reportable if the pathology report indicates a non-reportable diagnosis at the time the specimen is removed but subsequent clinical statements state the patient had a reportable tumor? See Discussion.

The 2007 SEER Manual (page 3) states that cases diagnosed clinically are reportable. Exception 2 states if enough time has passed that it is reasonable to assume the physician has seen the negative pathology report, but the clinician continues to call this a reportable disease, accession the case.

SEER reporting guidelines state that severe dysplasia is not reportable, however, many clinicians regard it to be equivalent to carcinoma in situ.

Example 1: In 09-2007 the pathology report for excisional biopsy of right floor of mouth states the final diagnosis is severe dysplasia. At the time, the case is not accessioned based on non-reportable pathology. Patient is subsequently admitted in 3-09. According to the clinical history the patient was diagnosed with squamous cell carcinoma in 2007 and treated with laser. Is this reportable? If yes, how is behavior to be coded? How is "Ambiguous Terminology at Diagnosis" to be coded?

Example 2: In 2-08, the pathology report for a punch biopsy of a skin lesion states the final diagnosis is atypical melanocytic hyperplasia. In 3-08, patient is admitted for re-excision. The clinical diagnosis states re-excision being done for melanoma in situ.

Reference: SINQ 20061123

A tumor that is non-reportable based on the pathology report diagnosis should not be accessioned if later clinician statements mistakenly refer to it as a reportable tumor. The exception in the 2007 SEER manual on page 3 is intended to allow the registrar to accession a case when the clinician actually disagrees with the pathology report and clinically diagnoses a reportable tumor.

 2009
20091097

Multiple Primaries--Lymphoma: How many primaries should be abstracted if DLBCL (9680/3) and Mantle Cell Lymphoma (9673/3) occur at the same time in different lymph nodes? How would Sequence be coded if the case is multiple primaries?

For cases diagnosed prior to 1/1/2010:It is important to note for this case that the two different types of NHL occurred in different lymph nodes; one type in one lymph node and the other type in another lymph node.

Use the fold-out table to determine single vs multiple primaries. According to the table, 9673/3 and 9680/3 would be two primaries no matter which of these was "first."

Assign the lower sequence number to the primary with the worse prognosis when two primaries are diagnosed simultaneously. Base the prognosis decision on the primary site, histology, and extent of disease for each of the primaries. If there is no difference in prognosis, the sequence numbers may be assigned in any order.

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
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
20091010 MP/H Rules/Histology--Breast: What histology is coded when a final diagnosis on a lumpectomy specimen states "adenocarcinoma" but the regional lymph nodes show "poorly differentiated adenocarcinoma with signet ring differentiation"? See Discussion.

3/23 left breast mass bx: infiltrating lobular carcinoma.

6/22 left breast lumpectomy: infiltrating adenocarcinoma; sentinel lymph nodes with metastatic poorly differentiated adenocarcinoma with signet ring differentiation. Axillary resection with poorly differentiated metastasis in 8/9 nodes. The path micro states: tissue consists of sections of breast tissue having an infiltrating ca which in some areas infiltrates as small duct-like structures, and in other areas as small gland-like structures. In addition, there are foci in which the cells infiltrate in a single file fashion. In a few areas, cells having a signet ring appearance similar to those seen in the lymph nodes are encountered. In other areas, the signet ring appearance is not prominent. Areas of ductal or lobular ca in situ are not identified (the lymph node resection specimen shows 'signet ring appearance in some areas but no ductlike or tubular structures observed')

The comment on the lumpectomy path states: 'This is an unusual tumor in that it has histologic characteristics in varying areas, which would be consistent with infiltrating ductal carcinoma, infiltrating lobular carcinoma, tubular carcinoma or signet ring cell carcinoma. The metastatic material (8/9 total axillary lymph nodes) is most consistent with the poorly differentiated signet ring type portion of the tumor undergoing metastasis.'

For cases diagnosed 2007 or later:

Code the histology 8140 [Adenocarcinoma, NOS] using Breast rule H14.

Code the histology from the final diagnosis on the pathology report of the most representative specimen (the lumpectomy in this case). Do not code histology from the microscopic description. Code the histology from the primary site whenever available, not the metastatic site.

Comments on pathology reports can be used to code histology. However, in this case the final diagnosis is more definitive than the comments. The comment provides several choices and none of these appear in the final diagnosis; an indication that the pathologist was not able to clearly identify a more specific type in this case.

 2009
20091115 MP/H Rules/Multiple primaries - - Melanoma: How many primaries are reported when a patient presents with a malignant melanoma (NOS) and a separate lentigo maligna, both on right chest? See Discussion.

MP/H rule M5 states that melanomas with ICD-O-3 histology codes that are different at the third number are multiple primaries. However, the 2007 MP/H fundamentals Webcast session on melanoma rules states that this is not two histologic types. Lentigo maligna is a growth pattern, not a histologic type. Will clarification be included in the next MP/H rules revision?

For cases diagnosed 2007 or later, two primaries are to be reported for this case. Rule M5 applies because there is a difference in the histology codes at the third digit.

Clarifications regarding histologic types of melanoma will be added to the rules when they are revised.

2009
20091081 Reportability/Histology--Brain and CNS: Is an "inflammatory myofibroblastic tumor" reportable for Brain and CNS sites? See Discussion. Histology code 8825/1 (Inflammatory Myofibroblastic Tumor) is not listed in the ICD-0-3 Primary Brain and CNS Site/Histology listing for reportable Brain/CNS tumors.

If the inflammatory myofibroblastic tumor is primary in one of the sites specified below and diagnosed 1/1/2004 or later, it is reportable.

Reportable brain and CNS tumors are any benign and borderline primary intracranial and CNS tumors with a behavior code of /0 or /1 in ICD-O-3 diagnosed 1/1/2004 and later, of the following sites:

  • Cerebral meninges C700
  • Spinal meninges C701
  • Meninges, NOS C709
  • Cerebrum C710
  • Frontal lobe C711
  • Temporal lobe C712
  • Parietal lobe C713
  • Occipital lobe C714
  • Ventricle, NOS C715
  • Cerebellum, NOS C716
  • Brain stem C717
  • Overlapping lesion of brain C718
  • Brain, NOS C719
  • Spinal cord C720
  • Cauda equine C721
  • Olfactory nerve C722
  • Optic nerve C723
  • Acoustic nerve C724
  • Cranial nerve, NOS C725
  • Overlapping lesion of brain and central nervous system C728
  • Nervous system, NOS C729
  • Pituitary gland C751
  • Craniopharyngeal duct C752
  • Pineal gland C753

 2009
20081045 MP/H Rules--Melanoma: How is histology coded for a regressing melanoma? See Discussion.

How is histology to be coded for the following tumors?

Example 1: Path showed malignant melanoma Histologic type: superficial spreading. Regression: present.

Example 2: Shave, mid back: malignant melanoma, lentigo melanoma type, level II, regression: present and prominent.

For cases diagnosed 2007-2014:

Apply MP/H Melanoma Histology Coding rule H5 and code the histologic type of the melanoma.

Code example 1 as 8743 [Superficial spreading melanoma].

Code example 2 as 8742 [Lentigo maligna melanoma].

 2008
20081004 First course treatment/Histology--Lymphoma: What treatment, if any, is coded for a patient with methotrexate induced lymphoma when the treatment plan is to take the patient off methotrexate? Also, is there a specific histology for drug induced lymphoma? See Discussion. Diffuse Large B-cell Lymphoma of soft palate & nasal septum, methotrexate induced, in 5/07. Patient was taken off methotrexate with complete resolution of disease. No other treatment was given. Patient was on methotrexate for treatment of rheumatoid arthritis.

For cases diagnosed prior to 1/1/2010:Treatment: Code the treatment fields to 00 [not done] in this case.

Document the discontinuation of methotrexate for rheumatoid arthritis in a text field.

Histology: Assign code 9680/36 [Malignant lymphoma, large B-cell, diffuse, NOS]. There is no specific histology code for therapy-related lymphoma.

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.

 2008