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Report Produced: 09/09/2025 17:19 PM

Report Question ID Question Discussion Answer Year
20220038

Solid Tumor Rules/Histology--Thyroid:  What is the histology code for sclerosing mucoepidermoid carcinoma with eosinophilla in the left thyroid and papillary thyroid carcinoma in the right thyroid?  See Discussion.

The left thyroid lobectomy/isthmusectomy returned a diagnosis of sclerosing mucoepidermoid carcinoma with eosinophina, 6.5 cm, replacing nearly the entire left lobe of the thyroid.

The patient has a completion thyroidectomy of the right lobe and returned the diagnosis of papillary thyroid carcinoma, 0.5 mm, in maximum dimension.

The endocrinologist describes it as "co-exsisting" and states the tumor is iodine non-avid.

Abstract two primaries and assign code 8260/3 (papillary adenocarcinoma, NOS) to the right thyroid using Solid Tumor Rules, Other Sites, Rule H14, and 8430/3 (mucoepidermoid carcinoma) to the left thyroid as these are separate tumors with different histology types according to WHO Classification of Tumors of Endocrine Organs, 4th edition.

 2022
20220027

Reportability/Heme & Lymphoid Neoplasms--CNS: Is ALK-positive histiocytosis, primary site Central Nervous System (CNS), reportable, and is the correct histology code 9750/3? See Discussion.

2022 case: Surgical Pathology Report-spinal cord tumor, biopsies: ALK-positive neoplasm most consistent with ALK-positive histiocytosis.

Report this 2022 case of ALK-positive histiocytosis using histology code 9751/3, Langerhans cell histiocytosis, disseminated. Use text fields to document that this is a case of ALK-positive histiocytosis. This term may be assigned a new code once the 5th edition of the Hematopoietic WHO Blue Book is released.

 2022
20220024

Update to Current Manual/Residence at diagnosis:  Would an exchange student be a temporary resident of the SEER area or a non-resident?  See Discussion.

A 17 year old exchange student was brought into the hospital with appendicitis.  The patient had an appendectomy; there was no follow up treatment.  5/27/2006 pathology report of vermiform appendix:  Adenocarcinoid appendix <5 mm tumor limited to appendix.

The patient has no record in Lexis Nexus and no social security number.  The address is a post office box; additionally, the patient’s birthplace is Switzerland and is lost to follow up.

Code the residence where the student is living for exchange students temporarily living in the U.S.  Code the temporary address if known or the Post Office Box if unknown.  We will add this scenario to the next release of the SEER manual.

 2022
20220016

Histology--Thyroid:  What is the correct histology code for a follicular carcinoma, minimally invasive, oncocytic variant of the thyroid?  See Discussion.

There is an ICD-O histology code for follicular carcinoma, minimally invasive (8335/3) as well as follicular carcinoma, oxyphilic cell (8290/3). Per SINQ 20150045, the term oncocytic is synonymous with oxyphilic in this context.

The Multiple Primaries/Histology General Instructions and histology rules do not include the term “variant” as a term that can be used to code a further histologic subtype. The term “variant” can be used for the Other Sites (non-updated STR sites) when the ICD-O-3.2 (or ICD-O-3 for older cases) provides the term “variant” in the histology name.

Code follicular carcinoma, minimally invasive, oncocytic variant of the thyroid to follicular carcinoma, oncocytic variant (8290/3).  The term "variant" is commonly used in thyroid histologies and if appropriate, used to determine histology code. The WHO Classification of Tumors of Endocrine Organs, 4th edition, lists synonyms for 8290/3 as Hürthle cell carcinoma; oncoycytic carcinoma; oxyphilic carcinoma; follicular carcinoma, Hürthle cell type; and follicular carcinoma, oncocytic variant.

 2022
20220041

Primary Site/Histology--Intrahepatic Duct:  How are primary site and histology coded for cholangiocarcinoma cases when the pathology only shows a liver tumor and other involvement.  See Discussion.

A common scenario is a patient has a positive CT of the abdomen/pelvis for liver mass only. Biopsy of the liver mass is positive for cholangiocarcinoma. The physician is also calling the liver tumor the primary site with histology of cholangiocarcinoma. There is no evidence of intrahepatic bile duct (C221) or gallbladder (C240) involvement which are sites specific to this histology. The hematology/oncology consult stages this as Stage IIIA, T3N0M0 intrahepatic cholangiocarcinoma.  Can we code cholangiocarcinoma with site code C220 (liver) or should we assume that C221 (intrahepatic bile ducts) would be a better code to reflect this histology?  

Assign C221 (intrahepatic bile duct) as the primary site for cholangiocarcinoma (8160/3).  Our expert GI pathologist confirms that even when intrahepatic bile ducts are not specifically mentioned, intrahepatic cholangiocarcinoma originates in the intrahepatic bile ducts.

 2022
20220011

Reportability/Ambiguous Terminology:  When the only source of information states the diagnosis as two terms, one reportable and one non-reportable, separated by a "slash" (/), should we report the case using the reportable term?  See Discussion.

For example:

-ultrasound of the right eye: consistent with a nevoma/melanoma; we could not find any indication that nevoma is a reportable term

-bladder biopsy pathology report:  severe urothelial dysplasia/carcinoma in situ (CIS)

As a central registry, we receive some limited information cases like this where there is no record of treatment or possibility to follow-back to physicians for clarification, so we want to make sure we are reporting them correctly.

If possible, try to obtain further information.

If no further information can be obtained, accession the case using the reportable term, melanoma and CIS in the respective examples, when there is a single report in which both reportable and non-reportable diagnostic terms are listed with a slash and there is no other information.  Most often, the slash indicates the terms are being used synonymously.

 2022
20220018

Solid Tumor Rules/Histology--Thyroid:  What is the correct histology code for the following thyroid primary with multiple tumors abstracted as one primary diagnosed prior to 2021?  See Discussion.

2016 Total thyroidectomy, Multifocal

-Dominant Tumor:  Right Lobe, Papillary thyroid carcinoma (8260/3)

-Tumors two through five:  Three tumors Papillary thyroid carcinoma (8260/3), and one tumor Papillary thyroid carcinoma, follicular variant (8340/3)

-An additional tumor: Non-invasive follicular thyroid neoplasm with papillary-like nuclear features (8343/2)

Code this multifocal thyroid carcinoma, single primary, as papillary thyroid carcinoma, follicular variant (8340/3) using Solid Tumor Rules, Other Sites, Rule H13 that says to code the most specific histologic term. We consulted with our endocrine specialty pathologist and when there is a mix of papillary and follicular variants, assign 8340.

Non-invasive follicular thyroid neoplasm with papillary-like nuclear features is coded as 8349/1 beginning in 2021.  According to the WHO Classification of Endocrine Organs, 4th edition, it was formerly classified as non-invasive encapsulated follicular variant of PTC (FVPTC) (8343/2) but was reclassified based on extremely low malignant potential.

 2022
20220020

Histology--Thyroid: What is the correct histology code for a thyroidectomy with final diagnosis of “Right lower lobe: papillary microcarcinoma, conventional type, 0.8 cm. Isthmus: papillary microcarcinoma, follicular variant, 0.2 cm. Left lobe: Papillary carcinoma, conventional, unencapsulated.” See Discussion.

We were previously told that papillary microcarcinoma is coded to 8260 (papillary thyroid carcinoma) and not papillary microcarcinoma (8341). That is an area of confusion. 

Based on the information provided, code histology to follicular variant of papillary thyroid carcinoma (8340/3).  The tumor is a mix of papillary and follicular variants.

 2022
20220022

Tumor Size--Pathologic--Anus: In 2019, the pathology report of an anal canal squamous cell carcinoma stated the tumor size is 2.5 cm from proximal to distal (3.5 cm in circumference).  Is the pathologic tumor size tumor size 025 or 035? 

Based on the information provided, code the tumor size as 035.  We asked an expert pathologist to review this question and she said to use the larger measurement.  She also said "the pathologist usually cuts the anus and rectum open like a tube; the “circumference” would be measured flat."

 2022
20220034

First Course Treatment--Lymphoma: Is the first round of systemic therapy coded as first course of therapy or is it all the therapy given to achieve remission for a lymphoma case with multiple treatments?  See Discussion.

Lymphoma case diagnosed in 2021: The patient had first round of systemic therapy as documented in the treatment plan and a post-chemotherapy PET scan that showed residual disease. The patient then had a different combination of systemic therapy and still had some residual disease. The patient was given a third round of different combination of systemic therapy in preparation for stem cell transplant. According to the physician post-stem cell transplant note, the patient achieved complete remission.

Is the first course of therapy the first round of systemic therapy only or is it all the therapy given to achieve remission?  It seems like only the first round of systemic therapy is first course of therapy for both leukemia and lymphoma in the hematopoietic manual. I thought all treatment for all hematopoietic cases was first course until remission achieved or progression was evident.

Code all treatments the patient received as first course of treatment. For lymphoma and leukemia, first course of treatment may include first-line, second-line, consolidation, maintenance, salvage, etc., any treatment to achieve remission.

We have added this to the agenda for the 2024 updates to the Hematopoietic Manual and Database.

 2022