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Report Produced: 05/06/2026 19:39 PM

Report Question ID Question Discussion Answer Year
20091033 CS Tumor Size--Ovary: Can the size of a tumor mass shadow seen on a CT scan be used to code CS Tumor Size? See Discussion. Ovarian primary: No surgery performed. CT abd/pelvis states "Bilateral pleural effusions, ascites. Right appendix region with tumor mass shadow 3 x 8 x 3.9cm"

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.Code CS tumor size 999 [Unknown; size not stated]. The size of the tumor is not known in this case.

Note that tumor size is not used for AJCC staging for ovary.

 2009
20091101 CS Reg LN Pos/Exam--Melanoma: How should these fields be coded for a case that is an unknown primary site melanoma with liver involvement and a positive axillary lymph node?

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.Code regional lymph nodes positive 01 [one positive lymph node] and regional lymph nodes examined 01 [one lymph node examined] (assuming the positive node was the only node examined).

If the only lymph node involvement is the positive axillary lymph node, it is reasonable to conclude that this is a regional lymph node. When only one chain of lymph nodes is involved with metastatic melanoma, the metastatic cells had to come from skin with direct drainage to those lymph nodes.

 2009
20091054

First course treatment--Liver: Is planned therapy second course therapy if it is administered after documented progression of disease? See Discussion.

A patient with hepatocellular carcinoma of the liver is waiting for a planned liver transplant. During the waiting period, a CT showed an increase in the liver nodule. The physician performed a bridging chemoembolization. Later on, the patient received a liver transplant. Is the liver transplant still first course treatment? Is the chemoembolization part of first course therapy? Per the SEER manual, first course therapy ends when the treatment plan is completed.

In this case, neither the chemoembolization nor the liver transplant is part of the first course of therapy. The documented treatment plan was changed after disease progression. Chemoembolization was not part of the original treatment plan. First course therapy ends at this point.

 2009
20091119

MP/H Rules/Multiple primaries--Lung: How many primaries are to be reported for an adenocarcinoma of the lung in the right middle lobe of the lung and bronchioalveolar carcinoma, non-mucinous type in the right upper lobe? See Discussion.

Bilobectomy revealed two tumors, adenocarcinoma in the right middle lobe and bronchioalveoar carcinoma non-mucinous type in the right upper lobe. MP/H rule M10 states that tumors with non-small cell carcinoma (8046) and a more specific non-small cell type (chart 1) are a single primary. Does rule M10 apply to only those cases for which one tumor is stated to be non-small cell, NOS? Or do we use chart 1 to identify specific subtypes? For this case, using chart 1, would we note that bronchioalveolar is a subtype of adenocarcinoma and count this case as a single primary? Most of the MP/H rules schemas have a rule making an adenocarcinoma and a more specific type of adenocarcinoma a single primary. Would we apply rule M10 to this case and count it as a single primary? Or would we move on to rule M11 and count the case as two primaries?

For cases diagnosed 2007 or later, Rule M11 applies. Accession two primaries.

Rule M10 applies only to cases for which one tumor is stated to be "non-small cell carcinoma."

 2009
20091108 MP/H Rules/Multiple Primaries--Lung: How do we apply the MP/H rules if a pathologist states a patient has multiple reportable primaries after he compares an October 2006 RLL lung specimen with a March 2009 RML lung specimen? See Discussion. Patient had a right lung lobectomy (RLL) in Oct. 2006 diagnosed as adenocarcinoma. In March of 2009, two nodules in the right upper lobe were identified. Following a RUL wedge resection, the pathology report indicated: Two foci of M.D. adenocarcinoma with mixed mucinous and micropapillary and solid patterns. COMMENT: The present tumor is compared to the previous adenocarcinoma reviewed in 2006. Although there is some overlap in their appearance, the present tumor shows a much greater component of mucinous adenocarcinoma. Because there is some difference in the appearance, and the nodule is located in a separate lobe, this will be dictated as a separate lung primary.

For cases diagnosed 2007 or later, this is two primaries.

MPH General Instructions tell us a pathologist may decide when there is recurrence when comparing the current tumor to a previous specimen. In this case, the pathologist did the comparison and documented that the second tumor is NOT a recurrence but a new primary.

Histologies described by the terms "pattern" and "component" do not indicate a more specific type when applying the histology rules. The histology for the 2009 diagnosis is adenocarcinoma [8140/3]. Rule H3 applies.

2009
20091076 Surgery of Primary Site/Scope Regional LN Surgery--Breast: How should these fields be coded when a sentinel lymph node dissection removes one-to-three axillary lymph nodes and a total/simple mastectomy is done? Assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast] for Surgery of Primary Site. Assign code 2 [Sentinel lymph node biopsy] for Scope of Regional Lymph Node surgery. Code 41 applies to a total/simple mastectomy with any number of sentinel lymph nodes removed -- as long as all of the nodes removed are designated as sentinel nodes. 2009
20091062 CS Site Specific Factor--Head & Neck: How is Site Specific Factor 2 coded when the pathologist describes regional lymph nodes as "matted"? See Discussion. The primary tumor is located in the tonsil. The patient underwent neck dissection. Pathology report stated there were matted regional lymph nodes. Does the term matted describe extracapsular extension? The definition for site specific factor 2 uses the term "fixed" to describe extracapsular extension (but not matted). For breast, fixed/matted appear to be interchangeable. Would they also be interchangeable for head and neck cases?

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."Matted" is not a synonym for "Fixed" in the CS schema for Head and Neck. "Matted" is not indicative of extracapsular extension for the Head and Neck schema.

 2009
20091055 Date therapy initiated/Systemic/Surgery Sequence--Breast: How are these fields coded when a patient has chemotherapy after a sentinel lymph node biopsy and has a lumpectomy after completing chemotherapy? See Discussion. On 4-10-08 a patient underwent sentinel lymph node biopsies. This was followed by chemotherapy which started on 4-15-08. The patient subsequently underwent a lumpectomy on 11-10-2008.

For this case, code Date Therapy Initiated to the date of the sentinel lymph node biopsy [04102008]. Assign code 3 [Systemic therapy after surgery] in Systemic/Surgery Sequence.

2009
20091037 MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle?

For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].

According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which 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
20091102 MP/H Rules/Histology--Thyroid: How should histology be coded for a diagnosis of "papillary sclerosing carcinoma" with an additional description of the tumor being "nonencapsulated"? See Discussion. Pathology report reads, "Papillary sclerosing carcinoma." In one case, the results are in CAP protocol format and next to 'Encapsulation of tumor' it says 'No.' In the other case, it is not in CAP format, but the microscopic description says, 'encapsulation of tumor - no.' Is the correct code 8350? For cases diagnosed 2007 or later, code 8350 [Nonencapsulated sclerosing carcinoma] per MP/H Other Sites Rule H11. The definition for 8350 in the Morphology section of ICD-O-3 includes nonencapsulated as well as diffuse sclerosing papillary carcinoma. When the pathologist states 'No' for encapsulated, that means nonencapsulated. 2009