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Report Produced: 02/23/2026 06:37 AM

Report Question ID Question Discussion Answer Year
20041053 CS Site Specific Factor 6--Breast: Can we interpret the in situ component as "minimal" when the pathology report states "1.1 cm infiltrating duct carcinoma and no extensive intraductal component"?

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.

Yes. Based on the information provided above, the in situ component is "mininmal" for the purpose of coding Breast CS Site Specific Factor 6. The phrase "no extensive intraductal component" suggests that there is some intraductal carcinoma present.

 2004
20041036

Surgery of Primary Site/Surgery codes, NOS--Colon: What tissue specimens are included under this field's code 41 [Subtotal colectomy/hemicolectomy plus resection of contiguous organ; example: small bowel, bladder]? See Discussion.

How is site specific surgery coded for the following two cases?

Example 1. A right hemicolectomy normally includes a portion of ileum.

Example 2. Subtotal colectomy with bilateral oophorectomy.

Code 40 includes a right hemicolectomy. A right hemicolectomy normally includes a small portion of the terminal ileum removed with the ileocecal valve. Assign code 41 when resection of CONTIGUOUS organs goes beyond what would normally be removed as part of a subtotal colectomy/hemicolectomy. Record non-contiguous organ resection in Surgical Procedure of Other Site.

Example 1: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy].

Example 2: Surgery of Primary Site -- 40 [Subtotal colectomy/hemicolectomy]. Surgical Procedure of Other Site -- 2 [Non-primary surgical procedure to other regional sites].

Addendum July 2021

For coding Surgical Procedure of Other Site, see the instructions for determining regional vs distant sites in the 2021 SEER manual under Coding Instructions #6 and #7 on pages 184-185. Do not use Summary Stage to determine regional vs distant for this data item.

 2004
20041099 First Course Treatment: If a patient makes a blanket refusal of all recommended therapy or refuses all treatment before any therapy was recommended, are only immunotherapy and hematologic/endocrine therapies to be coded as refused (code 87)? Or should all treatment modalities be coded as refused if a patient makes a blanket refusal? Or should none of the treatment modalities be coded as refused because we do not know what would have been recommended? See Discussion. Coding instructions for immunotherapy and for hematologic/endocrine procedures state that Code 87 is to be assigned if either of the following circumstances apply: 1) If the patient made a blanket refusal of all recommended treatment. 2) If the patient refused all treatment before any was recommended. These instructions are not included for other treatment modalities. When the patient refuses treatment, the first course of therapy is no treatment. Code all treatments as refused. 2004
20041082 Date of Diagnosis: When a 4/04 clinical impression indicates the appearance of a carcinoma that is contradicted by a negative 4/04 biopsy but is confirmed by a 5/04 resection, should the diagnosis date be coded to April or May? See Discussion.

4/04 colonscopy: irregular fungating mass that has appearance of carcinoma. 4/04 Bx: high grade dysplasia. 5/04: LAR. 5/04 Path: 3.2 X 2.5 cm mass wd adenoca with invasion of muscularis propria.

Should the diagnosis date be 4/04 based on the clinical impression during the colonoscopy OR 5/04 since the path for the bx was negative?

 The date of diagnosis for the example above is 05/04 -- the date of the pathology report confirming malignacy. The biopsy in 04/04 negated the 04/04 clinical statement. 2004
20041092 CS Extension--Bladder: How would the following statements be coded for bladder extension -- Code 03 [inferred description of non-invasion] vs code 15 [invasive confined to subepithelial connective tissue]. See Discussion.

1) no smooth muscle invasion

2) no muscle invasion

3) without muscle invasion

4) no invasion of muscularis propria

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.

For cases diagnosed in 2004 and later code CS extension:

1) no smooth muscle invasion -- 15

2) no muscle invasion -- 15

3) without muscle invasion -- 15

4) no invasion of muscularis propria -- 03

 2004
20041020 EOD-Extension--Sarcoma: How is this field coded for a soft tissue sarcoma that involves the overlying skin? For cases diagnosed 1998-2003: It depends on the location of the soft tissue sarcoma. If the tumor is very superficial, code EOD-Extension to 60 [Adjacent organs/structures]. However, if the soft tissue sarcoma is between muscles or "deep" according to the AJCC definition, then it would have to grow through the superficial fascia to get to the skin. In this case code EOD-Extension to 80 [Further contiguous extension]. 2004
20041090 CS Extension/CS Mets at Dx--Lung: How are these fields coded for bilateral pleural effusion for a right lung primary? A code of 72 in the CS Extension field leads to a T4, but bilateral pleural effusion is M1. Should CS Mets at Dx be coded 39?

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.

For bilateral malignant pleural effusion, code the ipsilateral malignant effusion in CS Extension and the contralateral malignant effusion in CS Mets at Dx. Assuming the bilateral pleural effusion is the furthest extension in this case, code CS Extension to 72 [Malignant pleural effusion]. Code CS Mets at Dx to 40 [Distant mets, NOS].

 2004
20041069

Reportability--Brain and CNS: Is a meningioma invading the bone malignant and, therefore, SEER reportable if diagnosed prior to 2004? See Discussion.

1. Meningothelial meningioma with prominent nuclear pleomorphism, infiltration into dura, calvarium, temporalis skeletal muscle.

Microscopic: Multifocal infiltration by meningothelial tumor...extensive infiltration of trabecular spaces, extension through inner and outer calvarial layers by meningioma...mitotic activity in tumor noted but below the 4 per 10 high power field threshold for diagnosis of atypical meningioma.

2. Aggressive (invasive) transitional type meningioma, neuroimaging and histology imply extensive invasive meningioma involving bone and paraspinal soft tissues. Microscopy:...invaded bone...focal EMA positivity diagnostic of invasive transitional type meningioma... tumor invades bone.

The two cases above are benign meningiomas and not reportable prior to 2004. According to an expert consultant, meningiomas are in the lining cells for the inner table of the skull and as such have an affinity for bone that allows them to penetrate adjacent bone without being "malignant."

The WHO Nervous System Tumor Classification states malignant meningioma exibits histological features of frank malignancy far in excess of the abnormalities present in atypical meningioma (WHO grade II). Examples of the histologic features of malignant meningioma are obviously malignant cytology, or high mitotic index (20 or more mitoses per 10 high-power fields). They correspond to WHO grade III and are usually fatal.

 2004
20041023 Histology (Pre-2007)--Lung: Should "moderately differentiated adenocarcinoma of scar type, intermixed with bronchiolo-alveolar carcinoma" be coded to 8250 [bronchiolo-alveolar adenocarcinoma, NOS] or 8255 [adenocarcinoma of mixed subtypes]?

For tumors diagnosed prior to 2007:

Code Histology to 8255 [Adenocarcinoma with mixed subtypes]. This is a single tumor containing both a scar carcinoma and a bronchiolo-alveolar carcinoma--use 8255. The synonym for 8255 is adenocarcinoma combined with other types of carcinoma (not just subtypes).

For tumors diagnosed 2007 or later, 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.

 2004
20041046

CS Tumor Size--Breast: When the diagnosis is inflammatory carcinoma of the breast, must the CS tumor size always be 998? See Discussion.

I have no specific example of a situation; I am writing an edit check and wondering if there would be any exceptions to this rule.

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.No. For inflammatory carcinoma, code the size of the tumor in CS tumor size. Use code 998 [diffuse] when the tumor is stated to be "diffuse."

Page 27 in Part I of the CS manual will be corrected to define code 998 for breast as only "diffuse." The errata should be distributed in July 2004.

 2004