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Report Produced: 09/14/2025 04:20 AM

Report Question ID Question Discussion Answer Year
20081121

Multiple primaries/Histology--Lymphoma: How many primaries should be abstracted and how should the histology field(s) be coded in this situation?

How would the bone marrow involvement by only NHL be handled? Composite lymphoma (9596) as defined by SEER and ICD-O is NHL and HD in one node which fits the final impression on the removed cervical node. See Discussion.

 Patient presented with cervical, supraclavicular & superior mediastinal lymphadenopathy. A cervical node was excised for pathological review. The final impression on that node was Composite lymphoma characterized by (1) Nodular Lymphocyte Predominant Hodgkin Lymphoma [HD] (2) CLL/SLL [NHL]. Then, a bone marrow aspirate/bx was performed revealing CLL/SLL [NHL].

For cases diagnosed prior to 1/1/2010:This is a single primary. The histology code is 9596/3 [composite Hodgkin and non-Hodgkin lymphoma].

According to the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, 9596/3 followed by 9670/3 is one primary.

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
20081006 Multiplicity Counter: Is there a time frame for the Multiplicity Counter or is it related to the duration for counting new tumors (i.e. 5 years for breast, etc) to capture the number of "local recurrences"? Record the number of tumors counted as a single primary at the time the case is abstracted. Later, if additional tumors are determined to be the same primary, update this field once. Do not update the multiplicity counter more than once. 2008
20081031

MP/H Rules--Breast: How many primaries are abstracted if a mastectomy specimen reveals two separate invasive tumors:

#1: Invasive apocrine carcinoma, poorly differentiated, 1.2cm, (9 o'clock). -Apocrine ductal carcinoma in situ (DCIS), high-grade with comedo necrosis; 2.0cm (9:30 o'clock).

#2: Invasive ductal carcinoma, well-differentiated, 1.0cm (12:30 o'clock). -Minor component of DCIS, low-grade? See Discussion.

 In the MP/H Rules, Table 1 lists apocrine as a type of intraductal carcinoma. Apocrine does not appear in Table 2, the list of specific duct carcinomas. If Apocrine is a type of ductal carcinoma, then Rule M11 would make this a single primary. If it is a single primary, what is the histology?

For cases diagnosed 2007 or later:

Using rule M11, there is one primary in the left breast. Apocrine is a specific duct carcinoma. To make this more clear, apocrine will be added to Table 2 in a future revision.

To code the histology, go to the multiple tumors module and start with rule H20. Stop at rule H29 and code the histology with the numerically higher ICD-O-3 code, 8500/3.

 2008
20081106

MP/H Rules--Breast: How many primaries for the following?

Breast lumpectomy: Three foci of invasive ductal carcinoma.

Tumor nodule #1 - Invasive ductal carcinoma.

Tumor nodule #2 - Invasive ductal carcinoma with tubular features.

Tumor nodule #3 - Invasive tubular carcinoma.

See Discussion.

According to the MP/H rules, this case is reportable as three primaries with histologies coded 8500, 8523 and 8211. However, our QC staff is having a problem accepting this. When the pathologist specifies that a ductal carcinoma has tubular features or is tubular type, isn't s/he saying that tubular is a type of duct? In addition, the first line of the FDx states, "Three foci of ductal carcinoma," which indicates that the pathologists interprets the three nodules to be ductal carcinoma.

For cases diagnosed 2007 or later:

These three tumors are three separate primaries. Rule M12 applies.

According to the 2007 MP/H rules, tubular carcinoma is not a type of duct carcinoma.

Among the paramount reasons for writing the MP/H rules are the non-standard usage of nomenclature by physicians and the inconsistency in interpretation of these non-standard phrases. The MP/H rules must be applied consistently by each cancer registrar in order for data to be comparable across registries.

 2008
20081136 CS Extension--Corpus uteri: Can a suspicious cytology be used to code extension? See Discussion.

Endometrial primary confirmed by biopsy on 10/26/06. Pelvic washing on 11/14/06 was 'suspicious for malignancy.' Resection path the same day stated the primary tumor invades the inner 1/3 of the myometrium.

Can we use the pelvic washing cytology & code CS extension 61 or should CS extension be coded 12?

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.Assign extension code 61 [cancer cells in peritoneal washings] for the case described above.

"Suspicious" is listed as a term indicating involvement. There is no exception noted for cytology reports. See page 122 of the 2007 SEER manual.

 2008
20081113

Reportability--Brain and CNS: Is a cavernoma reportable as a benign brain tumor? See Discussion.

Cavernous hemangiomas are typically described as vascular malformations in the brain. Per a search of the literature, cavernoma, cavernous hemangioma and cavernous malformation are all synonymous. There is some controversy as to whether cavernomas are vascular malformations or tumors. Cavernous hemangioma (9121/0) has been assigned a code in the ICD-O-3. The other terms are not even listed. Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. Would we report a lesion that is labeled cavernous hemangioma but not one that is labeled carvernoma? Are cavernous malformations of the brain to be reported as benign brain tumors? The MP/H guidelines for benign brain tumors do not include blood vessel tumors in chart 1.

Are the following tumors reportable? If so, what is the primary site?

Example 1: Patient admitted for resection. Clinical diagnosis is left temporal cavernous hemangioma. Path diagnosis is cerebral cortex and white matter showing cavernoma.

Example 2: Patient admitted for resection with clinical diagnosis of parietal cavernous hemangioma. Path shows A-V malformation.

Example 3: Patient had T4 spinal tumor removed. Path showed cavernous angioma.

Reference: I&R 18109 and 23460

Cavernoma is a reportable benign brain tumor. According to our pathologist consultant, cavernoma is synonymous with cavernous hemangioma.

Examples

1. Reportable. Primary site - C710 [cerebrum]

2. Not reportable. Path dx disproves clinical diagnosis.

3. Not reportable. Not a brain tumor.

 2008
20081129 MP/H Rules--Breast: What histology code should be used with invasive papillary carcinoma with cribriform carcinoma component? There is also DCIS adjacent to the invasive tumor, predominant cribriform and focal papillary patterns. This is a single breast tumor. See Discussion. Registry staff is divided between 8523 and 8255.

For cases diagnosed 2007 or later:

First apply rule H9, code the invasive. To determine the code for the invasive histology, start with rule H10 and stop at rule H15. Code the histology 8503 [papillary]. Papillary (8503) and cribriform (8201) are listed in Table 1 as specific duct types, but in this case they are invasive.

Table 1 and Table 2 will be clarified in the next version of the MP/H rules.

 2008
20081060 CS Tumor Size--Lung: If a 5/11/07 CT showed a 6.5 cm LLL mass and a 7/24/07 CT showed 8.4 cm LLL mass, do we code the larger tumor size identified within four months of diagnosis or do we code the first size documented at the time of diagnosis?

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 the larger tumor size.

 2008
20081116 CS Extension--Brain and CNS: How is this field coded for a malignant brain tumor that presents as a lesion with significant pressure on the left frontal ventricle and dilation of the right ventricles? See Discussion. CS Extension code 30 includes tumor that invades or encroaches upon the ventricular system. Does significant pressure mean the same thing as encroach?

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 assign extension code 30 in this case unless there is evidence elsewhere of ventricular system involvement.

"Significant pressure" is not synonymous with encroachment or involvement. See the list of ambiguous terms for CS staging on page 121 of the 2007 SEER manual.

 2008
20081112 MP/H Rules--Breast: Is a 2008 invasive ductal carcinoma counted as a new primary when it follows a 2005 invasive lobular carcinoma diagnosed in the same breast? See Discussion. The patient has invasive lobular breast carcinoma excised in 2005. She returns in 2008 with a new invasive ductal carcinoma tumor same breast. Following MP/H rules, M10 seems to apply, which states this is still a single primary. Does this mean that this invasive ductal carcinoma is ignored and the patient remains in the registry with only a lobular carcinoma primary?

For cases diagnosed 2007 or later:

Rule M10 applies. The 2008 diagnosis is not a new primary.

The abstract for the 2005 diagnosis should be annotated to include the new information.

 2008