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Report Produced: 02/12/2026 14:47 PM

Report Question ID Question Discussion Answer Year
20130029 Reportability--Heme & Lymphoid Neoplasms: Is "post polycythemic myelofibrosis" reportable? See Discussion. The bone marrow biopsy showed post polycythemic myelofibrosis. JAK2 mutations were present confirming the diagnosis of post polycythemic myelofibrosis. The patient does have a history of polycythemia vera (PV).

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Polycythemia Vera (PV) [9950/3] is reportable. The Abstractor Notes section in the Hematopoietic Database for PV indicates there are three phases of PV. The third phase is referred to as the "spent" or "post-polycythemic myelofibrosis phase". This patient appears to be in the third phase of PV. This would not be reported as a new primary if PV has already been reported.

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
20000852 Histology (Pre-2007)/Grade, Differentiation: What code is used to represent the histology "cystadenocarcinoma with multiple foci of high grade anaplastic and undifferentiated sarcoma"? See discussion. The case was presented at tumor conference. The physicians indicated that the patient would not have the same disease course as a patient with cystadenocarcinoma of the ovary. The physicians advised the use of a mixed histology code. However, there is no appropriate mixed histology code for cystadenocarcinoma, anaplastic carcinoma, and sarcoma. It doesn't seem as though these cases should be grouped and analyzed with cases having a single histology of cystadenocarcinoma.

For tumors diagnosed prior to 2007:

Code the Histology and Grade, Differentiation fields to 8440/34 [cystadenocarcinoma, anaplastic] because a combination code for the specified histologic type does not exist.

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.

 2000
20051010 Primary Site/Priorities--Breast: When there are conflicting references to subsite in different reports, which report has priority? See Discussion. The clinical site of the palpable mass is outer quadrant. The pathologist states inflammatory breast cancer located in the central breast. Should the site be coded to C501 for central breast, C509 for inflammatory breast ca, or C508 for outer quadrant?

Code the breast subsite from the pathology report (C501, central).

The priority order for coding subsite from conflicting reports is

1. Pathology report

2. Operative report

3. Physical examination

4. Mammogram, ultrasound

The primary site of inflammatory breast carcinoma is coded to C509 when there is no palpable tumor.

 2005
20041019 EOD-Extension--Lung: Is this field coded to 10 [tumor confined to one lung] or 20 [Tumor involving main stem bronchus >= 2 cm from carina] when there is no mention of the mainstem bronchus and a lobectomy is performed? See Discussion. The clinical work-up shows a mass at the left medial apex extending into the left lung. No mention of the main stem bronchus. Because a lobectomy was performed, we assume, per Note 2, that the tumor was greater than or equal to 2 cm from the carina. For cases diagnosed 1998-2003: Code the EOD-Extension field to 10 [tumor confined to one lung] for the case example. The EOD-Extension code 20 [Tumor involving main stem bronchus >= 2 cm from carina] applies to tumors involving the main stem bronchus. 2004
20071130 Reportability--Brain and CNS: Are schwannomas of the spinal cord reportable when they are intradural? See Discussion. The CNS guidelines basically indicate that schwannomas must all come from peripheral nerves and thus are not reportable when they are on the spinal cord. However, the COC Inquiry 18174 & 18068 states that schwannomas occasionally will develop inside the dura (intradural) on the spinal cord and would be reportable.

According to an expert consultant, schwannomas must be derived from Schwann cells which are not a part of the CNS. All schwannomas come from peripheral nerves. Benign and borderline tumors of the peripheral nerves (C47_), including peripheral nerves along the spinal cord, are not reportable.

Please see http://www.cdc.gov/cancer/npcr/training/index.htm for more information.

 2007
20031084 Histology (Pre-2007)--Colon: What code is used to represent the histology "Adenocarcinoma, intestinal type?" See Description. The code 8144/3 is not valid for colon primaries. Should we code these as 8140/3 [Adenocarcinoma, NOS] or over-ride the error message?

For tumors diagnosed prior to 2007:

Code adenocarcinoma, intestinal type of the colon 8140 [Adenocarcinoma, NOS]. Do not use code 8144 for intestinal type adenocarcinoma in the colon.

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.

 2003
20031094 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Breast: How many primaries are coded and what code(s) is/are used to represent the histology "invasive ductal carcinoma with extensive spindle metaplastic change [metaplastic carcinoma] with a second, separate, tumor "invasive ductal carcinoma, moderately differentiated with extensive associated DCIS"? See Description. The comment on the pathology report states, "due to the associated DCIS this smaller lesion is felt to most likely represent a synchronous second primary." Is this two primaries, one coded 8575/33 and the other coded 8500/32 or is this a single primary with a combination code -- 8523/33?

For tumors diagnosed prior to 2007:

Abstract as two breast primaries. Code to 8575/33 (metaplastic carcinoma) and 8500/32 (infiltrating duct carcinoma). There are two lesions with different histologic types.

Do not use code 8523 to combine separate tumors with different histologies.

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.

 2003
20031089 Primary Site/Histology (Pre-2007)--Bone: How are these fields coded for a squamous cell carcinoma in bone? See Description. The consult path report says "I believe that there is definitely high grade malignant tumor in this amputation specimen, and that this tumor represents an invasive squamous cell carcinoma, which is extending into the bone and permeating in between the bone trabeculae. ... The fact that squamous cell carcinoma can arise from the sinuses of chronic osteomyelitis is well recognized."

For tumors diagnosed prior to 2007:

Based on the information provided, code the primary site as C40._ or C41._ [bone] because the tumor originated in the sinuses of chronic osteomyelitis. Code to the site in which the tumor arises. Override the SEER site/histology edits to allow this rare combination of bone and squamous cell 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.

 2003
20081001

CS Tumor Size: Can an 'ulcerated mass' be used to code CS tumor size? See Discussion.

The CS Manual (p. 26, 4.a.) states do not code the size of the polyp, ulcer or cyst. However it states that a 'cystic mass' can be used to code TS if it is the only size given. Scopes Text: 'ulcerated' mass based at anal verge & ext 3-4 cm up into rectum.

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.Do not code CS Tumor size using the size of an ulcerated mass.

Answer from:

  • I & R System

  • American College of Surgeons

    		•  2008
    		20071101 Multiplicity Counter/CS Tumor Size: The Multiplicity Counter rule 6c states "Use code 99 when the tumor is described as diffuse". Is code 99 used in all circumstances when tumor size is coded to 998? See Discussion. The CS manual lists esophagus, stomach, familila/familial polyposis (colon), lung, and breast as the only circumstances when code 998 is valid. If this is correct, then if TS is coded to 998, then Multiplicity Counter must be 99. If the number of tumors is known, code the number in Multiplicity Counter. If the number of tumors is not known, assign code 99. If "diffuse" is the only information available to describe the tumor, assign code 99. 2007