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Report Produced: 02/10/2026 07:10 AM

Report Question ID Question Discussion Answer Year
20091052 Multiple Primaries--Lymphoma: How many primaries should be reported when a left tonsil biopsy is diagnosed with marginal zone lymphoma (9699) and a cervical lymph node biopsy is diagnosed with marginal zone lymphoma and grade 3 follicular lymphoma (9699 and 9698)?

For cases diagnosed prior to 1/1/2010:

Abstract two primaries: The first is a marginal zone lymphoma of tonsil and the second is a follicular lymphoma of cervical lymph node. According to the Single versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases (the tri-fold chart), marginal zone lymphoma (9699) and follicular lymphoma (9698) are different primaries.

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
20091127

MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are to be accessioned for a patient with Neurofibromatosis 2 (NF2) who presents with meningiomas on the left and right side of the brain and multiple meningiomas of the spinal cord? See Discussion.

We have a patient with NF2 who also has meningiomas diagnosed on the left and right side of the brain as well as multiple meningiomas of the spinal cord. Are the meningiomas all one primary (separate from the NF2): C70.9 and 9530/1?

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

Report NF2 because it occurs with reportable neoplasms. Note: Report NF only once per patient.

Per MP/H Benign CNS Rule M4, the meningiomas of the meninges/brain (C70.0) and meninges/CNS (C70.1) are multiple primaries. Code the meningiomas of the spine to the histology to 9530/1 [Multiple meningiomas] (Rule H6) because there are multiple tumors in the spine.

Per Rule M5, the meningiomas of the right and left side of the brain are multiple primaries. Code of each to the histology 9530/0 [Meningioma, NOS] per Rule H2 because they are separate primaries (assuming there is one tumor on each side of the brain).

 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
20091030 MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10?

For cases diagnosed 2007 or later:

The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.

Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.

For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites.

 2009
20091129 Primary Site--Breast: What subsite is to be coded for a case of invasive Paget disease of the nipple with an infiltrating ductal carcinoma of the lower inner quadrant? Code C50.9 [Breast, NOS]. Code the last digit of the primary site to '9' for single primaries when multiple tumors arise in different subsites of the same anatomic site and the point of origin cannot be determined. Nipple [C50.0] and LIQ [C50.3] fit this rule. This is a single primary per MP/H Breast Rule M9. 2009
20091038 CS Tumor Size--Breast: Do the tumor size instructions in the CS Manual take priority over those in the SEER manual? See Discussion. In regards to priority order of sources to be used in coding size for breast and lung, we are instructed to use the site-specific instructions in the 2004 SEER Manual over the general instructions in the CS Manual (see SINQ 20061109). Thus, physical exam size would be used over an imaging size. I&R question 2389 instructs registrars to use an imaging size over a physical exam size. This inconsistency creates confusion for them. Do the answers given in I&R not take into account the information in the SEER Manual? As a SEER Registry, which rules do we tell our hospitals to use? Are ACoS accredited hospitals required to use I&R over SINQ?

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.The current SEER instructions and the CS instructions for source of tumor size information are the same. The tumor size priority source instruction in the 2004 SEER manual is not included in the 2007 SEER manual. SINQ 20061109 has been updated for clarification. There is no conflict between SEER instructions and I&R instructions at this time. SEER and the CoC collaborate, endeavoring to provide consistent instructions and to resolve inconsistencies.

 2009
20091118 Surgery of Primary Site--Corpus uteri: How are the surgery fields to be coded when patient undergoes hysterectomy and omentectomy for endometrial primary? See Discussion.

The example for instruction 6 in the 2007 SEER manual on page 179 (for surgery of primary site) states "code an en bloc removal when the patient has a hysterectomy and an omentectomy." There is no Site-Specific Surgery code for corpus uteri that combines hysterectomy with omentectomy. Is the information about removal of the omentum lost or is it documented under Surgical Procedure of Other Site?

Use the most appropriate code in the "Surgery of Primary Site field." Do not code the omentectomy in "Surgical Procedure of Other Site" when it is performed with a hysterectomy for an endometrial primary. 2009
20091050 Date of Multiple Tumors--Breast: How is this field coded when a second breast tumor is found at mastectomy two months after the original breast cancer was diagnosed, but during initial workup and treatment? See Discussion. Breast cancer was diagnosed on core biopsy on 02-27-07. It was not known that the breast was harboring 2 tumors until mastectomy was done on 4-01-07. Both tumors are counted as one primary. Code "Date of Multiple Tumors" field to the date of the mastectomy. That is the date that multiple tumors were discovered. 2009
20091079 Primary site--Bladder: What is the correct subsite for "interureteric ridge"? See Discussion. Description: 4 mm nodule at base of bladder near interureteric ridge.

For this case, assign code C670 [Trigone of bladder]. The description for this case states that the tumor location is the base of the bladder. Base is a synonym for trigone.

The interureteric ridge (or interureteric crest, or interureteric fold) is a fold of mucous membrane extending accross the bladder between the two ureteric orifices. The trigone is located below the interureteric ridge.

 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