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Report Produced: 02/10/2026 20:59 PM

Report Question ID Question Discussion Answer Year
20100011

Reportability: Should a benign gangliocytic paraganglioma [8683/0] be a reportable (malignant) tumor based on the presence of lymph node metastases? See Discussion.

"Resection, periampullary duodenum: Gangliocytic paraganglioma, with metastasis to one large periduodunal lymph node. Six other small lymph nodes negative. COMMENT: The primary tumor in the duodenum is made up mainly endocrine cell component. This component appears to have metastasized to a periduodenal lymph node."

This neoplasm is reportable because it is malignant as proven by the lymph node metastases. Code the behavior as malignant (/3) when there are lymph node metastases.

 2010
20100024

Histology: How is this field coded for a perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential that is malignant based on the presence of metastases? See Discussion.

In 11/2006 the patient had surgery for a 6cm mass in the RUQ arising in the falciform ligament. The pathologic final diagnosis was: Perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential. In 10/2009 a liver biopsy showed metastatic perivascular epithelioid cell neoplasm.

Assign histology code 8005/3 [malignant clear cell tumor]. According to our expert pathology consultant, this is the best histology code available at this time for the occasional tumor which is designated as malignant. The appearance of metastatic disease clearly defines this case as malignant.

 2010
20100045

Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathologic diagnosis of "B-cell lymphoma, unclassifiable, with features intermediate between DLBCL and Burkitt lymphoma" that was clinically referred to as a "double hit lymphoma"?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code histology to 9680/3 [diffuse large B-cell lymphoma (DLBCL)]. Per the Alternate Names section in the Heme DB, B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma is one of the synonyms for for DLBCL.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010
20100012 Date of diagnosis--Breast: How is the date of diagnosis coded when a mammogram describes only "suspicious calcifications" with a BIRADS category of 4 assigned and the suspicious calcifications are subsequently proven to be malignant on biopsy? See Discussion. The date of diagnosis is the date when cancer was first diagnosed by a recognized medical practitioner, whether clinically or microscopically confirmed. Ambiguous terminology used to determine reportability is listed in part I of FORDS pages 3-4. No BIRADS categories are included and, therefore, should not be used by the registrar to determine the earliest date of diagnosis. In addition, the term "suspicious for calcification" is not reportable, because calcification is benign condition, unless the physician describes it as malignant. Reference 46637, 12/29/2009 FORDS - In the last paragraph there is a statement that no BIRAD categories are listed...cannot be used to determine earliest date of diagnosis. Does the SEER Program follow this guideline? The date of diagnosis for this case is the date of the biopsy. There is no reportable diagnosis on the mammogram. 2010
20100028

Primary site/Histology--Head & Neck: How are these fields coded when the final diagnosis for a skull based mass is "neuroendocrine carcinoma" and the IHC studies are incompatible with a brain/spinal cord primary (ependymoma)? See Discussion.

The pathology report final diagnosis is, "skull base mass, biopsy: neuroendocrine carcinoma, see note. NOTE: Ancillary IHC studies reveal ...the IHC signature is incompatible with ependymoma. The constellation of findings is diagnostic of well differentiated neuroendocrine carcinoma."

The site/histology combination of C410 and 8246/3 is 'impossible' by SEER edits. There is no override. What is the correct primary site and histology?

According to our subject matter expert physician, this unusual case is most likely a sino-nasal tumor (some variant of esthesioneuroblastoma [olfactory neuroblastoma]). Code to nasal cavity [C300] as indicated in ICD-O-3 by site-associated topography code attached to the morphology code for olfactory neuroblastoma [9522/3].

 2010
20100095

MP/H Rules/Multiple primaries--Kidney, renal pelvis: In a patient who was never disease free because of multiple recurrences of invasive transitional cell carcinoma of the bladder originally diagnosed in 2004, is an invasive high grade urothelial carcinoma of the renal pelvis diagnosed in 2010 a new primary? See Discussion.

Patient has invasive TCC of the bladder diagnosed in 2004, and has never been disease free.

In 2/18/10 a left renal pelvis wash showed urothelial carcinoma, high grade.

On 4/7/10 a nephroureterectomy revealed high grade urothelial carcinoma with sarcomatous and squamous differentiation invading through pelvic wall and perihilar soft tissue.

Is this a new renal pelvis primary?

For cases diagnosed 2007 or later, the renal pelvis is a new primary per rule M7. M7 will be better explained in the revised MP/H rules, but the rationale is that no field effect was present for more than 3 years. Although the bladder CA continued to recur, there were no other organs involved until 2010. M7 is intended to make the renal pelvis a new primary because there was no field effect (no organs other than bladder involved) for more than 3 years.

 2010
20100110

Reportability--Esophagus/Stomach: Are the terms "high grade dysplasia" and "severe dysplasia" synonymous with in situ for tumors in the gastrointestinal tract? See Discussion.

SINQ 20000245 states that high grade or severe dysplasia in not synonymous with in situ disease. However, per page 109 in the 7th edition of AJCC Cancer Staging Manual, high grade dysplasia is the only term listed under Tis. A note on that page explains that "high-grade dysplasia includes all noninvasive neoplastic epithelia that was formerly called carcinoma in situ, a diagnosis that is no longer used for columnar mucosae anywhere in the gastrointestinal tract."

There has been considerable pressure from registrars at larger reporting facilities to re-address this issue. The pathologists at these facilities state that they are correctly documenting the presence of in situ disease when they use the term high grade dysplasia for gastrointestinal tract tumors. In their opinion, it is not necessary to add the term in situ in parentheses following the use of the term high grade dysplasia to clarify the behavior of these lesions in their pathology reports. If the term "carcinoma in situ" is no longer being used by many pathologists for sites in the gastrointestinal tract, won't this lead to underreporting of in situ disease for these sites unless the reportability guidelines are changed?

For cancer reporting purposes, the terms "high grade dysplasia" and "severe dysplasia" are not synonymous with in situ for tumors in the gastrointestinal tract. These cases are only reportable when the pathologist documents carcinoma in situ or intraepithelial neoplasia grade III, or when the registry includes in their policies and procedures the pathologist's statement that he/she uses HGD to mean the same as CIS.

Reportability laws are customarily based on ICD-O. Because "high grade dysplasia" and "severe dysplasia" are not designated as in situ in the ICD-O, there is no legal authority to report these cases in most states.

NAACCR is reviewing this issue. See #5 on page 11 of the December 1, 2013 NAACCR Implementation document, http://www.naaccr.org/LinkClick.aspx?fileticket=u7d3sB71t5w%3d&tabid=126&mid=466

2010
20100010

MP/H Rules/Multiple primaries--Ovary: How many primaries are to be abstracted when a patient is diagnosed with serous cystadenocarcinoma [8441] of the right ovary and clear cell adenocarcinoma [8310] of the left ovary? See Discussion.

Patient had bilateral ovarian tumors. The right ovary had serous cystadenocarcinoma and left ovary had clear cell adenocarcinoma. The pathology COMMENT section stated, "Based on the histologic differences of the tumors within each ovary, feel these represent two distinct separate primaries. Lymph node metastases are clearly serous ca." The physician staged the right ovary as T2a N1 M0 and left ovary as T1c N0 M0. Do we accession one primary per rule M7 [Bilateral epithelial tumors (8000-8799) of the ovary within 60 days are a single primary]?

What is intention of Rule M7? If the histology in each ovary is different but within the range (8000-8799), is that supposed to be accessioned as one primary? Or is the intention of Rule M7 that tumors in both ovaries must have the SAME histology within that histology range to be a single primary?

For cases diagnosed 2007 or later, apply rule M8 and abstract this case as multiple primaries.

Rule M7 does not apply when each ovary has a distinctly different histology, even when both histologies are with the specified code range. This clarification will be added to the next version of the rules.

 2010
20100036 Behavior--Lung: Can an in situ behavior code be used for a bronchioalveolar carcinoma of the lung when the pathologist appears to use the term bronchioalveolar to describe an in situ pattern of growth exhibited by an adenocarcinoma? Is the use of the term "pattern" in this situation indicative of in situ tumor? See Discussion.

In ICD-O-3, bronchioloalveolar adenocarcinoma is described only by behavior code 3 (invasive). Would the behavior be coded as in situ for the following cases?

Example 1: Left lower lobe, partial resection shows bronchioloalveolar carcinoma with focal areas of fibrosis (see comment). Comment: Although the possibility that these areas represent stromal invasion can not be excluded, we favor the interpretation that these areas do not represent true invasion. Synoptic summary: Minimal pathologic stage: Local Extent.

Example 2: Lung tumor described as adenocarcinoma, predominantly bronchoalveolar pattern. For most sites, the term pattern is used only for in situ cancer and is not a specific term used for invasive tumors. Is the use of the term "pattern" in this situation indicative of in situ tumor?

Code the behavior indicated in the pathology report. If the pathologist states the bronchioloalveolar carcinoma is in situ, apply the ICD-O-3 matrix rule and assign 8250/2. Otherwise, code 8250/3. Do not use the term "pattern" to infer in situ behavior.

Code behavior /3 for both examples based on information provided.

2010
20100092 Primary site--Heme & Lymphoid Neoplasms: Should the primary site for the follicular lymphoma diagnosis be coded to C779 [Lymph nodes, NOS] when a bone marrow biopsy reveals both acute myeloid leukemia and follicular lymphoma? See Discussion. Bone marrow biopsy reveals acute myeloid leukemia and follicular lymphoma. There were no other studies done, no chemo given, and the patient expired shortly after diagnosis. Should the follicular lymphoma be coded to a primary site C779 [Lymph nodes, NOS]?

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Code the primary site to C421 [bone marrow]. Per Rule PH26, bone marrow is the primary site when lymphoma is present only in the bone marrow. All the available physical exams, scans, and other work-up must also be negative for lymph node, tissue, or organ involvement. When there is no additional workup beyond the bone marrow biopsy and that biopsy is positive, code the primary site to bone marrow in those situations as well.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

2010