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Report Produced: 02/22/2026 06:13 AM

Report Question ID Question Discussion Answer Year
20091111 Grade--Breast: How is this field coded for an "invasive ductal carcinoma, well differentiated, low nuclear grade"? Assign code 1 [Grade 1, well differentiated]. Use the table in the 2007 SEER Manual on page C-607. Both "low grade" and "well differentiated" are coded 1 in the grade field. 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
20091043

Multiple primaries--Lymphoma: Should a second primary lymphoma be accessioned if the reporting hospital disagrees with the final diagnosis stated on a review of slides? See Discussion.

Example: Patient had an original diagnosis of small lymphocytic lymphoma (9670/3) of lung in 1986 and later presents with small B-cell non-Hodgkin lymphoma (9670/3) of small bowel in 2008 at Hospital A. Slides sent for review at Hospital B where patient was also seen. Slides there read as low grade B-cell lymphoma most consistent with extranodal marginal B-cell lymphoma of mucosal associated tissue (MALT Lymphoma). Hospital A's pathology report stated that immunostains would exclude mantle cell lymphoma and MALT lymphoma and the original pathology report has not been amended to match the outside path diagnosis. Is this a second primary of MALT lymphoma (9699)?

For cases diagnosed prior to 1/1/2010:The 2008 diagnosis is not a new primary according to the Definitions of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table) using the pathology report diagnosis from the facility where the procedure was performed (Hospital A). Since Hospital A disagreed with the slide review and did not amend their diagnosis based on the slide review, do not use the slide review diagnosis in this case.

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
20091027 MP/H Rules/Multiple primaries--Thyroid: How many primaries should be coded in a patient with a 4/5/08 left thyroid lobectomy diagnosis of follicular carcinoma followed by a 7/25/08 right thyroid lobectomy diagnosis of papillary carcinoma, follicular variant?

For cases diagnosed 2007 or later:

Rule M17 under Other Sites applies. These are separate primaries based on their ICD-O-3 histology codes. Follicular carcinoma is coded 8330. Papillary carcinoma, follicular variant is coded 8340. The histology codes are different at the third number. Rule M6 does not apply because these diagnoses are more than 60 days apart.

 2009
20091089 Histology--Hematopoietic: How is histology coded for a "chronic lymphocytic leukemia with plasmacytic differentiation"?

For cases diagnosed prior to 1/1/2010:Assign histology code 9823/3 [Chronic lymphocytic leukemia]. Plasmacytic differentiation does not indicate a plasma cell or plasmacytic leukemia.

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
20091131 Multiplicity Counter/Type of Multiple Tumors--Breast: How are these fields coded when a patient underwent a lumpectomy demonstrating two measured foci of invasive ductal carcinoma (1.5 cm and 3 mm) and "focally seen" in situ ductal carcinoma (DCIS) followed by a re-excision that is positive for 1.5 mm focus of residual invasive carcinoma? See Discussion.

Lumpectomy path shows two foci of invasive ductal carcinoma, 1.5 cm & 3 mm sizes, and CAP summary lists "DCIS: focally seen", no further description. The re-excision pathology specimen finds a 1.5 mm focus of residual invasive carcinoma, very close to the new inferior margin (so registrar assumed this was probably not part of the previously excised mass), and no mention of any more in situ.

Can we assume the DCIS was associated with/part of the invasive tumors because it was not measured or described separately? If we say there are 3 tumors (for the measured invasive foci), should Type of Multiple Tumors be coded 30 [In situ and invasive] or 40 [Multiple invasive]?

Code 03 [3 tumors] in the multiplicity counter. Do not count the "focally seen" DCIS because it was not measured.

Code 30 [In situ and invasive] in Type of Multiple Tumors Reported as One Primary. The single primary reported for this case is a combination of in situ and invasive tumors.

2009
20091002

Multiplicity Counter--Ovary: Given the diffuse nature of ovarian cancer, should we count bilateral parenchymal involvment of ovaries as two tumors? See Discussion.

Are peritoneal implants mets and not counted as separate tumors, even though they're not stated to be metastatic in the path report, and are not coded as distant mets?

Code Multiplicity Counter to 02 [Two tumors present] for an epithelial ovarian primary involving both ovaries. Do not count the peritoneal implants; they are regional metastasis and not included in the multiplicity counter. An example like this will be added to the manual in the next revision.

 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
20091095 CS Site Specific Factor--Prostate: Please clarify how SEER registries should use code 040 for Site-Specific Factor 3 on prostate cases. See Discussion. The 6/11/09 NAACCR Webinar on prostate cancer pointed out that SSF 3 code 040 refers the registrar to Note 4, which states "when the apical, distal urethral, bladder base, or bladder neck margins are involved and there is no extracapsular extension, use code 040." The webinar went on to say that code 040 ONLY applies to these specific margins, and that if other margins are involved (for example, the 'right lateral margin'), we should not use code 040. Is this consistent with SEER's interpretation of Note 4? Are we to ignore involvement of margins other than those specified in Note 4, and consequently code SSF 3 within the 000-032 range? Would this also apply to code 048 (extracapsular extension and margins involved)?

Yes, SEER agrees. Code SSF3, code 040 per page C-740 of 2007 SEER manual exactly as stated in Note 4. According to the Inquiry and Response System of the CoC, Note 4 lists specific margins that were once thought to have a prognostic impact. Code 040 in SSF3 should be used only when those margins are involved.

Note 4 pertains to code 040, not to code 048.

2009
20091063 CS Lymph Nodes--Head and Neck: How is this field coded when a positive neck FNA is followed by a neck dissection that contains one of seventeen positive lymph nodes? See Discussion. The primary site is the right tongue. The patient underwent FNA of a right neck mass that was positive for squamous cell carcinoma. Subsequent right modified radical neck dissection showed one out of seventeen nodes positive for metastatic carcinoma. For head and neck primaries, the CS LN codes 10-19 represent a single positive ipsilateral regional node. Codes 20-29 represent multiple positive ipsilateral nodes.

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.If the neck dissection included the area of the positive FNA, count only the positive nodes from the dissection. Avoid double-counting a positive node for both an FNA and a dissection.

In the unlikely event that the dissection did not include the area of the positive FNA, add one positive node to the count from the dissection.

This instruction supersedes previous instructions.

 2009