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Report Produced: 02/11/2026 14:06 PM

Report Question ID Question Discussion Answer Year
20091082 Behavior--Breast: How is this field coded for a case in which the final diagnosis reports DCIS, but the CAP protocol or microscopic findings show microinvasion? See Discussion.

1. Path report for breast cancer has final diagnosis as 'DCIS' but the CAP protocol in the body of the report says 'microinvasion seen, T1mic.'

2. Path report says 'DCIS' in the final diagnosis and microinvasion is identified in the microscopic portion of the report, but it is not in CAP protocol format and not stated in the final diagnosis.

Code both scenarios /3 [malignant (invasive)]. Information regarding behavior is not limited to the final diagnosis or the CAP protocol. See page 84 in the 2007 SEER manual:

Code the behavior as malignant /3 if any portion of the primary tumor is invasive no matter how limited; i.e. microinvasion.

 2009
20091057 CS Site Specific Factor--Lymphoma: Can the term "intermediate risk" be used to code IPI score? See Discussion. Patient has Hodgkin disease. The physician states that the patient has bulky stage IIA intermediate risk disease. Is the term "risk" another way of stating IPI score? If so, how would intermediate risk be coded?

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 SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown].

 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
20091077 CS Site Specific Factor--Head & Neck: Can SSF 1-6 be coded using clinical information only, or does the source of information for lymph nodes need to be pathological?

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.CS Site Specific Factors 1 through 6 for head and neck sites may be coded using either clinical or pathologic information.

 2009
20091031 MP/H Rules/Histology--Thyroid: How is histology coded for a thyroid tumor described as "predominantly papillary carcinoma, tall cell variant, follicular type"?

For cases diagnosed 2007 or later, assign code 8340 [Papillary carcinoma, follicular variant] according to rule H15 for Other Sites.

"Predominantly" and "type" indicate specific histologies. "Variant" does not. See rule H13. The histology in this case is papillary and follicular. Tall cell variant is ignored.

 2009
20091019 MP/H Rules/Histology--Hematopoietic, NOS: Can a diagnosis of multiple myeloma be made if a bone marrow biopsy is negative? See Discussion. Patient with large mass nasal cavity. Biopsy shows plasmacytoma. Fine needle aspiration of the acetabulum is consistent with multiple myeloma. Skeletal survey shows multiple lytic lesions. Bone marrow biopsy is negative for myeloma. In light of negative bone marrow biopsy can this case be coded as multiple myeloma?

For cases diagnosed prior to 1/1/2010:Code this case as multiple myeloma. The fine needle aspiration of the acetabulum is a biopsy of bone marrow. According to our pathologist consultant, the positive bone marrow biopsy (acetabulum) and the multiple lytic bone lesions confirm multiple myeloma. The negative bone marrow biopsy is likely due to an insufficient sample.

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
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
20091069 CS Extension--Bladder: How should this field be coded for a high grade urothelial carcinoma with "focal micropapillary features and invasion of lamina propria, with a note stating there is invasive carcinoma focally involving thin muscle bundles...difficult to distinguish whether muscularis propria or muscularis mucosae"?

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.Assign CS Extension code 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15.

 2009
20091007 CS Extension--Lung: How is this field coded for a tumor in the right middle lobe with extension to the bronchus intermedius?

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.

Assign CS extension code 20

[Extension from other parts of lung to main stem bronchus, NOS

(EXCLUDES superficial tumor as described in code 11)

Tumor involving main stem bronchus greater than or equal to 2.0 cm from carina (primary in lung or main stem bronchus)].

A right middle lobe tumor that extends to the bronchus intermedius is one that is extending to the main stem bronchus from another part of the lung. The bronchus intermedius is the lower part of the main stem bronchus on the right. It is more than 2.0 cm away from the carina.

 2009
20091123

Reportability: Is a tumor reportable if the pathology report indicates a non-reportable diagnosis at the time the specimen is removed but subsequent clinical statements state the patient had a reportable tumor? See Discussion.

The 2007 SEER Manual (page 3) states that cases diagnosed clinically are reportable. Exception 2 states if enough time has passed that it is reasonable to assume the physician has seen the negative pathology report, but the clinician continues to call this a reportable disease, accession the case.

SEER reporting guidelines state that severe dysplasia is not reportable, however, many clinicians regard it to be equivalent to carcinoma in situ.

Example 1: In 09-2007 the pathology report for excisional biopsy of right floor of mouth states the final diagnosis is severe dysplasia. At the time, the case is not accessioned based on non-reportable pathology. Patient is subsequently admitted in 3-09. According to the clinical history the patient was diagnosed with squamous cell carcinoma in 2007 and treated with laser. Is this reportable? If yes, how is behavior to be coded? How is "Ambiguous Terminology at Diagnosis" to be coded?

Example 2: In 2-08, the pathology report for a punch biopsy of a skin lesion states the final diagnosis is atypical melanocytic hyperplasia. In 3-08, patient is admitted for re-excision. The clinical diagnosis states re-excision being done for melanoma in situ.

Reference: SINQ 20061123

A tumor that is non-reportable based on the pathology report diagnosis should not be accessioned if later clinician statements mistakenly refer to it as a reportable tumor. The exception in the 2007 SEER manual on page 3 is intended to allow the registrar to accession a case when the clinician actually disagrees with the pathology report and clinically diagnoses a reportable tumor.

 2009