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

Report Question ID Question Discussion Answer Year
20051145

CS Extension/CS Mets at Dx--Colon: How is a small focus of metastatic disease in the submucosa coded for a sigmoid primary? See Discussion.

Path final diagnosis states: "No lymph node metastases identified. One submucosal met in a block taken from a surgical margin section." Path micro states: "Microscopic involvement of the border between the serosa and muscularis propria. Sections of proximal & distal surgical margins reveal no tumor in one, and a small focus of metastatic disease in the submucosa of the other. This focus of tumor exists in a small vascular channel and is complete in and of itself; ie, it has not been cut thru by excision of the specimen from the patient."

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.

This submucosal metastasis does not affect CS extension. It is not part of CS or TNM staging.

According to the TNM supplement, "Multiple tumour foci in the mucosa or submucosa ("skip metastasis") are not part of the TNM classification and should not be classified as distant metastasis.

 2005
20051035 Reportability--Brain and CNS: Does a case of astrogliosis meet the criteria for gliomatosis cerebri? See Discussion.

Case clinically stated to be a glioma of the brain. Pathology from resection states astrogliosis.

Anderson's Pathology defines astrogliosis as astrocytic proliferations. Gliomatosis cerebri is defined as diffuse neoplastic transformation of poorly differentiated astrocytes over a wide area; predominantly invovles hemispheric white matter.

 The pathologic diagnosis for this case, astrogliosis, is not reportable to SEER. Take the definitive diagnosis for this case from the pathology report from the resection. The pathology report takes precendence over the clinical diagnosis. 2005
20051074 CS Extension/CS Lymph Nodes--Colon: What codes are used when large vessel invasion (V2 grossly evident) is stated to be present on a pathology report? See Discussion.

Example

Cecum, right hemicolectomy: poorly differentiated invasive adenocarcinoma of the cecum. Large vessel invasion (V2-grossly evident) is present. Microscopic description: The grossly described matted lymph node tissue shows an irregular nuclear contour and is classified as V2, grossly evident venous invasion based on staging criteria of the AJCC Cancer Staging Manual, 6th Edition.

Per note 2 in the coding scheme for CS-Extension, a nodule with irregular contour in the pericolic adipose tissue should be coded in CS-Extension to code 45. Is the large vessel invasion described in the path report the same process as a tumor nodule in pericolic fat? Should note 2 be used and CS-Extension coded to 45?

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.The description of large vessel invasion and irregular nuclear contour from the example above describes grossly matted LYMPH NODE tissue. Do not code this in the CS Extension field. Code the CS Lymph Nodes field appropriately based on the rest of the information for this case.

When large vessel invasion and irregular nuclear contour is used to describe a "tumor nodule," rather than a recognizable lymph node, code it in the CS extension field.

 2005
20051087 CS Site Specific Factor 3--Prostate: When a prostatectomy specimen shows tumor focally penetrating through the capsule into periprostatic striated muscle tissue, is the involvement coded to 041 [periprostatic tissue] or 052 [skeletal muscle, NOS]?

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.

Assign code 052 [Levator muscle, Skeletal muscle, NOS, Ureter]. The description for this case states periprostatic "striated" muscle tissue. According to our pathologist consultant, "striated muscle in this context is skeletal muscle and the term is being used to differentiate the muscle from smooth (non-striated) muscle." Smooth muscle involvement would be most likely be coded 050 [Extension to bladder neck...] because smooth muscle in a prostatectomy or TURP specimen is usually from the urinary bladder neck.

 2005
20051040 Primary Site--Sarcoma: What is the correct topography code for a partial lung lobectomy with pathology diagnosis of "pulmonary sarcoma with smooth muscle differentiation"? See Discussion.

Operative report: palpable 2x2cm mass in the mediastinal surface of the rt middle lobe and the contiguous upper lobe together.

Path comment after partial lung lobectomy: In all likelihood this is a malignant process occurring in smooth muscle changes surrounding vessels within the lung versus an undifferentiated epithelial tumor.

ADDENDUM DX: low grade pulmonary sarcoma with smooth muscle differentiation.

Consultant's report concurs with that of the original pathologist's report of malignant neoplasm compatible with smooth muscle origin.

 This case is unique. Assign topography code C493 [Connective, subcutaneous and other soft tissue of thorax]. Based on the information provided, this sarcoma has smooth muscle differentiation and originated in the muscle. Code the primary site to muscle. 2005
20051136 Surgery of Primary Site--Breast: How is the surgery field coded when an excisional biopsy that is originally stated to be negative is later determined to be positive on ROS and a mastectomy with negative findings is performed 2 years later? See Discussion.

Hospital 'A' performed a breast biopsy and found only atypia. Two years later Hospital 'B' re-read the first biopsy as multifocal ductal carcinoma in situ, cribriform type. A mastectomy at Hospital 'B' followed and all specimens from this were negative.

Do we report the procedure at Hospital 'A' an excisional biopsy, despite the negative findings at the time?

For hospital A, follow the instructions in the 2004 SEER Manual on page 5, #4. For hospital B, the case is not reportable.

The diagnosis date is the date of first excision. Code the breast excision from Hospital A as surgery, first course treatment. The mastectomy was not part of first course treatment.

 2005
20051054 CS Eval--Ovary: How is CS Mets Eval coded when the patient has positive pleural effusion confirmed by cytology?

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.Code CS Mets Eval for the example above 3 [path exam of metastatic tissue] assuming there has been no pre-treatment. Positive cytology is required for confirmation of pleural effusion for an ovarian primary.

 2005
20051112 Collaborative Staging--Hematopoietic, NOS: Which Collaborative Staging schema is used for a connective, subcutaneous and soft tissue primary of the pelvis [C495] with the morphology of Langerhans cell sarcoma [9756/39]? See Discussion. On page C-411 of the SEER manual for the connective, subcutaneous, and other soft tissues schema it lists exceptions for certain morphologies and the above is not listed as an exception. On the Hematopoietic scheme it lists the above morphology.

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.Use the hematopoietic schema on page C-709 of the 2004 SEER manual. The histologically defined schemas have priority over the site schemas when both apply. See page 115 of the 2004 SEER manual.

The morphology codes listed on page C-411 pertain to the SEER Site Specific Guidelines.

 2005
20051118 CS Tumor Size--Rectum: Should the tumor size be coded to 080 from the colonoscopy size or 075 from the CT scan size? See Discussion. 6/29/04 Colonoscopy with biopsy: near obstructing circumferential friable mass extending from 8 to 16cm above anal verge. 6/30/04 CT Scan Abdomen/Pelvis: 7.5X7.2cm large rectal mass. The patient had radiation with concurrent 5-FU. Surgery is done after treatment.

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.

Code tumor size as 080 (8cm). Code the largest pretreatment size recorded when there is preoperative systemic treatment.

 2005
20051078 Surgery of Primary Site--Melanoma: If the surgical margins are greater than 1 cm for length and width but less than 1 cm for depth, do we code surgery in the 30-33 range? Yes, assign a surgery code from the 30-33 range when any margin is less than 1 cm. Since tumor thickness is an important prognostic factor for cutaneous melanoma, the deep margin is of particular importance. 2005