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Report Produced: 02/11/2026 10:36 AM

Report Question ID Question Discussion Answer Year
20091018 MP/H Rules/Multiple Primaries/CS Extension: How many primaries are to be accessioned when tumors are present bilaterally in the pleura and fallopian tubes? See Discussion.

For both pleura and fallopian tube, the MP/H rules indicate that bilateral involvement of these sites should be coded as multiple primaries. However, both of these sites have CS extension codes that classify the contralateral disease as regional extension.

Is a case described as a left sided pleural mesothelioma that has right sided pleural disease coded as one or two primaries? How is CS coded?

For cases diagnosed 2007 or later:

For a pleural or fallopian tube primary, if there is tumor(s) on the left and separate tumor(s) on the right and neither is stated to be metastatic from the other, abstract as multiple primaries according to rule M8 for other sites. If both sides are involved, but there is only one tumor, rule M2 for other sites applies and this is a single primary. Code each primary separately in CS.

 2009
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
20091130

MP/H Rules/Histology--Breast: What is the correct histology code and MP/H rule used for 1) infiltrating ductal carcinoma, mucinous type and 2) infiltrating ductal carcinoma with features of tubular carcinoma? See Discussion.

There is confusion as to which rule applies. Should the histologies be coded to 8480/3 [mucinous adenocarcinoma] and 8211/3 [tubular adenocarcinoma] respectively per rule H12? Rule H12 states to code the most specific histologic term; "type" and "with features of" are used in the pathologic diagnosis and are both terms that can be used to code the specific histology. Or would the histology be coded 8523 for both examples per rule H17 because neither histologic codes 8480/3 or 8211/3 are included as examples of duct carcinomas, nor are they included in Table 2?

For cases diagnosed 2007 or later, code 8523 [infiltrating duct mixed with other types of carcinoma] for

1. Infiltrating ductal carcinoma, mucinous type and

2. Infiltrating ductal carcinoma with features of tubular carcinoma

The infiltrating ductal types in Rule H12 are listed (8022, 8035, 8501-8508) and do not include mucinous or tubular. We cannot use this rule. The first rule that applies to these single tumors is H17, code to 8523. If you look up 8523 in the numerical morphology section of ICD-O-3, you will see similar examples included in the definition of this code.

2009
20091094 Reportability--Anal canal: Are squamous cell carcinomas arising in a condyloma of the rectum reportable or should we assume that the site is skin of anus or perianal area and not reportable? Squamous cell carcinoma arising in a rectal condyloma is reportable. Do not assume the site is skin of anus or perianal. 2009
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
20091009 MP/H Rules/Histology--Kidney: How do you code histology for a renal cell carcinoma when pathologists disagree as to whether or not the tumor is consistent with thyroid-like follicular carcinoma of the kidney? See Discussion. Final diagnosis states 'left radical nephrectomy, renal cell carcinoma.' The CAP Histologic Type is listed as: Unclassified, most consistent with primary thyroid-like follicular carcinoma of the kidney.' Because of the unusual histology it was sent for a consult to a genitourinary pathology specialist. His response was: 'histologic features not typical for any of the known subtypes of renal cell carcinoma and are not consistent with primary thyroid-like follicular carcinoma of the kidney, a distinct renal tumor that we have recently published in the literature.' The tumor was TTF-1 negative, arguing against metastasis from a thyroid primary. For cases diagnosed 2007 or later, assign code 8312 [renal cell carcinoma, NOS]. The diagnosis is renal cell carcinoma, but the specific type is in question. 2009
20091085 MP/H Rules/Histology--Breast: How is histology coded for a breast primary with a final diagnosis of "infiltrating duct carcinoma with apocrine features"? See Discussion. I & R has conflicting answers: #25719 (dated 3/17/2008) says per rule H12 this is 8401/3 but #23347 (dated 8/12/07) says per rule H16, this is 8523/3.

For cases diagnosed 2007 or later, assign histology code 8401/3 [apocrine adenocarcinoma] according to rule H12. Apocrine is a type of duct carcinoma, see table 1. Code 8401 should be listed in Rule H12. Apocrine should be removed from table 3.

These corrections will appear in the revised version of the rules.

 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
20091097

Multiple Primaries--Lymphoma: How many primaries should be abstracted if DLBCL (9680/3) and Mantle Cell Lymphoma (9673/3) occur at the same time in different lymph nodes? How would Sequence be coded if the case is multiple primaries?

For cases diagnosed prior to 1/1/2010:It is important to note for this case that the two different types of NHL occurred in different lymph nodes; one type in one lymph node and the other type in another lymph node.

Use the fold-out table to determine single vs multiple primaries. According to the table, 9673/3 and 9680/3 would be two primaries no matter which of these was "first."

Assign the lower sequence number to the primary with the worse prognosis when two primaries are diagnosed simultaneously. Base the prognosis decision on the primary site, histology, and extent of disease for each of the primaries. If there is no difference in prognosis, the sequence numbers may be assigned in any order.

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
20091023 Sugery of Primary Site--Breast: When a patient is simultaneously diagnosed with bilateral breast cancer and bilateral mastectomies are done, do you code the total mastectomies to 40 or 41 or 42?

Abstract cancer of the left breast and cancer of the right breast as separate primaries. Code the surgery for each primary independent of the other primary.

For the first primary, assign code 41 [Total (simple) mastectomy, NOS WITHOUT removal of uninvolved contralateral breast].

For the second primary, assign the code for the procedure performed on that site.

 2009