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Report Produced: 09/16/2025 05:21 AM

Report Question ID Question Discussion Answer Year
20021059 Surgery of Primary Site--Soft Tissue: What code is used to represent this field when an excisional biopsy of a soft tissue sarcoma is followed two weeks later with a wide excision (re-excision)? For cases diagnosed 1/1/2003 and after: Code the Surgery of Primary Site field to 26 [partial resection]. According to the CoC, "Excision" in the surgery codes refers to the lesion and "partial resection" refers to the organ. The biopsy is a local excision (code 25). The wide resection is code 26, presuming that more than just the remaining lesion was removed. 2002
20020024 Reportability--Cervix: The SEER Program Code Manual lists CIN III and carcinoma in situ of the cervix as not being reportable for cases diagnosed in 1996 or later, but does not list "adenocarcinoma in situ" or "squamous cell carcinoma in situ." Are these histologies still reportable?

For primary site cervix uteri, only histologies with behavior codes of 3 [invasive] are reportable to SEER for all registries.

Some SEER registries have opted to continue to collect behavior codes of 2 [in situ] for cervix uteri primaries.

 2002
20021069 Histology (Pre-2007)--Breast: What code is used to represent the histology "infiltrating lobular carcinoma, solid and classical subtypes"?

For tumors diagnosed prior to 2007:

Code the Histology field to 8520 [Lobular carcinoma].

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.

 2002
20021210 Date of Diagnosis/Histology (Pre-2007)--Breast: When there is a delay between the clinical diagnosis of a malignancy and the surgical resection of the primary site, can the resection be used to code the date of diagnosis, extension, size of the primary tumor, and histology? See discussion.

For example, mammogram March 28th states "certainly represents malignancy." Nothing else done until November 1st when pt presents w/skin retraction on PE and bone mets. A mastectomy November 6th shows "ductal ca w/dermal lymphatic invasion and tumor measuring 3.5 cm."

How is the date of diagnosis, extension, tumor size & histology coded for this case?

For tumors diagnosed prior to 2007:

Code the Date of Diagnosis to March. Code the Histology field to 8500/3 [Infiltrating duct carcinoma]. Histology can be upgraded from a clinical histology to a pathological histology anytime.

For cases diagnosed 1998-2003, in coding extension, you need to assess whether there has been progression of disease or not. If progression of disease is verified, do not code extension using the surgical information from November. Code the extension and tumor size based on the mammogram and physical examination at the time of the mammogram, if available.

If no progression of disease is verified, use surgical information to code extension and tumor size.

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.

 2002
20020020

Multiple Primaries (Pre-2007)--Breast: When two breast tumors with two different histologies, such as duct and mucinous are diagnosed in the same breast at the same time, are they reportable as two primaries? See discussion.

Our rule is that multiple lesions of different histologic types are separate primaries. However, for separate tumors of duct and lobular, we report as a single primary. Since we now have a combination code for duct and other types of ca, do we report as a single primary or continue to report as separate primaries?

For tumors diagnosed prior to 2007:

When there are two breast tumors, one mucinous, the other duct carcinoma, report as two primaries when the pathologist's opinion clearly states that there are separate primaries.

If there is no such information from the pathologist, the two tumors must be separate with clear (negative) margins to be reported as two primaries. Otherwise, report as one primary.

The ICD-O-3 combination codes are not intended to combine tumors of different histologic types.

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.

 2002
20020044

Terminology/EOD-Extension--Prostate: How does SEER define the prostatic "apex"? See discussion.

Some pathologists define the prostatic apex as including the bottom third of the prostate whereas others regard only the bottom-most portion of the gland to be the apex.

SEER defines the apex as being the bottom-most portion of the gland. Apex means "narrowest part," which in the prostate would be the bottom-most portion of the gland.

 2002
20021090 Primary Site--Ovary/Peritoneum: How should the Primary Site field be coded when no resection is done and it is uncertain whether the primary site is in the ovary or the peritoneum? See discussion. CT: ascites, omental cake and peritoneal studding. H&P impression: probable ovarian or peritoneal primary. Repeat CT: no enlarged adnexal mass seen to suggest ca of ovary, but possibility couldn't be ruled out. Omental bx: Metastatic ca. Comment: "IHC stains have been performed and are not typical of ovarian ca, although do not exclude an ovarian primary." After the bx, there were two clinical diagnoses written a month apart with no evidence of further work-up between those dates. The first diagnosis was "ovarian ca". The second was "Peritoneal carcinomatosis 2 month ago; Primary is unknown, possibly ovarian."

Use the best information available to identify the primary site. In this case, it is the physician's clinical assessment. Code the Primary Site to C56.9 [Ovary] for this example because the ovary is indicated to be the primary site according to the physicians involved.

When there is no surgical procedure involving the removal of the ovaries, code the Primary Site based on the clinical assessment of the disease location. If the disease is only noted to be in the peritoneum, code site to peritoneum, NOS. If the disease is seen clinically in both the ovary and the peritoneum, code site to ovary.

 2002
20020066 Chemotherapy: How is treatment with Iressa (Gefitinib) coded?

Code treatment with Iressa as chemotherapy.

Iressa is an epidermal growth factor inhibitor. While it doesn't kill cells directly, it damages the cell reproduction process. We classify it as a chemotherapy agent.

 2002
20021039 Grade, Differentiation--Breast: How do we code grade for a breast primary diagnosis of "Low grade invasive duct, modified Bloom-Richardson grade II/III (tubule formation 2, nuclear grade 1, mitotic rate 1)"? This appears to add up to a Bloom-Richardson score of 4, which does not fit with a Bloom-Richardson II/III.

Code the Grade, Differentiation field to 1 [grade I] using the information from the BR score.

For cases diagnosed 1998-2003: Grade or differentiation information from breast pathology reports is used in the following priority order:

1. Terminology (well, moderately, poorly)

2. Histologic grade (grade I, grade II)

3. BR scores

4. BR grade

5. Nuclear grade

On the hierarchical list for coding breast grade, the first two priorities do not apply to this case, but the third (Bloom-Richardson scores) does. Add the BR information (2+1+1) for a total score of 4, which translates to BR low grade (code 1). The statement of "II/III" may be a typo that should state I/III.

 2002
20021003 Multiple Primaries (Pre-2007): Whenever two hollow organs are diagnosed simultaneously with the same histology, one being invasive and the other in situ, can one assume that mucosal spread has occurred and that this situation represents one primary? In the absence of a physician statement, how do you determine mucosal spread from one organ to another?

For tumors diagnosed prior to 2007:

Yes, this type of situation represents one primary. A tumor that is breaking down can be invasive in the center with in situ cancer at the margins. Occasionally the in situ margin can move into a contiguous organ with the same type of epithelium.

Physicians may describe mucosal spread in various manners. You will see the terms "intramucosal extension," "in situ component extending to," or statements of an invasive component in one organ, with adjacent/associated in situ carcinoma in a contiguous organ with the same type of epithelium. A frequent example of this process is bladder cancer extending into the prostatic urethra via mucosal spread.

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.

 2002