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Report Produced: 03/01/2026 19:36 PM

Report Question ID Question Discussion Answer Year
20021070 CS Extension/CS Lymph Nodes--Breast: How would you interpret the phrase "axillary lymph node tissue, not clearly a lymph node" or the phrase "satellite nodule of invasive tumor, left axillary lymph node or chest wall tissue"? See discussion. A lumpectomy with axillary lymph node dissection and removal of nodule in anterior axillary line revealed negative lymph nodes. The nodule specimen was labeled "axillary lymph tissue, not clearly a lymph node". The microscopic description for that specimen stated "Fibroadipose tissue. A fragment of a lymph node is incidentally sampled in block 4 and it is free of tumor". The final path dx stated "Satellite nodule of invasive tumor, left axillary lymph node, or chest wall tissue. Comment: If the tissue is considered chest wall this would be a stage IIIB. If it is considered an intramammary satellite nodule, this is a stage I". The clinician repeated what the comment said, and added "If lymph node mets, this is a stage II." Code the invasive tumor in the axillary area as a regional lymph node metastasis. According to the AJCC, cancerous nodules in the axillary fat adjacent to the breast, without histologic evidence of residual lymph node tissue, are classified as regional lymph node metastases. 2002
20021087 Multiple Primaries (Pre-2007)--Head & Neck: How many primaries are represented when a1998 invasive squamous cell carcinoma of the true vocal cord is followed by a 1999 diagnosis of in situ squamous cell carcinoma of the true vocal cord (called "recurrent" by the clinician), and in 2001 there is another invasive squamous cell carcinoma of the true vocal cord (no statement of recurrence)? Would your answer be any different if no statement of "recurrent" had been made in 1999?

For tumors diagnosed prior to 2007:

Code this case as two primaries, an invasive true vocal cord primary in 1998 and another invasive true vocal cord primary in 2001.

If there had been no statement of recurrence for the 1999 in situ diagnosis and the 1999 diagnosis was more than two months following the 1998 diagnosis, this case would be coded as three primaries.

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
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
20021031 Primary Site--Meninges: Should the primary site for a meningioma of the right frontal lobe be coded to C71.1 or C70.0? See discussion. In the opinion of some neurologists it is more important to capture the lobe in which the meningioma is located rather than code the primary site to meninges. Should a meningioma always be coded to meninges for primary site? Code the Primary Site field to C70.0 [cerebral meninges], the suggested site code for most meningiomas. Meningiomas arise from the meninges, not the brain (although they can invade brain). ICD-O-3 does not differentiate the specific location of the brain that the meninges cover. The information of interest to neurologists would have to be captured in an optional or user-defined field. 2002
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
20020002 Date Therapy Initiated: What date should be entered in Date Therapy Initiated when treatment follows a surgical procedure that is not coded under Surgery of Primary Site? See discussion. If a patient has a surgical procedure that is not coded in the Surgery of Primary Site field and then the patient undergoes additional first course of treatment, such as radiation therapy, how should the Date Therapy Initiated field be coded? In this example, code the Date Therapy Initiated field to the date of the first surgical procedure. If a SEER edit is triggered, please notify us. 2002
20021117 Multiple Primaries (Pre-2007)--Bladder/Prostatic Urethra: Is the prostatic urethra a new primary for a case with a history of recurrent noninvasive bladder cancer that was subsequently diagnosed with transitional cell carcinoma in situ of the prostatic urethra and had a subsequent clinical diagnosis of "refractory bladder carcinoma"?

For tumors diagnosed prior to 2007:

If the histology of the bladder primary is "transitional cell carcinoma" or "papillary transitional cell carcinoma," do not code the prostatic urethra as a new primary. This is probably a case of intraluminal (mucosal) spread of the original tumor, rather than separate primaries. The clinical diagnosis supports this view.

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
20021124

Multiple Primaries (Pre-2007)/Primary Site/EOD-Extension--Lung: Should lung cases be counted as more than one primary when nodules removed from separate lobes of the same lung have either the same histology or they are different immunophenotypes of the same main histologic classification (e.g., adenocarcinoma)? See discussion.

1. Path report: "Two nodules (RLL, RUL) of primary pulmonary demonstrate adenocarcinoma with different histologic appearances and different immunophenotypes consistent with synchronous lung adenocarcinomas." Per ICC interpretation, two lung primaries are favored.

2. Path report: "Two peripheral nodules (LLL, LUL) demonstrate similar P.D. non-small cell carcinoma with features of large cell undifferentiated carcinoma."

For tumors diagnosed prior to 2007:

According to current SEER rules, both examples represent one primary because both tumors are in one lung and of a single histologic type. Code the Primary Site field to C34.9 [Lung, NOS] for both examples and the EOD-Extension field to 77 [Separate tumor nodules in different lobe]. This will capture the fact that there are multiple tumors within the lung for each of these examples.

Differences in immunophenotypes confirm independent de novo cancers and rule out metastasis. Immunophenotype differences do not equate to different histologies. In the first example described, there are different histologic features; however, the main classification 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
20021008 Surgery of Primary Site/Surgical Procedure of Other Site--Bladder: What codes are used to represent these fields for a deeply invasive bladder primary treated initially with a TURP (for suspected prostate extension that turns out to be pathologically negative) and a TURB that is subsequently treated with a cystoprostatectomy?

For cases diagnosed 1/1/2003 and after, code:

1. Surgery of Primary Site field to 60 [Radical cystectomy (male only)] because the cystoprostatectomy was the most extensive (definitive) surgery performed to the primary site.

2. Surgical Procedure of Other Site to 2 [Non-primary surgical procedure to other regional sites] based on the TURP.

 2002