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Report Produced: 07/01/2025 23:03 PM

Report Question ID Question Discussion Answer Year
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
20081138 MP/H Rules/Histology--Lung: What is the correct histology code for a neuroendocrine neoplasm described as a carcinoid and also referred to as oncocytic? See Discussion.

Left mainstem bronchus mass excised: metaplastic endobronchial mucosa with submucosa containing an infiltrating poorly diff malignant tumor. Origin of tumor is not identified in overlying mucosa. IHC stains will be performed.

Addendum #1. IHC stains show well diff neuroendocrine neoplasm, favor carcinoid. Recommend sending this to expert in lung neoplastic pathologist.

Addendum #2. (lung path specialist) oncocytic neuroendocrine neoplasm.

Is this 8246 or 8290 or something else?

 For cases diagnosed 2007 or later, code as 8246 [Neuroendocrine carcinoma, NOS]. According to our pathologist consultant, the neuroendocrine description is more specific than the oncocytic description in this case. 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
20081053

Multiple primaries--Lymphoma: Is a splenectomy done for non-Hodgkin lymphoma diffuse large B-cell of the spleen a composite histology and a single primary if a perihilar lymph node with Hodgkin lymphoma classic type is found at the time of this surgery?

For cases diagnosed prior to 1/1/2010:This is two primaries -- Non-Hodgkin lymphoma (NHL) in the spleen and Hodgkin lymphoma (HD) in a lymph node.

Composite lymphoma is NHL and HD both in a single lymph node.

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
20081002 Primary site: What is the correct primary site code for angiosarcoma of the spleen with mets to bone marrow C42.2 vs C49x? See Discussion.

Robbins Pathology states the following about liver angiosarcomas: Hepatic angiosarcomas are rare but of interest because they are associated with distinct carcinogens, including arsenic (exposure to arsenical pesticides), Thorocast (a radioactive contrast medium previously widely used in radiology), and polyvinyl chloride (PVC) (widely used in plastics). The increased frequency of angiosarcomas among works in the PVC industry is one of the truly well-documented instances of chemical carcinogenesis in humans. With all these agents, there is a very long latent period of many years between exposure and the development of tumors.

Could the same apply to the spleen?

 Code C422 [Spleen] as the primary site for angiosarcoma of spleen with metastasis to bone marrow. 2008
20071107

MP/H Rules/Recurrence--Breast: If the pathologist and oncologist call a 2007 lobular carcinoma that appears in a skin nodule of a mastectomy scar a recurrence of a patient's 1975 primary breast duct carcinoma, should we abstract this as a new primary? See Discussion.

According to the pathologist and oncologist, the change in histology is attributed to the present availability of E-cadherin, which was not available in 1975.

For cases diagnosed 2007 or later, abstract the 2007 diagnosis as a separate primary using rule M5.

Rule M5 applies to this case because it comes before rule M12. Furthermore, based on your statement, the answer presumes that the original tumor was duct carcinoma only, there was no lobular carcinoma present. This must be a new primary because there are two different histologies.

The 2007 MP/H rules were developed with input from clinicians. They advised that a subsequent breast tumor more than five years later is a new primary. It is important to apply the rules so that these cases are handled in a consistant manner across all registries.

 2007
20071058

CS Tumor Size: Is a measured "area" equivalent to a tumor, mass or lesion size? See Discussion.

Collaborative Stage manual, page 26

Rule 4a: "always code size of the primary tumor, not size of the polyp, ulcer, cyst or distant metastasis."

Rule 4e: Additional rule for breast primaries: Example: Duct carcinoma in situ covering a 1.9 cm area with focal areas of invasive ductal carcinoma. Record the tumor size as 1.9 cm.

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.In general, a measured area is not equivalent to a tumor size.

Do not apply the rule related to the breast example to other primary sites. This example in the CS manual pertains to coding tumor size for breast primaries when the size of the invasive component is not stated. In the example, the area involved with duct carcinoma in situ is the only measurement available. The size of the invasive component was not given.

 2007
20071074 MP/H Rules/Multiple Primaries--Lung: How many primaries should be reported when an "adenocarcinoma" is discovered in one of several new nodules at the scar in a lung and it is less than a year after a wedge resection for a diagnosis of "bronchioalveolar adenocarcinoma" in the same lung? See Discussion.

In March 2006 patient diagnosed with bronchioalveolar adenocarcinoma [8250/3] and had wedge resection. In November 2006 a CT chest shows nodules at the scar suspicious for recurrence. In January, 2007, there was a biopsy of one of the nodules showing adenocarcinoma [8140/3].

Is this part of the original disease process diagnosed in March 2006 or should it be abstracted as a new primary based on 2007 MP/H rules (histology is different at the first 3 digits)?

For cases diagnosed 2007 or later:

Try to obtain more information/clarification on the 2007 diagnosis -- for example, is it metastasis?

Based only on the information provided for this case, the 2007 diagnosis is a separate primary.

Use the 2007 MP/H rules to assess the 2007 diagnosis. Begin with rule M3 in the multiple tumors section. Stop at rule M11, multiple primaries.

 2007
20071054 Date of Diagnosis: Can the phrase "suspicious for a primary lung tumor" from a CT be used to code date of diagnosis? See Discussion. Thorax CT on 4/18/05 states 'enlarged RUL nodular opacity suspicious for a primary lung tumor.' Biopsy confirmation was not done until 8/4/05 because patient declined further work-up until then. Would date of diagnoses be 4/18/05 or 8/4/05?

Code the diagnosis date 08/04/2005 based on the biopsy.

The statement "suspicious for a primary tumor" is not a clinical diagnosis of cancer or malignancy.

 2007
20071083 MP/H Rules/Multiple Primaries--Bladder/Renal Pelvis: Is a non-invasive papillary transitional cell carcinoma of the bladder diagnosed one year after the occurrence of an invasive papillary transitional cell carcinoma of the renal pelvis reported as one or two primaries?

For cases diagnosed 2007 or later:

This is a single primary with renal pelvis as primary site.

Use the 2007 MP/H rules to determine if the 2007 diagnosis is a new primary. Use the Urinary rules, multiple tumors module. Start with rule M3. Follow the rules down to Rule M8 and stop. This is an example of implantation effect.

 2007