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Report Produced: 02/11/2026 12:10 PM

Report Question ID Question Discussion Answer Year
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
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
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
20091078 MP/H Rules/Multiple Primaries--Head & Neck: How many primaries should be reported when an invasive squamous cell carcinoma of the right mandibular body (C06.9) was diagnosed in 2004 (treated with surgery and radical neck dissection), and an invasive squamous cell carcinoma of the left buccal mucosa (C06.0) was diagnosed in 2007? See Discussion. According to the MP/H Rules, it appears Rule M12 would apply since none of the others fit and these would be a single primary.

For cases diagnosed 2007-2014:

Based on the information provided, the primary site code for the 2004 primary should be C031 [mandibular gingiva, lower alveolar mucosa, etc.].

The 2007 diagnosis would be a separate primary according to rule M7 because the patient was disease free following treatment for the 2004 diagnosis. C031 and C060 are different at the third character.

 2009
20091084 Primary site--Colon: How do you determine the correct subsite when there is conflicting information in different reports? Are there priority rules for coding subsite for sites other than Head and Neck? See Discussion. The path report for a hemicolectomy says, " Specimen: left colon..." and the microscopic says, "...received in formalin designated left colon..." The Operative procedure report says, "Postoperative diagnosis - splenic flexure tumor." The text of this report says, "Mobilizing the splenic flexure mass was incredibly difficult..." and then goes on to describe exactly how and where it was resected. The discharge summary says adenosquamous carcinoma of the splenic flexure. SINQ20051010 says to use the pathology report first, but this was written before the new MP/H rules.

Use the operative report information to code primary site in this case. It is more accurate.

The operative report is usually a better source of location information compared to the pathology report. The pathologist can only reiterate the location as it was reported to him/her.

The 2007 SEER manual states "Unless otherwise instructed, use all available information to code the site," page 69.

 2009
20091024

MP/H Rules/Multiple primaries--Urinary: Are diagnoses in bladder, ureter, renal pelvis, and other urinary made prior to 2007 used in determining multiple primaries? See Discussion.

Per the General Information for MPH, Rule #3, the rules are effective for cases diagnosed January 1, 2007 and after. Do not use these rules to abstract cases diagnosed prior to January 1, 2007.

Example: Is a 2006 diagnosis of a renal pelvis primary with the histology 8130/3 and a 2007 diagnosis of a bladder primary with histology 8130/3 "multiple tumors" or is the bladder tumor a new primary because it is a single tumor at the time of diagnosis in 2007?

For cases diagnosed 2007 or later:

Use the 2007 MP/H rules for urinary sites to assess tumors diagnosed in 2007 or later.

For the example above, use the 2007 rules to determine whether or not the bladder tumor diagnosed in 2007 is a new primary. Use the Multiple Tumors module when comparing a 2007 or later diagnosis to an earlier diagnosis. Start with rule M3. Stop at rule M8. The 2007 bladder urothelial tumor is not a new primary since there is an existing 2006 renal pelvis urothelial primary.

 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