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Report Produced: 02/13/2026 00:58 AM

Report Question ID Question Discussion Answer Year
20071049 MP/H Rules/Histology--Colon: If a tubulovillous (TV) adenoma is in situ and other polyp(s) have an invasive component, does the in situ TV adenoma still have priority and should rule H18 be applied?

For cases diagnosed 2007 or later, always give precedence to coding the invasive. Rule H18 applies UNLESS the adenocarcinoma in the TV is in situ and the others are invasive. In this case, code the histology of the invasive adenocarcinoma.

This clarification will be added when the MP/H manual is revised.

 2007
20071076 MP/H Rules/Histology--Thyroid: Regarding rule H15, is the mixed code 8340 [Papillary carcinoma, follicular variant] used when there are subtypes of these histologies described, such as a tumor diagnosed with follicular and papillary microcarcinoma or should 8341 [Papillary microcarcinoma] be used?

For cases diagnosed 2007 or later:

For coding purposes, this is a papillary and follicular combination that would be coded to the combination code 8340/3 [Papillary carcinoma, follicular variant].

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.

 2007
20071098 Multiplicity Counter/Date of Multiple Tumors/CS Tumor Size--Lung: How are these fields to be coded when work-up of a malignancy spans a couple of months and reveals developing nodules? See Discussion. Example: Chest CT on 4-26-07 reveals 2.2 cm mass in lingula, left lung, consistent with lung malignancy. Biopsy on 5-18-07 shows non-small cell carcinoma. PET scan on 6-6-07 shows left upper lobe mass consistent with known non-small cell lung carcinoma. Second developing mass increasing in prominence since 4-07 in periphery of left upper lobe, approximately 3.6 cm which may represent intrapulmonary mets or second primary neoplasm. At least 3 additional intrapulmonary nodules have developed since 4-07, two in the left upper lobe and one in the right upper lobe, suspicious for mets.

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.Multiplicity Counter/Date of Multiple Tumors

Apply the multiple primary rules first and record the number of tumors determined to be a single primary in Multiplicity Counter. Record the corresponding date in Date of Multiple Tumors. These data items may be updated once if future tumors are determined to be the same primary as the initial diagnosis.

CS Tumor Size

Include information gathered through

  • completion of surgery(ies) in first course of treatment OR

  • all information available within four months of the date of diagnosis in the absence of disease progression

    • WHICHEVER IS LONGER.

    Metastasis known to have developed after the diagnosis was established should be excluded.

    		 2007
    		20071106

    MP/H Rules--Bladder: Does rule M6 mean that any combination of tumors with the histologies 8050, 8120-8124, or 8130-8131 are the same primary regardless of the amount of time between tumor occurrences? See Discussion.

    Many interpret Rule M7 to mean when separate occurrences of TCC of the bladder are diagnosed more than 3 years apart, it is reportable as a second primary. However, doesn't Rule M6 mean that if the histology is any combination of 8050, 8120-8124 or 8130-8131 for tumors diagnosed more than 3 years apart, they are reported as a single primary?

    For cases diagnosed 2007 or later:

    Papillary, transitional cell and/or papillary transitional cell carcinomas of the bladder are a single primary using Rule M6. Rule M6 includes diagnoses within 3 years of each other AND diagnoses more than three years apart for the histologies listed. If rule M6 applies to your case, stop. Do not continue on to Rule M7.

    		 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
    		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
    		20071029 CS Lymph Nodes--Kidney, renal pelvis: Under what circumstances would code 80 [Lymph nodes, NOS] be used to document the presence of positive lymph nodes? See Discussion. The CS Schema for Kidney (Renal Parenchyma) states to use code 70 for Regional Lymph Nodes, NOS. The schema for for Renal Pelvis states to use code 50 for Regional Lymph Nodes, NOS. Both schemas have a Code 80, for Lymph Nodes, NOS that maps to N1 in both schemas.

    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 80 can be used for positive lymph nodes when you are unable to determine if they are regional or distant. CS Lymph Nodes code 80 is provided for this situation in accordance with the downstaging rule.

    Code 80 should be used very infrequently and only when there is no indication whether the involved lymph nodes are regional or distant.

    		 2007
    		20071117 MP/H Rules/Histology--Brain: How many primaries are reported and what is the histology for a single brain tumor described as a low grade astrocytoma at the time of the initial partial resection and a low grade glioneuronal neoplasm at the time of the subsequent total resection? See Discussion. On 4/20/07 a partial resection of a brain tumor is interpreted as low grade astrocytoma. Patient has a gross total resection on 8/13/07 with this diagnosis: low grade glioneuronal neoplasm (see comment). Comment: This case has been reviewed at ---. Dr. agrees with our interpretation (low grade glioneuronal neoplasm, possibly a dysembryoplastic neuroepithelial tumor).

    For cases diagnosed 2007 or later, this is a single primary. A single tumor is always a single primary.

    Assign histology code 9400/3 [Astrocytoma, low grade]. This diagnosis was not revised or amended based on the later surgery. It is possible that the malignant component was entirely removed during the first surgery.

    		 2007
    		20071028 MP/H Rules--Lung: Why the term "nodule" is not included as an equivalent term along with tumor, mass, lesion and neoplasm in the 2007 lung multiple primary rules?

    Answer revised July 2008

    For cases diagnosed 2007 or later:

    For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.

    This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.

    		 2007
    		20071114 Ambiguous Terminology/Date of Diagnosis: How would you code the diagnosis date when the body of an imaging report uses reportable ambiguous terminology while the final impression in that same report uses non-reportable ambiguous terminology? Would you code the diagnosis date to the date of the scan or to the subsequent biopsy date that confirmed a malignancy? See Discussion. Within the body of a mammogram report, the radiologist stated, "diffuse inflammatory tissue throughout the rt breast w/ large rt axillary lymph nodes, consistent with an inflammatory carcinoma of rt breast." His final impression, however, said "extremely suspicious rt breast w/ extremely dense breast parenchyma and adenopathy in axilla, suggesting an inflammatory carcinoma." The patient then went on to have a biopsy, which was indeed positive for cancer.

    Accept the reportable ambiguous terminology from the body of the mammogram. Record the date of the mammogram as the date of diagnosis.

    The guidelines on page 4 of the 2007 SEER manual addressing discrepancies within the medical record can be applied to discrepancies within one report.

    The instructions are:

    If one section of the medical record(s) uses a reportable term such as

    apparently and another section of the medical record(s) uses a term that is not on the reportable list, accept the reportable term and accession the case.

    		 2007