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Report Produced: 05/06/2026 12:04 PM

Report Question ID Question Discussion Answer Year
20091130

MP/H Rules/Histology--Breast: What is the correct histology code and MP/H rule used for 1) infiltrating ductal carcinoma, mucinous type and 2) infiltrating ductal carcinoma with features of tubular carcinoma? See Discussion.

There is confusion as to which rule applies. Should the histologies be coded to 8480/3 [mucinous adenocarcinoma] and 8211/3 [tubular adenocarcinoma] respectively per rule H12? Rule H12 states to code the most specific histologic term; "type" and "with features of" are used in the pathologic diagnosis and are both terms that can be used to code the specific histology. Or would the histology be coded 8523 for both examples per rule H17 because neither histologic codes 8480/3 or 8211/3 are included as examples of duct carcinomas, nor are they included in Table 2?

For cases diagnosed 2007 or later, code 8523 [infiltrating duct mixed with other types of carcinoma] for

1. Infiltrating ductal carcinoma, mucinous type and

2. Infiltrating ductal carcinoma with features of tubular carcinoma

The infiltrating ductal types in Rule H12 are listed (8022, 8035, 8501-8508) and do not include mucinous or tubular. We cannot use this rule. The first rule that applies to these single tumors is H17, code to 8523. If you look up 8523 in the numerical morphology section of ICD-O-3, you will see similar examples included in the definition of this code.

2009
20091003 MP/H Rules/Histology--Peritoneal primary: Can the cell types from the primary site and a metastatic site be combined to code histology? See Discussion. Patient has vaginal mass biopsy diagnosed as 'papillary carcinoma with psammoma bodies.' Two weeks later the patient has laparoscopy with multiple peritoneal biopsies, diagnosed as 'well differentiated serous adenocarcinoma'. Patient stated to have peritoneal primary with mets to vagina and was treated with chemotherapy. Do we code the histology to 8441/31 from the primary site biopsies, or can we use 8460/3, combining the cell types from the primary and metastatic sites? Please see SINQ 20041062 for a similar question before the 2007 MP/H rules.

For cases diagnosed 2007 or later, assign code 8441 [serous adenocarcinoma, NOS].

Code the histology from the primary site when available. Do not combine histologies from primary and metastatic sites.

In this primary peritoneal case, the diagnosis from the peritoneal biopsies was serous adenocarcinoma.

 2009
20091072 Histology--Brain and CNS: How is histology coded for a "rosette-forming glioneuronal tumor" of the fourth ventricle?

Assign histology code 9505/1 [Ganglioglioma, NOS].

Rosette-forming glioneuronal tumor of the 4th ventricle is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.

 2009
20091128

MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a patient was diagnosed with breast carcinoma in 2001 and was subsequently diagnosed with a mammary carcinoma in a chest wall mass in 2008? See Discussion.

Patient was diagnosed with invasive lobular carcinoma of the right breast in April 2001. Following modified radical mastectomy in May 2001, the patient was disease free. In December 2008 the patient was diagnosed with a right chest wall mass, invasive poorly differentiated mammary carcinoma with lobular origin. If this is a new primary in 2008, would we code the primary site to breast or chest wall? Please see I&R answers 25924, 22163 and 26155 with similar case scenarios that give two different answers. One response indicates coding this type of scenario as new primary to chest wall and the other two responses indicate this should not be a new primary because the chest wall is a metastatic site. The pathology report does not state that this is metastatic and it is unknown if there is breast tissue left behind at the chest wall.

For cases diagnosed 2007 or later, this case is a single primary. The chest wall (NOS) is a metastatic site for breast cancer. There is no mention of residual breast tissue, so the 2008 diagnosis cannot be a new primary.

"Chest wall" is an ambiguous term. It can mean the internal chest wall or the external chest wall. When the path report states that the "recurrence" is in residual breast tissue, this is most likely the external chest wall and the residual breast tissue is part of the breast not removed by the MRM. In contrast, skin or the chest wall, NOS, are regional metastases.

 2009
20091007 CS Extension--Lung: How is this field coded for a tumor in the right middle lobe with extension to the bronchus intermedius?

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.

Assign CS extension code 20

[Extension from other parts of lung to main stem bronchus, NOS

(EXCLUDES superficial tumor as described in code 11)

Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)].

A right middle lobe tumor that extends to the bronchus intermedius is one that is extending to the main stem bronchus from another part of the lung. The bronchus intermedius is the lower part of the main stem bronchus on the right. It is more than 2.0 cm away from the carina.

 2009
20091063 CS Lymph Nodes--Head and Neck: How is this field coded when a positive neck FNA is followed by a neck dissection that contains one of seventeen positive lymph nodes? See Discussion. The primary site is the right tongue. The patient underwent FNA of a right neck mass that was positive for squamous cell carcinoma. Subsequent right modified radical neck dissection showed one out of seventeen nodes positive for metastatic carcinoma. For head and neck primaries, the CS LN codes 10-19 represent a single positive ipsilateral regional node. Codes 20-29 represent multiple positive ipsilateral nodes.

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.If the neck dissection included the area of the positive FNA, count only the positive nodes from the dissection. Avoid double-counting a positive node for both an FNA and a dissection.

In the unlikely event that the dissection did not include the area of the positive FNA, add one positive node to the count from the dissection.

This instruction supersedes previous instructions.

 2009
20091019 MP/H Rules/Histology--Hematopoietic, NOS: Can a diagnosis of multiple myeloma be made if a bone marrow biopsy is negative? See Discussion. Patient with large mass nasal cavity. Biopsy shows plasmacytoma. Fine needle aspiration of the acetabulum is consistent with multiple myeloma. Skeletal survey shows multiple lytic lesions. Bone marrow biopsy is negative for myeloma. In light of negative bone marrow biopsy can this case be coded as multiple myeloma?

For cases diagnosed prior to 1/1/2010:Code this case as multiple myeloma. The fine needle aspiration of the acetabulum is a biopsy of bone marrow. According to our pathologist consultant, the positive bone marrow biopsy (acetabulum) and the multiple lytic bone lesions confirm multiple myeloma. The negative bone marrow biopsy is likely due to an insufficient sample.

For cases diagnosed 1/1/10 and later, 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.

 2009
20091023 Sugery of Primary Site--Breast: When a patient is simultaneously diagnosed with bilateral breast cancer and bilateral mastectomies are done, do you code the total mastectomies to 40 or 41 or 42?

Abstract cancer of the left breast and cancer of the right breast as separate primaries. Code the surgery for each primary independent of the other primary.

For the first primary, assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast].

For the second primary, assign the code for the procedure performed on that site.

 2009
20091001 CS Lymph Nodes/CS Mets at DX--Ovary: Are lymph nodes in the pericolic mesentery of the sigmoid that are removed during ovarian cancer debulking surgery, coded as regional or distant? See Discussion. Debulking surgery found tumor in both ovaries and in lymph nodes of pericolic mesentery, which was removed en bloc with a segment of sigmoid colon (colon had tumor implants involving serosa). Pericolic nodes are not listed as regional for ovary. However Note 2 in the CS manual for Extension states "sigmoid mesentery" is a regional pelvic organ, and that metastatic deposits here should be coded in the extension field, not as distant mets. Should lymph nodes from this same area be coded as regional or distant?

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.

Lymph nodes in the mesentery of the sigmoid colon are regional for an ovarian primary. Code involved sigmoid mesenteric nodes under CS Lymph Nodes.

 2009
20091020 MP/H Rules/Histology--Breast: How do you code histology for a breast tumor when the comment section of the pathology report compares the current resected specimen with a previous needle biopsy? See Discussion. A single tumor is described on the breast needle biopsy as "infiltrating lobular carcinoma and ductal carcinoma in situ" and on the lumpectomy specimen as "infiltrating duct carcinoma." Per the COMMENT section on the pathology report: "Tumor resection was compared to previous needle biopsy. The appropriate designation is probably a terminal duct/lobular lesion." For cases diagnosed 2007 or later, assign code 8522 [Infiltrating duct and lobular carcinoma] according to Breast MP/H rule H16. The comment on the lumpectomy pathology report takes both the lumpectomy information and the biopsy information into consideration. "Probable" is an ambiguous term used to code histology. 2009