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Report Produced: 02/19/2026 18:21 PM

Report Question ID Question Discussion Answer Year
20031133 First Course Treatment--Thyroid: Is hormone replacement following total thyroidectomy coded as first course treatment for all thyroid cases?

Code Hormone therapy as 01 [Hormone therapy administered as first course therapy] when thyroid replacement therapy is part of the first course of treatment for follicular or papillary thyroid cancer following thyroidectomy.

Thyroid hormone replacement therapy has a treatment effect on differentiated (follicular and papillary) carcinomas of the thyroid. This treatment effect is not seen for most medullary and undifferentiated thyroid cancers.

 2003
20031052

Diagnostic Confirmation--Hematopoietic, NOS: Is a multiple myeloma diagnosed by an FNA of the lumbar spine (or any other non-bone marrow location) a diagnostic confirmation 1 or 2? See Description.

Does the rule on page 111 of the SEER Program Coding Manual, 3rd Edition, for code 1 apply to myelomas (in the same way it applies to leukemias)?

Assign code 1 [Positive histology] for aspiration of bone marrow. This rule is not limited to leukemias.

 2003
20031198 Surgery of Primary Site/Date Therapy Initiated--Head & Neck: Would a biopsy, NOS, that removed the majority of the tumor be used to code these fields? See Description. Patient underwent biopsy, NOS, of a carcinoma of the tongue. Subsequent glossectomy revealed microscopic focus of residual squamous cell carcinoma. If the biopsy NOS removed all macroscopic disease, code the date of the biopsy NOS as the date therapy initiated. If macroscopic disease remained following the biopsy NOS, code the glossectomy date as the date therapy initiated. 2003
20031066 Histology (Pre-2007): Is 8524 [lobular mixed with other carcinoma] or 8490 [signet ring cell carcinoma] used to represent a diagnosis of "infiltrating lobular with signet ring features?"

For tumors diagnosed prior to January 1, 2004:

According to our pathologist consultant, for this specific case, code to 8490 [Signet ring cell carcinoma].

Our pathologist states: "Signet ring cell carcinoma is most often a variant of lobular carcinoma (as it appears to be in this case - it is less frequently a variant of ductal), and I think it's appropriate to code it as such. Coding to lobular would also be ok, though that would lose the special feature of the signet ring cells. I would rather not code to 8524, since it is not really a mix of lobular and something else."

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
20031196 EOD-Pathological Extension--Prostate: How is this field coded when biopsy findings differ from prostatectomy findings? See Description. Needle biopsy of prostate clearly states cancer arising in the apex. Clinical extension would then be 33. After prostatectomy, the path report states only one lobe involved with cancer and the apex was negative for cancer. Would the pathological extension then be coded to a 20 to truly reflect the surgical findings? For cases diagnosed 1998-2003: Combine the information from the needle biopsy and the prostatectomy and code the pathologic EOD to 34 [Extending to the prostatic apex]. The case example above is very similar to Example 4 on page 2 of the Prostate EOD Coding Guidelines. 2003
20031134 Surgery of Primary Site/Immunotherapy--Bladder: Is administration of BCG coded as both surgery and immunotherapy? Yes, code as both surgery and immunotherapy. The CoC included immunotherapy/BCG under surgery and also under immunotherapy by request of the clinical advisor for bladder, reflecting the mixed-modality nature of the treatments. [Answer from CoC I & R] 2003
20031034

Histology (Pre-2007)--Kidney, renal pelvis: What codes are used to represent the histologies of 1) "renal papillary (chromophil) carcinoma" and 2) "chromophil renal cell carcinoma?"

For tumors diagnosed prior to 2007:

Code "chromophil" to 8260 [papillary renal cell]. According to our pathologist consultant, in the case of chromophil, most authors regard this as more or less synonymous with papillary renal cell [8260]. "More or less" because papillary is an old term descriptive of the microscopic structure, while chromophil is newer and based on the cytology; because most of the latter are papillary the current usage assumes them to be equivalent.

1) The diagnosis "renal papillary (chromophil) carcinoma" tells us that the pathologist who wrote it was seeing both pattern and cytologic features, and is regarding papillary equivalent to chromophil; thus, code to 8260.

2) Code "chromophil renal cell carcinoma" to 8260.

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
20031174 Multiple Primaries (Pre-2007)/Recurrence--Breast: Has SEER established a priority of medical opinions to determine the number of primaries or a time parameter establishing recurrence? When a pathologist and a physician refer to the subsequent reappearence in the same breast as both "recurrence" and "new primary"? See Description.

Example 1. Patient was diagnosed with right breast cancer in 1999 and underwent lumpectomy followed by radiation therapy. In 2001, patient was again found to have right breast cancer and was admitted for mastectomy. The surgeon stated that this was recurrence. The patient's primary care physician stated the patient had a new primary. Is there a priority order if the multiple physicians involved in a patient's care do not agree on the diagnosis?

Example 2. Patient was diagnosed in 1998 with left breast cancer. In 2000, the patient again was diagnosed with left breast cancer. There was no mention of recurrence so case was accessioned as a second primary. In 2003, patient was again admitted for an unrelated disease. In the H&P, the physician stated that the patient had recurrent breast cancer in 2000. Do we remove the second primary from our file based on this statement three years later?

Example 3. Patient was diagnosed with Paget's disease with intraductal carcinoma, left breast, in 1997. In August 2002, patient underwent left mastectomy for DCIS, left breast. In November 2002, patient's oncologist stated that patient had been on Evista for 5 years and had recurrent cancer despite Evista. Do we accession this as one or two primaries?

For tumors diagnosed prior to 2007:

Use the best information available. In general, information from the time closest to the event in question is more accurate than later information. The opinion of the pathologist tends to be the most valuable. Beyond that, SEER has not established a hierarchy of physician opinions.

Be aware that a physician's use of the term "recurrence" does not always mean that the second tumor originated from cells from the first tumor.

Examples 1, 2 & 3. Follow SEER rules for determining multiple primaries. In each case, the diagnoses are more than two months apart. Abstract as two primaries.

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
20031036 Histology--Hematopoietic, NOS: When both the path and clinical diagnoses simultaneously reflect reportable diagnoses but one is a worse form of the same disease process, which diagnosis do we code? See Description. Would this case be coded to RAEB or AML? Bone marrow diagnosis: Hypercellular marrow with profound trilinieage dyspoietic changes. Comment: the features are consistent with RAEB. Clinical diagnosis five days later states: Myelodysplastic syndrome, early acute myelocytic leukemia (likely AML).

For cases diagnosed prior to 1/1/2010:When several diagnoses are made as part of the diagnostic process within two months, code the one with the worst prognosis.

Code the case example as acute myelocytic leukemia.

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.

2003
20031151 EOD-Size of Primary Tumor: Can size be coded from a needle bx that removes all of the invasive tumor and just leaves a "focus of in situ"? See Description. For example: needle bx diagnosis is "tiny focus of tissue highly suspicious for tubular ca." The lumpectomy path states "single focus of low grade DCIS, no residual ductal ca." Can size be coded 001? Code tumor size to 001 [Microscopic focus or foci only] for the invasive component. Code the tumor size 990 for cases diagnosed in 2004 and forward. Disregard the microscopic tumor found at further resection. 2003