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Report Produced: 03/01/2026 12:54 PM

Report Question ID Question Discussion Answer Year
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
20081077 MP/H Rules--Ovary: How do you code histology for a diagnosis of "clear cell CA, predominately cystic." For cases diagnosed 2007 or later, assign histology code 8310 [Clear cell carcinoma]. Cystic describes the appearance of the tumor. Clear cell is the histologic type. Code clear cell carcinoma 8310/3. Rule H11 applies. 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
20081015

MP/H Rules/Multiple primaries--Lung: Should a subsequent primary be abstracted using rule M8 for a patient diagnosed in January 2000 with adenocarcinoma of the right upper lung if the patient initially sought alternative therapies and presented in September 2007 for a right upper lobe lung mass with extension into the mediastinum, mediastinal lymph node mets and a pericardial effusion? See Discussion.

After more than seven years, the patient in this case decided to proceed with the originally suggested standard therapy. Is this a multiple primary case because the tumors are "diagnosed" more than 3 years apart? Or should we assume this is further progression of the 2000 case because it was originally only treated with alternative therapies? The clinician in this case indicates the patient is being referred for treatment to the right upper lung originally diagnosed in 2000.

For cases diagnosed 2007 or later:

Do not abstract a 2007 primary for this case. From the information provided, there is disease progression/extension and lymph node metastasis in 2007; but there are no new lung tumors in 2007. Therefore, the 2007 MP/H rules do not apply.

 2008
20081017 Ambiguous terminology/Reportability--Leukemia: Is a 'suspicious peripheral blood smear' the same as a suspicious cytology? See Discussion. The final diagnosis on the path report for a peripheral blood smear is stated to be "suspicious for malignancy." The microscopic description states that the "lymphoid population raises the concern of chronic lymphocytic leukemia." Nothing further was done. Is this a reportable case? If so, should it be coded as a leukemia or a malignancy NOS?

For cases diagnosed prior to 1/1/2010:Do not accession a leukemia case based only on a "suspicious" peripheral blood smear. If a confirmed diagnosis, clinical confirmation or further information becomes available later, accession the case at that time.

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
20081008 Surgery of Primary Site--Breast: How is this field coded when a re-excision follows a prior mastectomy?

Code the most extensive surgery in Surgery of Primary Site. This is a cumulative field. Assign the appropriate code including all surgeries of the primary site performed during the first course of treatment.

The correct code for mastectomy followed by re-excision will depend on the extent of the re-excision. For example, if the re-excision removed muscle, code radical mastectomy.

 2008
20081001

CS Tumor Size: Can an 'ulcerated mass' be used to code CS tumor size? See Discussion.

The CS Manual (p. 26, 4.a.) states do not code the size of the polyp, ulcer or cyst. However it states that a 'cystic mass' can be used to code TS if it is the only size given. Scopes Text: 'ulcerated' mass based at anal verge & ext 3-4 cm up into rectum.

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 CS Tumor size using the size of an ulcerated mass.

Answer from:

  • I & R System

  • American College of Surgeons

    		•  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
    		20081065 Surgery of Primary Site--Melanoma: Which surgery codes should be used for cases that have a 1 cm margin? See Discussion. For a melanoma case the surgery codes in the 30's are to be used when margins are stated to be less than 1 cm. The codes in the 40's are to be used for cases where the margins are greater than 1 cm. If the margin is exactly 1 cm, assign a surgery code from the 20-36 range. Use a code in the 40's only when the margin is greater than 1 cm. 2008
    		20081122 MP/H Rules/Histology--Breast: Patient has single invasive left breast tumor diagnosed in 2008. Final pathology diagnosis is "Invasive solid papillary carcinoma". No mention of ductal in report. What is histology?

    For cases diagnosed 2007 or later:

    As of July 2010:

    Code the histology 8503 [Infiltrating papillary adenocarcinoma].

    This is solid papillary, not solid AND papillary carcinoma. Solid is an adjective modifying papillary, in other words, a subtype of papillary. We do not have a code for solid papillary, so we code to the NOS, papillary using rule H14.

    		 2008