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Report Produced: 02/20/2026 11:39 AM

Report Question ID Question Discussion Answer Year
20081126

MP/H Rules--Brain and CNS: Are stigmata of neurofibromatosis in the brain reportable neurofibromatosis lesions? See Discussion.

Reference: SINQ 20051108; SINQ 20061018 Three year old patient with history of neurofibromatosis 1. 3/05 MRI of the brain showed right optic nerve glioma. It also showed heterogeneous high t2 signal in the middle cerebellar peduncles and near the genu of the internal capsules bilaterally are stigmata of neurofibromatosis type I. 3/08 MRI showed new mass suspicious for glioma in the hypothalamus. Clinical diagnosis is benign glioma secondary to diagnosis of neurofibromatosis. How many primaries are to be accessioned for this patient? Should the matrix principle be invoked for the second glioma? Should the behavior code for the glioma be 0?

For cases diagnosed 2007 through 2017

Accession NF (9540/1) when there is CNS tumor -- a glioma or some other intracranial/intraspinal tumor. Stigmata of NF are reportable when the stigmata themselves are reportable tumors. For example, glioma, or another intracranial/intraspinal tumor. Do not report sitgmata that are only termed "stigmata seen on MRI," for example, without other reportable terminology.

Do NOT accession NF (9540/1) when there is only peripheral nerve/nervous system involvement.

Accession the neurofibromatosis itself only once per patient. Accession any initial neoplasm in the CNS separately. Abstract and code any subsequent CNS neoplasms according to the multiple primary brain rules.

Accession three primaries for the case described above.

  1. Neurofibromatosis (C729 9540/1)
  • Optic nerve glioma (C723 9421/3)--> see below.
  • Hypothalamus glioma (C710 9380/0)

--> Optic nerve gliomas associated with NF are pilocytic astrocytomas. Code pilocytic astrocytoma as 9421/3 in North America.

For cases diagnosed 2018 or later

See the 2018 Solid Tumor Rules for Non-Malignant CNS tumors.

 2008
20081128

MP/H Rules/Histology--Breast: What is the histology code for the following?

4/21/03 Left breast: infiltrating ductal carcinoma, grade 3 micropapillary type. Tumor size: 3.5 cms; deep margin negative. Skin, nipple & areola positive for invasive ductal carcinoma. Dermal lymphatic invasion by carcinoma breast. Extensive intraductal component absent. 6+/6. See Discussion.

 How should histology be coded for a 2003 diagnosis and also for the same diagnosis in 2007 or later?

For a case diagnosed in 2003, code 8507/3 [Duct micropapillary carcinoma]. See Coding Complex Morphologic Diagnoses, revised August 2002, 3rd example on page 5 and page 3, #4.

For cases diagnosed 2007 or later, code 8507/3 [Duct micropapillary carcinoma]. Use rule H12.

 2008
20081024 CS Site Specific Factor--Breast: How is SSF6 coded when CS tumor size is coded from a clinical report, not from pathology? See Discussion. A breast ultrasound displays a 2 cm tumor. Core biopsy diagnosis is lobular carcinoma in situ. No further record for patient. Tumor size coded to 020. Should SSF 6 be coded to 010 "Entire tumor reported as in situ (no invasive component reported)" because it was pathologically confirmed, or to 888 because size was coded based on a clinical exam - the ultrasound?

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 SSF6 888 [Clinical tumor size coded]. When the size recorded in CS Tumor Size is not determined pathologically, 888 must be coded in SSF6. Note: The code in SSF 6 pertains to pathologic tumor size. It describes the relationship of invasive and in situ tumor in the tumor size coded.

 2008
20081088 CS Lymph Nodes/CS Mets at Dx: How should these fields be coded for an in situ diagnosis when the patient was diagnosed by biopsy only and there is no information in the chart regarding an evaluation of lymph nodes or metastatic sites? See Discussion.

In reference to the case below, does it make a difference if the CS T stage is known based on the primary excision but there is no clinical information in the record regarding the nodes or metastasis evaluation.

This scenario is seen on outpatient records of breast biopsies and melanoma excisions; i.e., punch bx followed by gross excision of the lesion but the medical record contains no clinical information or statement of everything else normal.

I&R Question 17625 2/16/2006

A patient was diagnosed with ductal carcinoma in situ by needle core biopsy of the right breast. There was no further information in the chart stating if or where the patient went for staging work-up and treatment. What are the codes for CS Extension, CS Regional Lymph Nodes and CS Distant Mets at Dx?

I&R Answer: Sufficient tissue must be taken to determine the T category. If this is the case, CS Extension = 00.

Unless the physician makes the statement that the physical exam is negative, code the CS Regional Lymph Nodes = 99 CS Distant Mets at DX = 99.

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 CS Lymph Nodes and CS Mets at Dx 00 [None] for an in situ diagnosis with no other information.

The CS instructions state that CS LN's should be coded 00 for in situ because in situ by definition is non-invasive. The same logic applies to CS mets in the case of in situ. The I&R answer will be revised.

 2008
20081011 Surgery of Primary Site/CS Reg LN Exam/Scope Regional LN Surgery--Rectum: How are these fields coded when a patient develops a non-tumor related complication that requires an additional sigmoid resection that removes 2 additional lymph nodes one week following a low anterior resection that removed 4 lymph nodes? See Discussion. Patient had a low-lying rectal cancer that was biopsied and then treated with radiation and chemo followed by a low anterior resection. Four nodes were removed. There was no residual tumor. The patient returned one week later due to a rectal bleed, thought to be an abscess. During surgical exploration it was found that the anastomosis had broken down and it was decided to do a sigmoid colectomy. Residual disease was not suspected. Two additional nodes were removed.

Surgery of primary site: Assign code 30 [low anterior resection]. Code the most extensive surgery (i.e. the highest surgery code) applicable.

CS Reg LN Exam: Code 04 [four nodes removed].

Scope of regional lymph node surgery: Code 5 [4 or more regional lymph nodes removed].

The sigmoid colectomy was performed for a surgical complication, thus it was not cancer-directed therapy. The regional lymph nodes removed during that procedure were not removed to diagnose cancer or stage the disease, and they were not removed during the initial treatment. Please see SEER manual for instructions for coding Regional Lymph Node Surgery.

 2008
20081025 MP/H Rules/Histology--Anus: What is the correct histology code and MP/H histology rule to use for AIN-3 arising in a polyp? See Discussion.

Patient has colonoscopy with excision of small 5mm polyp in rectum (no mention of anus or anal canal); path reads out: AIN-3 (anal intraepithelial neoplasm grade 3).

In coding the histology using the "Other Sites" rules, H2 would be the first rule that applies for this case. However, we lose the fact that the AIN-3 arose in a polyp (H3). Is this how SEER wants these cases coded?

 For cases diagnosed 2007 or later, apply rule H2 and assign histology code 8077/2 (squamous intraepithelial neoplasia, grade III). Apply the rules in order, H2 precedes H3. 2008
20081086 Reportability: Is a case reportable if a benign diagnosis is obtained on a resection that follows a positive needle aspiration? See Discussion. Fine needle aspiration of the thyroid diagnosis was "positive for malignant cells, favor medullary carcinoma." Subsequent thyroidectomy was reported as benign. This case is reportable. The cytology is positive. Report as medulary carcinoma of the thyroid. 2008
20081073

CS Extension/Ambiguous terminology--Pancreas: Should an exception be made for "abuts" or "encased/encasing" regarding CS pancreas extension? See Discussion.

According to the CS Manual regarding ambiguous terminology, we do not accept "abuts" or "encased/encasing" as involvement. According to the March/April 2008 issue of "CA, A Cancer Journal for Clinicians", vol 58, number 2, an article concerning Pancreas staging by M.D. Anderson researchers/clinicians recommends defining unresectable involvement of the celiac axis/mesenteric artery with the terms "abutment" as involvement of 180 degrees or less of the circumference of the vessel, and "encasement" as more than 180 degree involvement. A large comprehensive cancer center in our area has already adopted these guidelines.

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.Follow the current CS instructions regarding ambiguous terminology. "Abuts" and "encased/encasing" are not involvement.

The American College of Surgeons Commission on Cancer provided the following in response to this question: This concept can be considered for CS version 2, but it would need to be made in conjunction with acceptance of that same theory in AJCC 7th Edition so that the stage can be derived. Many times what can be defined and accepted in a closed environment of a single institution research project cannot be duplicated and accepted across the nation and in every community facility. Would pathologists specify the > or < 180 degree involvement in every pathology report? It would also have to be reviewed to see if this idea has been accepted by the larger oncology community, or just the idea of a single institution.

 2008
20081003 Reportability--Brain and CNS: For von Hippel Lindau disease with multiple hemagioblastomas, is each hemangioblastoma reportable as a new primary? See Discussion. Diagnosis of von Hippel-Landau disease, multiple brain surgeries between 2002 and 2007 for recurring hemangioblastomas, 9161/1. This disease manifests as multiple (recurring) hemangioblastomas.

For cases diagnosed 2007-2014:

If the hemagioblastomas occur in sites with different ICD-O-3 topography codes, they are separate primaries.

Please note: Rule M4 in the Benign & Borderline Intracranial and CNS Tumors MP/H coding rules on the SEER website has been corrected to read:

Tumors with ICD-O-3 topography codes that are different at the second (Cxx), third (Cxx) and/or fourth (Cxx) characters are multiple primaries.(http://www.seer.cancer.gov/tools/mphrules/benign_brain.html)

 2008
20081127 MP/H Rules/Histology--Thyroid: How would the histology "micropapillary carcinoma" of the thyroid be coded for cases dx'd 2007 and after?

For cases diagnosed 2007 or later, assign code 8260/3 [Papillary adenocarcinoma] according to rule H14.

For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.

 2008