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Report Produced: 02/12/2026 16:47 PM

Report Question ID Question Discussion Answer Year
20170036

Grade--Prostate: How are the prostate-related fields completed when documentation in pathology reports only includes one of the new grade groups? See Discussion.

Our pathologists have starting to use a new prostate cancer grading system that was adopted by WHO in 2016. The new grading scheme correlates with the prior Gleason grading scheme as follows:

Grade Group 1 = Gleason score 6 or less

Grade Group 2 = Gleason score 3+4=7

Grade Group 3 = Gleason score 4+3 = 7

Grade Group 4 = Gleason score 8

Grade Group 5 = Gleason score 9-10

Our pathologists are no longer dictating the Gleason Primary and Secondary Pattern values nor the Gleason's Score. Reverse correlation from the new grade groups to the required patterns and score are difficult with Grade Groups 2 and 3 needing to be distinguished from one another and Grade Group 5 including two unique scores.

The prostate-related fields include:

Collaborative Site Specific Factor 7: Gleason's Primary Pattern and Secondary Pattern Values on Needle Core Biopsy/TURP

Collaborative Site Specific Factor 8: Gleason's Score On Needle Core Biopsy/TURP

Collaborative Site Specific Factor 9: Gleason's Primary Pattern and Secondary Pattern Values on Prostatectomy/Autopsy

Collaborative Site Specific Factor 10: Gleason's Score on Prostatectomy/Autopsy

When all you have is the grade group, you may use the following table to convert the Prostate Grade Groups to the appropriate code for the indicated fields.

Grade Group Gleason Score Gleason Pattern SSF7 SSF8 SSF9 SSF10 Grade/diff

Grade Group 1 6 or less <=3+3 099 999 099 999 1

Grade Group 2 7 3+4 034 007 034 007 2

Grade Group 3 7 4+3 043 007 043 007 2

Grade Group 4 8 4+4, 3+5, 5+3 999 999 999 999 3

Grade Group 5 9-10 4+5, 5+4, 5+5 099 999 099 999 3

 2017
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
20021091

Reportability--Hematopoietic, NOS: Are the terms "thrombocytosis, NOS" and "thrombocythemia, NOS" non-reportable to SEER? See discussion.

Our understanding from SEER about how to classify these types of clinical impressions for the 2001 and later reportable blood diseases is as follows: If we cannot prove that it is malignant, then we should be conservative and exclude the case for reporting to SEER.

For cases diagnosed prior to 1/1/2010:The terms "thrombocytosis, NOS" and "thrombocythemia, NOS" are not reportable to SEER.

For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2002
20020054

Multiple Primaries (Pre-2007)--Ovary: Are mucinous cystic tumors of low malignant potential diagnosed in the left ovary in 12/2000 and in the right ovary in 7/2001 reportable as two primaries? See discussion.

Page 14 of the SEER Program Code Manual, 3rd Edition, states that bilateral retinoblastomas and bilateral Wilms tumor are always single primaries whether simultaneous or not. Does this apply to bilateral ovarian tumors as well?

For cases diagnosed 2001-2006:

Borderline tumors are not reportable to SEER as of 2001. If you are collecting them in your registry, use the following procedure: Exception 1 in the SEER Program Code Manual, 3rd Edition, responds to the issue of processing ovarian tumors. Simultaneously occurring ovarian tumors with a single histology are coded as one primary. In the case you cite, the right ovary primary occurred 7 months after the left ovary primary. This is not simultaneous, so it would be counted as a second primary.

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
20051095 Chemotherapy/Immunotherapy: How do we code Rituxan for Non-Hodgkin Lymphoma and Herceptin for breast cancer? See Discussion.

Page 195 of the SEER Manual 2004 lists these as examples of Immunotherapy. The new SEER*Rx categorizes these as chemotherapy.

(Sinq # 20041025 says to code Avastin and Erbitux as chemotherapy, too.)

Code Rituxan and Herceptin as chemotherapy.

SEER*Rx is effective for cases diagnosed 1-1-2005 and forward. It replaces all previous references. Be sure to use SEER*Rx [http://seer.cancer.gov/tools/seerrx/]

because some agents changed categories when SEER*Rx was deployed.

It is neither required nor recommended that cases treated prior to 2005 be recoded.

 2005
20081063 MP/H Rules--Breast: How many primaries should be abstracted when a patient has a mass at 6:00 that showed poorly differentiated ductal carcinoma and a hypoechoic nodule at 9:00 that was excised with no real tumor present there though path showed angiolymphatic invasion by carcinoma throughout the entire specimen? See Discussion.

Palpable mass in right breast at 6:00. Path stated 'poorly differentiated ductal carcinoma with extensive necrosis and extensive angiolymphatic invasion. Focal high grade comedocarcinoma (1%)'. Another hypoechoic nodule was seen at the 9:00 position. This mass was excised from surrounding tissue. This mass was more like an inflammatory mass; there was no real tumor present there. Path report stated "Breast mass 9:00 excisional biopsy - angiolymphatic invasion by mammary carcinoma throughout the entire specimen."

Is this two primaries because of the two different histology codes: 8500 and 8010?

 For cases diagnosed 2007 or later, abstract as a single primary using rule M3 (a single tumor is always a single primary). There was one tumor present according to the information provided. The second specimen was not a separate tumor ("There was no real tumor present there"). 2008
20130042 Reportability--Heme & Lymphoid Neoplasms: Is follicular lymphoma in situ reportable? See Discussion.

Parotid mass and intraparotid lymph node biopsy: Follicular lymphoma in situ (see note).

Note: The morphologic findings in conjunction with the results of immunohistochemical stains demonstrate focal follicular lymphoma in situ in a background of reactive follicular hyperplasia. Cytogenetic studies on the parotid mass demonstrated a normal karyotype. FISH analysis for BCL2 and BCL6 gene rearrangements has been requested and will be reported separately.

Per the Note under Case Reportability Instructions Rule 3 in the Hematopoietic and Lymphoid Neoplasm Manual, do not report in situ [/2] lymphomas. 2013
20170001

MP/H Rules/Histology--Kidney: How is the histology coded and what rule(s) apply to the classification of succinate dehydrogenase-deficient renal cell carcinoma? See Discussion.

Partial nephrectomy showed carcinoma, histologic type: succinate dehydrogenase-deficient renal cell carcinoma. This is not a term in the ICD-O, and is not a histology covered in the Kidney MPH rules. However, a recent web search indicates this is a specific type of RCC that was added to the 2016 WHO classification of RCC (per abstract: https://www.ncbi.nlm.nih.gov/pubmed/27179267) and makes up 0.05-0.2% of RCC cases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229399/).

Code the histology to renal cell carcinoma, NOS (8312/3). While WHO lists succinate dehydrogenase-deficient renal cell carcinoma in the latest edition, no specific histology code is provided. MP/H Rule H10 applies since only one histology type is provided, though no code is listed.

 2017
20081134

MP/H Rules--Breast: For tubulolobular carcinoma, do we use 8522? See Discussion.

Path comment: This mixed variant of ductal and lobular carcinoma has been called in the past tubulolobular carcinoma, however, more recently is a mixed pattern of ductal and lobular carcinoma and not a variant of lobular carcinoma.

For cases diagnosed 2007 or later, use rule H18 and assign code 8524 [lobular mixed with other types of carcinoma]. According to the MP/H rules, tubular is not a specific type of duct or lobular. This is based on the latest WHO classification of breast tumors.

The combination histology of tubular and lobular will be reviewed during the upcoming revision of the MP/H rules.

 2008
20071099

MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion.

Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma."

This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code?

For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma.

"Components" is not a term indicative of a more specific histology. See note under rule H5.

 2007