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Report Produced: 08/28/2025 05:26 AM

Report Question ID Question Discussion Answer Year
20160051

Diagnostic confirmation: When a CT guided Fine Needle Aspiration is performed and the pathology report indicates smears and cell block were prepared, if the diagnosis is positive for cancer, can you code diagnostic confirmation as 2 (positive cytology) because of the cell block?

Yes, assign diagnostic confirmation code 2 for diagnosis based on smears and cell block from CT guided FNA. This reply pertains to solid tumors.

2016
20160014

Surgery of primary site--Lung: Should microwave ablation be coded as treatment for lung cancer, and if so, how should it be coded?

Code microwave tumor ablation as surgery. For lung, assign code 15.

This question was discussed by the technical advisory group – a small group of representatives from each standard setter which meets periodically. The group agreed on this consensus answer.

2016
20160046

MP/H Rules/Multiple primaries--Bladder: How many primaries should be reported for the case below? See discussion.

1993 Renal pelvis: Papillary urothelial carcinoma

1994 Bladder: Noninvasive bladder ca NOS

6/11/13 Bladder: Noninvasive papillary urothelial carcinoma

8/19/14 Bladder: urothelial carcinoma in situ

2/13/15 Bladder: Papillary urothelial carcinoma

Would this situation be 2 primaries - 1993 Renal pelvis and 1994 Bladder with the 2015 being the same primary as 1993 Renal pelvis? Or 3 primaries - 1993 Renal pelvis, 1994 Bladder, 2015 Bladder?

Abstract four primaries, 1993 renal pelvis, 1994 bladder, 2013 bladder, and 2015 bladder.

The 1993 renal pelvis diagnosis and the 1994 bladder diagnosis are separate primaries based on the rules in effect at that time (See pages 7-11, http://seer.cancer.gov/archive/manuals/historic/codeman_1992.pdf )

For the remaining diagnoses, the 2007 MP/H rules apply. The 2013 bladder diagnosis is a new primary per rule M7. The 2014 bladder diagnosis is not a new primary per rule M6. The 2015 bladder diagnosis is a new primary per rule M5.

2016
20160030

Reportability--Carcinoid: Is a diagnosis of carcinoid heart disease, based solely on clinical information and no pathology, reportable?

Carcinoid heart disease is not reportable but this diagnosis indicates that the patient likely has a carcinoid tumor which may be reportable. Obtain further information.

2016
20160061

Reportability/Behavior--Small intestine: Is a carcinoid tumor, described as benign, reportable? See Discussion.

 

A segmental resection pathology report states "benign mucosal endocrine proliferation consistent with a 0.3 cm duodenal carcinoid tumor." The diagnosis comment further states, "the separate small endocrine lesion is histologically benign, consistent with a 3 mm carcinoid tumor." This seems to be an example of a description of a microcarcinoid tumor referenced in SINQ 20160011. However, in this new case the pathologist specifically states the tumor is benign.

The WHO definition of microcarcinoid indicates this is a precursor lesion, which seems to indicate it is not malignant. However, SEER's previous answer stated we should report these tumors because the ICD-O-3 definition of carcinoid is 8240/3. Do you think that the mention of the term "benign" in the pathology report is actually related to the size of this lesion? Is the reference to benign mucosal endocrine proliferation referring to the WHO classification (making the case reportable as stated in SINQ 20160011), or is this a situation in which we should apply the Matrix Rule and the case is nonreportable?

This carcinoid tumor, described as benign, is not reportable. According to our expert pathologist consultant, this case is not reportable because the pathologist uses "benign" to describe the mucosal endocrine proliferation and based on that, the neuroendocrine cell proliferation is hyperplasia/benign - not reportable.

2016
20160017

Surgery of Primary Site--Melanoma: Please further explain the SEER Note under Melanoma surgery codes 30-36 for these two examples. Are both examples coded 31?

1. Shave bx: +melanoma in situ, +microscopic margins  Wide excision: no residual melanoma in situ

2. Shave bx: melanoma, +microscopic margin   Wide excision: Melanoma, margins negative (margin status negative but distance not stated)

Revised answer: Assign surgery code 30 for both examples based on the SEER Note on the top of page 2 in the Surgery of Primary Site Codes for Skin: If it is stated to be a wide excision or reexcision, but the margins are unknown, code to 30.

 2016
20160016

MP/H Rules/Histology--Bladder: Can the histology for a high grade urothelial carcinoma described as having "extensive sarcomatoid dedifferentiation" be coded to sarcomatoid transitional cell carcinoma (8122/3)?

Example; TURBT, Final Diagnosis - Urothelial carcinoma, high grade. Type/grade comment: Extensive sarcomatoid dedifferentiation is present (40-50% of tumor volume).

Code high grade urothelial carcinoma described as having "extensive sarcomatoid dedifferentiation" to sarcomatoid transitional cell carcinoma (8122/3).

2016
20160073

MP/H Rules/Multiple primaries/Histology: What histology and how many primaries are coded for a mixed germ cell tumor with a somatic type malignancy (rhabdomysarcoma) if the patient was diagnosed with seminoma of the testis in 2009 followed by a 2015 metastatic germ cell tumor in a retroperitoneal lymph node, stated to be a recurrence of the testicular cancer? See Discussion.

In September 2009 the patient was diagnosed with seminoma, classical type, following an orchiectomy. Testicular mass recurrence in 2014 was treated with chemotherapy.

Then in April 2015 a retroperitoneal dissection of a peri-aortic LN was positive for mixed germ cell tumor with somatic type malignancy (rhabdomyosarcoma) involving 1/11 nodes. Path Comment: major component of tumor is teratoma, rhabdomyosarcoma represents <5% of mass.

Now in October 2016, the patient has a retroperitoneal mass biopsy positive for spindle cell sarcoma with rhabdomyosarcomatous differentiation. The comment section of the pathology report states, "Given the history of a germ cell tumor w/ rhadbomosarcomatous component, the findings are consistent with a recurrence of rhabdomyosarcomatous component of germ cell tumor."

Can a seminoma transform to a mixed germ cell tumor with a somatic type malignancy (see SINQ 20140082 - testicular teratoma with somatic type malignancy)?

According to our expert pathologist consultant, yes, seminoma could transform to a mixed germ cell tumor with a somatic type malignancy. He advises us to code this case as 9061/3.

From our expert pathologist consultant: This occurs as "reprogramming" of the initial germ cell tumor/seminoma cell. The process is not understood, but genetic studies support this progression concept. Most often the next step is teratoma. It is out of the teratoma that the somatic malignancy usually comes. I do wonder about the possibility that this was really an embryonal carcinoma which resembles a seminoma - occasionally this can be a difficult separation. I wonder if they radiated the scrotum following the orchiectomy, also, given the scrotal recurrence.

 2016
20160024

Reportability--Melanoma:  Please explain how a CTR is to interpret the guideline in the MP/H rules (Cutaneous Melanoma): Evolving melanoma (borderline evolving melanoma): Evolving melanoma are tumors of uncertain biologic behavior. Histological changes of borderline evolving melanoma are too subtle for a definitive diagnosis of melanoma in situ. Is this to mean that evolving melanoma in situ is not reportable? Or should we follow the guidelines in SEER Question 20130022 that states the reportability terms for melanoma and melanoma in situ.

Follow the guidelines in SINQ 20130022 for now. When the MP/H rules are revised, new instructions will be implemented.

See also SINQ 200120078 and 20110069.

2016
20160028

MP/H/Histology--Sarcoma:  How should Ewing Sarcoma/primitive neuroectodermal tumor (PNET) be coded for a 2012 case?  See Discussion.

SEER SINQ 20031051 applies to cases diagnosed before 2007 and advises:  Code histology as 9260/3, Ewing sarcoma. Ewing sarcoma is a specific histology on the continuum of primitive neuroectodermal tumors. Code Ewing sarcoma as it is more specific than PNET, NOS.

For tumors diagnosed 2007 or later, refer to the MP/H rules.

Apply 2007 MP/H rule H6 and assign the numerically higher ICD-O-3 code that reflects PNET (9364/3).

According to the WHO Tumors of Soft Tissue and Bone, though Ewing sarcoma ICD-O-3 code is 9260/3, Ewing sarcoma with a higher degree of neuroectodermal differentiation present is classically termed peripheral neuroectodermal tumors (PNET).  WHO does not offer guidance how to classify tumors stated to be Ewing sarcoma PNET.

Histology code 9364/3 is assigned for a Ewing/PNET that arises outside of the brain/CNS. Peripheral neuroectodermal tumor (PNET) and peripheral primitive neuroectodermal tumor (PPNET) are Ewing family tumors.

Histology code 9473/3 (PNET, primitive neuroectodermal tumor, central primitive neuroectodermal tumor, or supratentorial PNET) is only used for tumors arising inside the brain/CNS.

2016