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Report Produced: 02/25/2026 22:28 PM

Report Question ID Question Discussion Answer Year
20071050 MP/H Rules/Histology--Colon: Regarding histology rule H21, is there a hierarchy or do you code the higher histology if there is an adenocarcinoma arising in a polyp and an adenocarcinoma in a villous adenoma?

For cases diagnosed 2007 or later:

If you arrive at H21 and have an additional decision to make regarding the use of 8210, 8261 or 8263, you must make another pass through the histology rules. The second pass will determine which of the two or three histology codes to assign. The answer will vary depending of the specifics of the case.

Example:

Transverse colon: Adenocarcinoma in an adenomatous polyp involving muscularis propria and adenocarcinoma in a villous adenoma involving subserosa of transverse colon. Start with rule H15 because there are multiple tumors. Stop at H21 -- code either 8210 or 8261. To decide between 8210 and 8261, make a second pass through the histology rules, starting again with H15. Stop at H20. Code the histology of the most invasive tumor, 8210 [Adenocarcinoma in adenomatous polyp].

 2007
20071020 Histology--CLL/SLL: What is the correct histology code for a lymph node described in the pathology report comment section as "phenotypically consistent with chronic lymphocytic leukemia"? See Discussion. Current rules instruct us to select the lymphoma code for lymph node and/or tissue with the dual diagnosis of chronic lymphocytic leukemia/small lymphocytic lymphoma. We have a cervical lymph node biopsy with that dual diagnosis, however, the pathology comment states that after immunohistochemistry testing, the lymph node is "phenotypically consistent with chronic lymphocytic leukemia." No bone marrow or blood work-up is performed.

For cases diagnosed prior to 1/1/2010:Code Small Lymphocytic Lymphoma. The current rules have not changed. Code to lymphoma because the diagnosis was made on a lymph node.

"Phenotypically consistent" means the lymph node contains CLL/SLL, not some other hematopoietic or metastatic disease.

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.

 2007
20071041

Reportability/Chemotherapy--Hematopoietic, NOS: Is pyridoxine-responsive sideroblastic anemia (SA) reportable and is pyridoxine coded as chemotherapy for SA and refractory anemia with ringed sideroblasts (RARS)? See Discussion.

Patient has refractory anemia with ringed sideroblasts on bone marrow path. The physician mentions it might be due to pyridoxine deficiency. Per the SEER*Rx, pyridoxine (aka Vitamin B6) is not coded as treatment. What causes RARS and SA? Is pyridoxine treatment for either disease process? Or is the pyridoxine just treating one aspect of the anemia? The patient has no other treatment but this.

For cases diagnosed prior to 1/1/2010:Sideroblastic anemia (SA) is not reportable. SA is not the same as refractory anemia with ringed sideroblasts (RARS). Therefore, do not code pyridoxine administered for SA as therapy. If the patient had RARS that "might be due to pyridoxine deficiency," the replacement pyridoxine would not be coded as chemotherapy because it does not control or kill malignant cells. If the pyridoxine was successful in alleviating the refractory anemia, the RARS would be reversible and would not meet the criteria for a reportable blood disease; i.e. irreversible, clonal.

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.

 2007
20071007 MP/H Rules/Histology: In the absence of a tissue diagnosis, should the histology field be coded based on the findings of a suspicious cytology or a CT scan that clinically confirmed the diagnosis? See Discussion. Cytology (brushings at ERCP) which are highly suspicious of adenocarcinoma. A CT of the abdomen performed the next day shows a mass, most likely Klatskin tumor. Can the histology be coded to Klatskin tumor [8162/3] based on the CT findings?

For cases diagnosed 2007 or later, code the histology to 8162/3 [Klatskin tumor] using the histology from the CT. This case is confirmed clinically based on the CT. It cannot be accessioned based on suspicious cytology.

Rule H8 in the 2007 Histology Coding Rules for Other Sites provides instructions for coding histology when the pathology report and cytology report are not available.

 2007
20071008 Histology (Pre-2007)--Breast: How is "invasive lobular carcinoma with signet ring cell features (95%) and ductal features (5%)" coded for a single tumor diagnosed prior to 2007?

For cases diagnosed 1/1/04-12/31/06, code histology to 8524 [Lobular mixed with other types of carcinoma]. Assuming there is no mention of in situ, Histology Coding Rule 3 applies: Use a mixed histology code if one exists

For cases diagnosed 2007-2014, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2007
20071043 Multiplicity Counter: Are in situ tumors diagnosed more than 60 days after invasive tumors of the same site and histology included in the Multiplicity Counter? If an in situ tumor following an invasive tumor is a single primary according to the multiple primary rules for that particular site, include the in situ and the invasive tumors in the multiplicity counter. 2007
20071096 Multiplicity Counter--Prostate: How is multiplicity counter to be coded for a clinically inapparent prostate cancer for which sextant needle biopsy cores on left and right sides are positive for adenocarcinoma? See Discussion.

Prostate cancer typically presents as multifocal diffuse disease. The coding exercise in the MPH rules presentations coded prostate cancer as one tumor.

Reference: SEER Training Web Casts - Other Sites Rules Practicum

 Code the number of tumors present if known. This information can be taken from any part of the record, including imaging and prostatectomy. If the only information available is "diffuse," or "multifocal," assign code 99. Do not assume there are multiple tumors just beacause there are multiple biopsies. When there is no information about the number of tumors, code Multiplicity Counter to 99 and Type of Multiple Tumors to 99. 2007
20071037 CS Extension--Breast: Is the term "erosion" the same as "ulceration"?

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.

"Erosion" is not synonymous with "ulceration" when coding CS extension for breast.

 2007
20071123

MP/H Rules/Reportability/Diagnostic Confirmation--Colon: Please clarify how to code diagnostic confirmation when there is no mention of a malignant polyp in the pathology report of a familial polyposis case given this statement: "Even if you have only one malignant polyp it is a single primary if there is a diagnosis of FAP. Even if there is no mention of a malignant polyp, if there is a diagnosis of FAP you will use this rule."

For cases diagnosed 2007 or later:

In the very unlikely event of a FAP diagnosis with no malignancy, the case would not be reportable.

When FAP is diagnosed along with a colon malignancy, it is presumed that the malignancy originated in one of the numerous polyps, even if this is not explicitly stated. Use rule M3 for any colon malignancy (in a polyp, frank, or not stated) with a diagnosis of FAP and abstract as a single primary.

2007
20071130 Reportability--Brain and CNS: Are schwannomas of the spinal cord reportable when they are intradural? See Discussion. The CNS guidelines basically indicate that schwannomas must all come from peripheral nerves and thus are not reportable when they are on the spinal cord. However, the COC Inquiry 18174 & 18068 states that schwannomas occasionally will develop inside the dura (intradural) on the spinal cord and would be reportable.

According to an expert consultant, schwannomas must be derived from Schwann cells which are not a part of the CNS. All schwannomas come from peripheral nerves. Benign and borderline tumors of the peripheral nerves (C47_), including peripheral nerves along the spinal cord, are not reportable.

Please see http://www.cdc.gov/cancer/npcr/training/index.htm for more information.

 2007