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Report Produced: 03/02/2026 09:50 AM

Report Question ID Question Discussion Answer Year
20180096

Reportability/Histology--Small intestine: Is a neuroendocrine microtumor of the duodenum a reportable tumor? See Discussion.

This comment was added to the pathology report by the pathologist: A focus of neuroendocrine microtumor measured 350 micrometers, qualifying as a neuroendocrine microtumor. Focus was immunohistochemically positive for chromogranin and synaptophysin and negative for gastrin. The Ki-67/CD45 immunostain showed <1% positivity in microtumor.

Neuroendocrine microtumor of the duodenum is reportable as 8240/3. "Microtumor" pertains to the size/amount of NET and not to a histologic type.

 2018
20180105

2018 Solid Tumor Rules/Histology--Lung: What is the appropriate histology code for the case below in the Discussion section? Is there a difference between adenocarcinoma in situ (bronchioloalveolar carcinoma), non-mucinous type (8252/2) and adenocarcinoma in-situ, mucinous? See Discussion.

Procedure: Wedge, resection specimen, Laterality: Right, Tumor site: Right upper lobe, Tumor size: 1.0 cm in greatest dimension, Histologic type: Adenocarcinoma in-situ, mucinous, Histologic grade: N/A, Visceral pleura invasion: Not identified, Tumor extension: N/A, Margins: Uninvolved, Lymphocytosis.

Assign 8253/2 for adenocarcinoma in situ, mucinous. New codes were added in 2018 for mucinous adenocarcinoma in situ for lung cancer only as all cases were not invasive. Pathologist are discouraged from using the term BAC. In-situ lung tumors can now be identified as either mucinous or non-mucinous and the appropriate ICD-O code should be assigned based on diagnosis.

 2018
20180064

Solid Tumor Rules (2018)/Recurrence--Breast: Does any recurrence within the multiple primaries-stated timeframe count, not those just in the primary site? See Discussion.

A patient has a left breast cancer diagnosed in 2011; then has a "recurrence" in her lymph nodes in 2017. In 2018, she has a new left breast mass that is the same histology and behavior as the 2011 cancer. Based on the 2017 "recurrence" in the lymph nodes, this is not a new breast primary, is that correct?

This is a single primary using 2018 Breast Solid Tumor Rule M11. Rule M8 does not apply because the patient was not clinically disease free for 5 years. We are interpreting the 2017 diagnosis as lymph node metastasis from the 2011 breast cancer diagnosis.

 2018
20180106

First Course Treatment--Other Therapy: Please explain how to code this new therapy, peptide receptor radionuclide therapy (PRRT) for rare neuroendocrine tumors. See Discussion.

According to this article, PRRT treatment lutetium Lu 177 dotatate was approved earlier this year by the United States Food and Drug Administration for adult use. PRRT is a nuclear medicine therapy that travels throughout the body looking for a certain receptor within neuroendocrine tumors. These include pancreatic and small neuroendocrine tumors in the gastrointestinal tract. Once absorbed into the tumor, the radioactive material starts to break down tumor cells, killing them. It is the first radioactive drug approved for the targeted treatment of gastroenteropancreatic neuroendocrine tumors.

(http://cinj.org/rutgers-cancer-institute-new-jersey-and-robert-wood-johnson-university-hospital-are-first-state ).

For cases diagnosed prior to 2023: Code Peptide Receptor Radionuclide Therapy (PRRT) in the data item Other Therapy, code 1, Other.

See SINQ 20220042 and 20230005 for information pertaining to cases diagnosed in 2023 or later.

 2018
20180019

Marital Status: Is Marital Status always a self-reported status? See Discussion.

The SEER Manual states that Marriage is self-reported for the instruction in code 2, but it does not indicate if all other marital statuses are self-reported.

Examples: How is Marital Status reported for the following situations?

1. Patient with multiple tumors in the database, for the first tumor marital status is reported as married (code 2), for the subsequent tumor, marital status is reported as single (code 1).

2. Patient self- reports as single, but also has children.

3. Patient states they are in common law marriage, but our state is not a common law marriage state.

Marital Status is self-reported because the information is recorded in the medical record based on information obtained from the patient. Use text fields to document relevant information.

Examples

1. Assign code 2 for the first tumor and assign code 1 for the subsequent tumor unless the available information indicates the patient is divorced at the time of the subsequent tumor diagnosis. Patient may self-report single after a divorce. Assign code 4 in that situation.

The code assigned for marital status reflects the patient's marital status at the time of diagnosis for the tumor being abstracted. It is possible that marital status may be different for each tumor if the patient has multiple tumors.

2. If marital status is stated to be single, assign code 1.

3. If marital status is stated to be common law marriage, assign code 2.

Common Law Marriage is defined as a couple living together for a period of time and declaring themselves as married to friends, family, and the community, having never gone through a formal ceremony or obtained a marriage license.

 2018
20180032

Reportability--Appendix: Is low grade appendiceal mucinous neoplasm (LAMN) reportable for 2018? It is staged as pTis(LAMN) AJCC 8th ed by pathologist.

Low grade appendiceal mucinous neoplasm (LAMN) is not reportable in 2018. See page 6, https://20tqtx36s1la18rvn82wcmpn-wpengine.netdna-ssl.com/wp-content/uploads/2018/02/2018-ICD-O-3-Coding-Table-Alpha-order-.pdf. Use cancer registry reportability instructions to determine reportability. Do not use the AJCC TNM manual to determine reportability.

 2018
20180078

Solid Tumor Rules (2018)/Histology--Breast: How is histology coded and which rule applies for a single in situ tumor that is described as an encapsulated papillary carcinoma (EPC) with conventional ductal carcinoma in situ (DCIS)? See Discussion.

Patient had a breast excision that proved a single tumor with no evidence of invasive carcinoma. The final diagnosis stated: Size (extent) of EPC DCIS: Spanning approximately 1.3 cm. The pathologist did not describe separate foci of DCIS; only one tumor comprised of both encapsulated papillary carcinoma and DCIS. The encapsulated papillary carcinoma was not described as invasive. The pathology noted: This case is best classified as EPC conventional DCIS. No conventional stromal invasion is identified. Solid Tumor Rule M2 confirms a single tumor is a single primary.

However, there does not appear to be an H Rule that instructs how to code histology. The Single Tumor: In Situ Only module, has only three H Rules and none of them apply to this case. The patient does not have Paget disease (H1), does not have a single histology (H2, there are multiple histologies present as DCIS and EPC are listed on different rows in Table 3) and does not have DCIS and LCIS (H3). How does one arrive at the correct histology for this case?

Code histology to 8500/2. Per April 2019 update: Rule H5 applies: Code DCIS 8500/2 when there is a combination of DCIS and any other carcinoma in situ.

The 4th Ed WHO Tumors of the Breast states that tumors with encapsulated papillary carcinoma in situ in the absence of DCIS in the surrounding tissue have a very favorable prognosis. Only tumors without DCIS should be coded to 8504/2. The component of DCIS will determine treatment.

 2018
20180069

Solid Tumor Rules (2018)/Behavior--Brain and CNS: The Behavior coding instructions in the Non-Malignant Central Nervous System (CNS) Equivalent Terms and Definitions section refer to Table 1 for help coding behavior when the other priority order instructions do not apply; however, the behavior cannot be reasonably determined using Table 1 alone for all WHO Grade I neoplasms. Should an additional default, such as the ICD-O-3 or Tables 5 and 6, be used to determine behavior? See Discussion.

Similar to an issue previously submitted SINQ 20180063, Table 1 (WHO Grades of Select CNS Neoplasms) in the Non-Malignant CNS Equivalent Terms and Definitions section states WHO Grade I tumors are always non-malignant. However, this does not mean that the tumors listed in Table 1 as WHO Grade I are always benign (/0). Some tumors listed with a WHO Grade I have a behavior of /1 (borderline) per the ICD-O-3 and/or Tables 5 and 6. The Behavior coding instructions do not currently indicate these are the appropriate sources to use when the pathologist and/or physician do not comment on the behavior of these tumors. In our area, pathologists do not explicitly state the behavior for these tumors; the pathologist only assigns the WHO Grade.

There is no way for us to know what behavior to assign WHO grade II tumors when the pathologist does not provide that information. Defaulting to either benign or malignant is incorrect. Please follow back with the pathologist to determine behavior.

The behavior must be non-malignant, meaning /0 or /1, or the tumor is a WHO Grade 1, to be reportable as non-malignant CNS tumor. Refer to Table Instructions under Table 1, WHO Grades of Select CNS Neoplasms that says to use non-malignant CNS rules for all WHO Grade 1 tumors and to use the appropriate rules for WHO Grade 2 tumors

Use ICD-O and all updates if not listed in Table 6 according to non-malignant CNS Histology Rule H3 (for single tumor) and Rule H8 (for multiple tumors) when only one histology is present.

 2018
20180079

Solid Tumor Rules/Multiple primaries--Breast: How many primaries should be abstracted when papillary carcinoma is identified in two biopsies and a subsequent lumpectomy identified invasive ductal carcinoma with multifocal ductal carcinoma in situ (DCIS)? See Discussion.

The right breast ultrasound shows a 1.4 cm mass at 8 o'clock and a separate mass .6 cm at 7 o'clock (site code for both C50.5). Pathology report: Right 8 o'clock core needle biopsy fragments of intracystic noninvasive papillary carcinoma (8504/2), right 7 o'clock core needle biopsy fragments of intracystic noninvasive papillary carcinoma (8504/2). Then, another facility performs a right breast lumpectomy (operative note not available). Outside Facility: Right breast lumpectomy pathology shows invasive ductal carcinoma .6cm (8500/3) multifocal DCIS .5cm greatest dimension tumor site right breast NOS.

Should we use Rule M12-Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3 in the Equivalent Terms and Definitions. Timing is irrelevant. Note: Each row in the table is a distinctly different histology. So would this be two primaries C50.5 (8504/2) and C50.9 (8500/3)?

Abstract as multiple primaries using Breast Solid Tumor Rule M12 as these are separate, non-contiguous tumors on different rows in Table 3.

 2018
20180103

Histology/Grade--Small intestine: For a 2017 diagnosis, is the grade/differentiation field coded 1 or 9 when the diagnosis is well-differentiated neuroendocrine tumor (NET) (carcinoid)? It seems as though the term well-differentiated defines type of neuroendocrine tumor so they can diagnosis the carcinoid. See Discussion.

5/15/17 Duodenal bulb, biopsy: Fragments of duodenal mucosa with well differentiated neuroendocrine tumor (carcinoid), extending to the edge of specimen and peptic duodenitis in the submitted tissue. No significant intraepithelial lymphocytosis.

Assign grade code 1 for well-differentiated NET (8240/3). Well-differentiated is synonymous with NET, grade 1, according to WHO Classification of Tumors of the Digestive System.

 2018