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Report Produced: 12/19/2025 05:19 AM

Report Question ID Question Discussion Answer Year
20081038

Histology/Primary site: What is the correct histology code for sarcomatoid carcinoma of the mandible diagnosed in 2007? See Discussion.

Left mandible resection: Malignant tumor, favor high grade sarcomatoid carcinoma. Please see comment.

Comment: Considering the focal stain with P63 and the consult from Mayo Clinic done on the previous biopsy, the diagnosis of sarcomatoid carcinoma is more likely.

Gross: left mandible resection...sectioning reveals a...mass that has replaced the majority of the mandibular bone and is at the medial, anterior lateral and posterior soft tissue margins and comes to within 2.4 cm of the anterior boney resection margin and 1.9 cm of the smooth articular temporal mandibular joint surface.

The combination of C411 and 8033/3 is impossible (with no override available).

Code the primary site C031 [Mandibular gingiva]. Code the histology 8033 [sarcomatoid carcinoma]. This tumor originated in the mandibular gingiva and invaded the bone (mandible) -- It did not originate in the bone. This type of tumor does not originate in bone.

 2008
20150015

Primary Site--Testis:  What is the prmary site for a 38 y/o male diagnosed with testicular cancer in a formerly undescended testis that was treated with orchiopexy at age 10-11?  See discussion.

Should it be coded to where the testis was physically at the time of diagnosis (C621), or should it be coded to C620 to reflect the increased risk for developing malignancy in an undescended testis?

Code the primary site C621 (descended testis). The primary site of this neoplasm is a scrotal (descended) testis. The history of orchiopexy can be noted in a text field, but does not change the primary site in this case.

2015
20091017

Primary site--Esophagus: How is primary site coded for a tumor arising in a segment of the esophagus that was reconstructed using a segment of the colon? See Discussion.

A patient had a ruptured esophagus 25 years ago and had a segment of colon removed and transplanted to serve as esophagus. In 2007, the patient was diagnosed with carcinoma in a polyp by endoscopic biopsy of the transplanted 'esophagus'. What is the primary site code? Is this the same site schema to be used for Collaborative staging and surgery coding?

Code the primary site esophagus, NOS [C159]. Use the surgery codes and collaborative staging schema for esophagus. Document the unusual nature of this case in text fields.

2009
20000487 Primary Site--Kaposi Sarcoma: Would the following Kaposi primaries be examples of cases not coded to skin for primary site? See discussion.

1. KS developed initially as a lesion in the oral cavity and followed by the appearance of skin lesions.

2. KS found in a resected parotid gland with metastasis to the parotid gland lymph node. No skin lesions identified.

3. KS discovered in a biopsied 3 cm axillary lymph node. Clinically, the patient had hepatosplenomegaly, ascites, and extensive mesenteric lymph nodes. (No mention of skin.)

Code the Primary Site field as follows:

1. C44.9 [Skin, NOS] as the default value when lesions develop simultaneously in skin and non-skin areas.

2. C07.9 [Parotid gland]

3. C44.9 [Skin, NOS] as the default value when there is no mention of lesions in the skin or other primary site.

Edward Klatt states in Practical AIDS Pathology, "...Visceral Kaposi (involving one or more internal organ sites) is also present in three-fourths of cases, but may not be diagnosed prior to autopsy. Visceral involvement frequently includes the lung, lymph nodes and gastro-intestinal tract."

 2000
20000280 Primary Site--Breast: Is there a hierarchy for coding subsite for breast cases when there is conflicting information in the physical exam, mammogram, operative and pathology reports as to the exact location of the primary? See discussion.

Example: Two mammograms were performed. One report indicates the lesion is at 12:00 and the other indicates it is in the upper central quadrant. However, the pathology report from the modified radical mastectomy specimen indicates the mass is in the UIQ.

According to one of our physicians, when a pathologist has a mastectomy specimen with attached axillary contents, the location of the lesion (subsite) is very accurate.

Code the Primary Site field to C50.2 [upper inner quadrant]. In general, the priority for using information is pathologic, operative, and clinical findings. The pathology report would take precedence in this case.

The 2004 SEER Program Code manual will include the following instructions for determining breast subsite.

Priority Order for Coding Subsites

Use the information from reports in the following priority order to code a subsite when the medical record contains conflicting information:

1 Pathology report

2 Operative report

3 Physical examination

4 Mammogram, ultrasound

If the pathology proves invasive tumor in one subsite and insitu tumor in all other involved subsites, code to the subsite involved with invasive tumor.

 2000
20021154

Primary Site: What code is used to represent the primary site for a "teratocarcinoma with features of embryonal carcinoma" removed from the thigh muscle in a patient with x-ray negative testicles? See discussion.

The case was reviewed by AFIP and called "extratesticular." Per our pathology consultant, the site should be coded to unknown because it is very doubtful that the tumor was primary in the soft tissue of the thigh. According to him, such tumors don't originate exclusively in the testes, but tend to occur along the central axis such as the mediastinum or retroperitoneum. If an extratesticular tumor arises in either of these areas, the primary site should be code to the mediastinum or the peritoneum rather than to unknown. Lesions primary in the testicle may also undergo maturation with fibrosis and involution. This process often leaves little evidence of the original tumor in the testis.

Code the Primary Site field to C809 [unknown] for this case. The thigh tumor is a metastatic site.

 2002
20130123

Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diffuse large B-cell lymphoma, immunoblastic variant involving the left maxillary vestibule and entire left maxilla? See Discussion.

The clinical history indicates a destructive, quickly growing intra-oral lesion in the left soft tissue vestibule and the entire left maxilla.

Pathology report final diagnosis: Oral cavity, left maxilla, incisional biopsy: Malignant lymphoma, non-Hodgkin, diffuse large B-cell type, immunoblastic variant.

Code the primary site to C068 [overlapping lesion of the mouth] per Rule PH24. Code the primary site to the organ when lymphoma is present only in an organ.

This lesion overlaps the left soft tissue of the maxilla (the maxillary gingiva) [C030] and the left vestibule of the mouth [C061]. There is no documentation indicating in which specific site the lesion arose. The maxilla is the upper jawbone. The soft tissue that overlies the maxilla is a part of the oral cavity. It is reasonable to interpret the documentation such that the tumor in the maxilla is an extension of the overlapping oral mucosa tumor.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

 2013
20120086 Primary site: What is the single primary site used for a patient with multiple tumors in the duodenum and jejunum? See discussion. The patient has a tumor in the jejunum and another tumor in the duodenum. Both tumors have the same histology. This disease process is a single primary per Other Sites Rule M18. Is the primary site coded to the more invasive tumor? If the tumors are equally invasive, is the primary site coded to C179?

Code the primary site to C179 [small intestine, NOS] for multiple invasive tumors of the small intestine accessioned as a single primary.

The steps used to arrive at this decision are:

Step 1: Go to the Primary Site subsection located in Section IV of the 2012 SEER Manual titled "Description of This Neoplasm."

Step 2: Apply instruction 5. "Code the last digit of the primary site code to '9' for single primaries, when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined." Code the primary site to C179 [small intestine, NOS].

When multiple tumors arising in different subsites are accessioned as a single primary, the primary site is coded to the NOS code, in this case small intestine, NOS [C179]. The level of invasion does not determine the primary site, unless one or more of the tumors is in situ and another is invasive.

 2012
20110127

Primary Site--Brain and CNS: Are meninges surrounding cranial nerves cranial meninges [C700] or a part of the specific nerve's sheath? Is the primary site for an optic nerve sheath meningioma coded to optic nerve [C723] or cranial meninges [C700]?

Code the primary site to cranial meninges [C700].

 2011
20120029 Primary site--Lung: What is the code for primary site if a small cell carcinoma presents as mediastinal masses?

Code the primary site to main bronchus [C340].

Primary small cell carcinoma in the thymus/mediastinum is rare. A bronchial lesion with extension into the mediastinum is much more likely. In a case like this, it is difficult to be sure exactly where the tumor arose, however, it is recommended the default site be the main bronchus when there is no information to the contrary.

 2012