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Report Produced: 02/10/2026 16:08 PM

Report Question ID Question Discussion Answer Year
20091025

MP/H Rules/Multiple primaries--Urinary: How should we handle urinary tract tumors diagnosed before the MP rules went into effect when determining the number of primaries to report primaries? How do you apply rules M5, M6 and M8 when an invasive bladder tumor and other urinary site tumors occur before and after the effective date of these rules? See Discussion.

Example: Patient with a prior in situ carcinoma of the bladder in 11/89, left ureter papillary transition cell carcinoma in situ diagnosed in 5/05, left renal pelvis papillary transition cell carcinoma in situ diagnosed in 8/07 and invasive bladder carcinoma diagnosed in 3/08. When an invasive bladder tumor and other urinary site tumors occur, do you stop with the bladder at rule M5 and M6 never reaching M8?

For cases diagnosed 2007 or later:

Use the 2007 MP/H rules for urinary sites to assess diagnoses made in 2007-2014. Use the multiple tumors module to compare a diagnosis in 2007-2014 to an earlier diagnosis.

For the example above, start by comparing the left renal pelvis diagnosis in 8/07 to the earlier left ureter primary diagnosed 5/05. Start with rule M3. Stop at rule M8. The 8/07 renal pelvis diagnosis is not a new primary. Next, compare the 3/08 bladder tumor to the earlier left ureter primary diagnosed 5/05. Start with rule M3. Stop at rule M5. The 3/08 bladder tumor is a new primary because it is an invasive diagnosis following an in situ diagnosis. Use only the more recent of the two earlier urinary diagnoses for comparison. Do not compare the 2007 and later diagnoses to the 11/89 in situ bladder primary in this case.

 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
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
20091049 P/H Rules/Multiple Primaries--Lung/Breast: Can we assume that a current tissue specimen is a recurrence of previous primary if a pathologist states that he has compared the current specimen with the slides from the prior tumor and concludes that the current tumor is "similar" to a previous tumor? See Discussion.

The MP/H rule general information section states that we do not accession a second primary unless a pathologist compares the current tumor to the original tumor and states that the current tumor is a recurrence of cancer from the previous primary. In our experience it is rare that a pathologist speaks so bluntly. They frequently hedge somewhat.

Are the following statements worded strongly enough for us to make the assumption that the current tumor is a recurrence of patient's previous cancer?

Example 1: Pathologist states: Patient's prior lung tumor reviewed. The tumor in the current case (left lower lobe) shows similarities to some areas of the patient's prior left lower lobe tumor.

Example 2: Pathologist states: The focus of ductal carcinoma in the mastectomy specimen does resemble the carcinoma in the previous partial mastectomy specimen. (Slides reviewed).

All pathologists do not use words in the same way. Therefore, we will not provide a list of specific words to accept or not to accept in order to determine recurrence. For cases diagnosed 2007 or later, do not base your decision about recurrence on words such as "similar" or "resembles." If the pathologist believes two or more tumors are the same or believes one is a recurrence of another after comparison, accept it. When pathologists believe that two or more tumors are not the same or believe that one is not a recurrence of another, there is usually a strong statement indicating that opinion. 2009
20091048 Surgery of Primary Site--Lymphoma/Soft Tissue: How is this field coded for an excision of a neck mass that found lymphoma in soft tissue (C49.0)? See Discussion. CT scan showed soft tissue mass in the retropharynx. 9/23/2008 Laryngoscopy with biopsy taken of left tonsil and left base of tongue and random biopsies of nasopharynx; FNA of left neck. Path stated left tonsil, squamous papilloma. Left base of tongue, no significant histopathology. Nasopharynx biopsies, compatible with tonsillar tissue. Pretracheal lymph node biopsies, mild reactive lymphoid hyperplasia. 9/30/2008 Excision of left neck mass with limited deep jugular chain lymph node dissection. Path stated lymph node left jugular biopsy, no tumor seen. Soft tissue, left neck biopsy, malignant B cell lymphoma with plasmacytoid differentiation. Addendum from consult: favor a diagnosis of a marginal zone lymphoma. Per the gross description, the specimen was fibrofatty connective tissue in which there is a tumor infiltrate. Assign code 26 [partial resection]. Use the surgery codes that apply to the primary site. See page C-597 of the 2007 SEER manual for surgery of primary site codes applicable to primary sites of soft tissue coded to C490 - C499. 2009
20091068 Primary site--Bladder: What is the appropriate subsite for "adjacent to the bladder neck"? Assign code C679 [Bladder, NOS]. It is not possible to determine the location of the tumor from the description. A tumor that is "adjacent to bladder neck" could be located in the trigone or on the bladder wall (anterior, posterior or lateral). 2009
20091090 First course treatment--Leukemia: How should an allogeneic stem cell transplant for acute myeloid leukemia be coded in the Hematologic Transplant and Endocrine Procedures field? See Discussion. There is debate as to whether this procedure should be coded as a 12 in order to capture the allogeneic part of the procedure. Assign code 20 [Stem cell harvest (stem cell transplant) and infusion as first course therapy] for stem cell procedures, even allogeneic procedures. 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
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
20091065

Primary Site/CS Extension--Lymphoma: How are these fields coded for a non-Hodgkins lymphoma case with scans that show non-specific parenchymal lung nodules and a large mediastinal mass? See Discussion.

Patient presented with large bulky mediastinal mass. CT showed no pleural effusion. Findings also show non-specific parenchymal lung nodules. Biopsy of mediastinal mass showed malignant B-cell lymphoma of follicle center cell origin. Abdomen /Pelvis CT showed borderline lymph nodes in bifurcation. Clinical diagnosis was probable stage 3 if not 4 lymphoma. Per lymphoma guidelines, if extra-nodal primary site is assigned to the extranodal site if an extra-nodal site and its regional lymph nodes are involved. Would the parenchymal lung nodules be indicative of pulmonary involvement? If so, would primary site be lung? Or, would the parenchymal nodules be stage 4 disease and primary site be assigned to lymph nodes?

For cases diagnosed prior to 1/1/2010, 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 Primary Site to C779 [Lymph node, NOS]. In this case, there is no statement that lymphoma involves the lung. "Nonspecific parenchymal lung nodules" are not indicative of lymphoma involvement. Consequently, this cannot be assumed to be an extra-nodal lymphoma. Additionally, it is not clear whether or not the "borderline" pelvic lymph nodes are involved. If the physician cannot provide more information, follow instruction 4.e in the SEER manual on page 72.

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