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Report Produced: 05/26/2026 06:03 AM

Report Question ID Question Discussion Answer Year
20021151

Reportability: A "gastrointestinal stromal tumor" (GIST) is not always stated to be "malignant" in the path report even though the tumor appears to meet criteria for malignancy. Is the tumor SEER reportable? See discussion.

Evaluation of Malignancy and Prognosis of Gastrointestinal Stromal Tumors: A Review. Miettinen, M. et al, Human Pathology 2002 May; 33(5) 478-83). This article states there is an increasing number of GISTs because the majority of tumors previously diagnosed as gastrointestinal smooth muscle tumors (leiomyomas, leiomyoblastomas and leiomyosarcomas) are now classified as GISTs. It states that gastrointestinal autonomic nerve tumors (GANTs) are also GISTs based on their KIT positivity and presence of KIT-activating mutations. This article also states that a GIST is probably malignant if it meets the following criteria: 1) Intestinal tumors: Maximum diameter >5 cm or more than 5 mitoses per 50 HPFs. 2) Gastric tumors: Maximum diameter >10 cm or more than 5 mitoses per 50 HPFs.

Some of the path reports that meet these criteria use the word "malignant", and others do not. Some of the cases that are not called "malignant" in the path diagnosis are signed out clinically as "malignant."

The case is reportable if a pathologist or clinician confirms a diagnosis of cancer. If there is no such confirmation, the case is not SEER reportable.

 2002
20021173 Histology (Pre-2007): What code is used to represent a review of slides histology of "in situ squamous cell carcinoma and multiple detached fragments of atypical papillary squamous epithelium; highly suspicious for invasive carcinoma"? See discussion. The original pathologist indicated a final diagnosis of moderately differentiated squamous cell carcinoma. The slides were sent for review to another facility. The reviewing pathologist rendered the diagnosis stated in the question section.

For tumors diagnosed prior to 2007:

Code the Histology field to 8070 [squamous cell carcinoma].

The review diagnosis was also squamous cell carcinoma. The expression "atypical papillary squamous epithelium" does not modify the cancer histology.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021063 EOD-Pathologic Review of Number of Regional Lymph Nodes Examined: What code is used to represent this field when a path report from a lymph node biopsy or dissection describes lymph node "portions" or "fragments"? See discussion.

1) Lymph nodes, right pelvic dissection: No evidence of malignancy in 4 portions of lymph node examined. (Should we code the number examined as 01, 04, or 97?)

2) Lymph nodes, left pelvic dissection: 5 fragments of lymph nodes show no evidence of malignancy. (Should we code the number examined as 05 or 97?)

3) Biopsy of right neck mass: Malignancy in fragments of lymph nodes. The following month, pt had a right modified lymph node dissection: 16/32 lymph nodes are positive for malignancy. (Should we code the number examined as 32, 33, 97, 98?)

For cases diagnosed 1998-2003:

The total number of lymph nodes examined is recorded in EOD-Num of Reg LN Examined. If the number of actual lymph nodes represented by the "fragments" or "portions" cannot be determined, assign code 96, 97, or 98 as appropriate.

1) Based on the terminology "four portions of lymph node (singular)" code to 01 despite "dissection" terminology.

2) Code to 97 based on "fragments of lymph nodes (pleural)" terminology and procedure identified as dissection.

3) Code to 97 based on statement of "fragments of lymph nodes (pleural)" for biopsy plus dissection.

 2002
20021108 Histology (Pre-2007)/Grade, Differentiation: What code is used to represent the histology of "well differentiated low grade lipoma-like liposarcoma (atypical lipoma)"? See discussion. The pathologic microscopic description states, "Well differentiated lipoma-like liposarcoma, sometimes termed atypical lipoma. This tumor will behave in a low grade malignant fashion. Slow growing recurrences can be expected. Metastatic disease is very rare unless the tumor dedifferentiates."

For tumors diagnosed prior to 2007:

Code the Histology field to 8851/3 [Liposarcoma, well differentiated] and the Grade to 1 [Well differentiated]. This histology is reportable to SEER.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002
20021152 Primary Site: Can we assume the primary site for "chordoma" is soft tissue if the bone is not stated to be involved?

Default the coding of the Primary Site field for chordomas to the bone where the tumor began in the body if the primary site is not clearly stated to be soft tissue. Bone is often the primary site for chordomas.

Based on advice from pathologist consultants: This is one of those situations where we can be quite comfortable with a default, in this case to bone, not soft tissue. Chordoma is a tumor arising in the nucleus pulposis, presumably from remnants of notochord - thus its exclusive origin is in the sacrococcygeal region, spheno-occipital region, and vertebral bodies, otherwise known collectively as the axial skeleton. Any "chordoma" in soft tissue (with no relationship to axial skeleton) is probably a myxoid chondrosarcoma or parachordoma (extremely rare).

 2002
20021040 Other Therapy: What code is used to represent treatment with "Epithilone" or "Epothilone"? Code the Other Cancer-Directed Therapy field to 2 [Other experimental cancer-directed therapy (not included elsewhere)], until the exact mechanism of action is determined for this drug. This drug is in phase I clinical trials. It has a similar action to Taxol, but is derived from a different source. 2002
20021150 SEER Guidelines Over Time: Should we apply the current guidelines to previously missed older cases now being reported to the central registry? See discussion.

1. We receive "straggler" cases for coding that were diagnosed when previous coding schemes and guidelines were applicable. When a specific guideline is in place for a given time period and is later changed in some way, we try to use the specific guideline that was in place at the time of diagnosis when coding the incoming case. However, it is not always possible to remember or to be able to access those old guidelines.

2. There are situations when coding old cases that have no applicable guideline for the older diagnosis years but current SEER documentation informs the coder how to handle the situation. For example, in the SEER Program Code Manual (3rd ed), 3 new guidelines were added for coding of differentiation. There were no guidelines in the previous SEER manual that specifically covered those situations. Should we use the current rules in coding differentiation on the older incoming case?

 Code all fields according to the instructions that were in effect at the time the case was diagnosed. If the old guidelines are unavailable or non-existent, code the case in the current scheme. The year the case was abstracted will indicate that the case was a late entry into the system and that could account for the differences in coding seen by a reviewer. 2002
20021154

Primary Site: What code is used to represent the primary site for a "teratocarcinoma with features of embryonal carcinoma" removed from the thigh muscle in a patient with x-ray negative testicles? See discussion.

The case was reviewed by AFIP and called "extratesticular." Per our pathology consultant, the site should be coded to unknown because it is very doubtful that the tumor was primary in the soft tissue of the thigh. According to him, such tumors don't originate exclusively in the testes, but tend to occur along the central axis such as the mediastinum or retroperitoneum. If an extratesticular tumor arises in either of these areas, the primary site should be code to the mediastinum or the peritoneum rather than to unknown. Lesions primary in the testicle may also undergo maturation with fibrosis and involution. This process often leaves little evidence of the original tumor in the testis.

Code the Primary Site field to C809 [unknown] for this case. The thigh tumor is a metastatic site.

 2002
20020024 Reportability--Cervix: The SEER Program Code Manual lists CIN III and carcinoma in situ of the cervix as not being reportable for cases diagnosed in 1996 or later, but does not list "adenocarcinoma in situ" or "squamous cell carcinoma in situ." Are these histologies still reportable?

For primary site cervix uteri, only histologies with behavior codes of 3 [invasive] are reportable to SEER for all registries.

Some SEER registries have opted to continue to collect behavior codes of 2 [in situ] for cervix uteri primaries.

 2002
20021157 Histology (Pre-2007)/Grade, Differentiation--Lung: What code is used to represent the histology for a lung biopsy of "non-small cell carcinoma with features of poorly differentiated adenocarcinoma"? See discussion. Non-small cell carcinoma does not appear to be an NOS term in ICD-O-3. The term "with features of" indicates a majority of tumor. Which rule should be used to code histology?

For tumors diagnosed prior to 2007:

Code the Histology and the Grade, Differentiation fields to 8140/33 [adenocarcinoma, poorly differentiated].

The term "non-small cell carcinoma" is used to represent a broad category of epithelial cancers. Non-small cell carcinoma [8046/3] is grouped in the ICD-O-3 under "Epithelial Neoplasms, NOS." The term can be used by a pathologist when he rules out the fact that the patient has a small cell cancer by stating that the malignancy is a non-small cell type of cancer. In this case, the type of non-small cell cancer present in the specimen is adenocarcinoma.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

 2002