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Report Produced: 02/16/2026 22:59 PM

Report Question ID Question Discussion Answer Year
20051025

Reportability/Behavior--Thymus: Are "lymphocyte predominant thymoma with microscopic capsule invasion" and "Polygonal epithelial cell thymoma with invasion of the lung and pericardial fat" reportable?

Please see SINQ 20110038 for the most recent information on reporting thymoma.

2005
20051103 CS Extension/Histology (Pre-2007)--Melanoma: When do the terms "regression is present," "apparent regression," or "undergoing regression" affect the coding of melanoma cases? See Discussion.

For melanoma, many path reports document the presence or absence of regression. At what point does the presence of regression become significant enough to code it for histology and for CS Extension?

Example 1: Skin biopsy showed malignant melanoma, Breslow thickness 0.38 mm, Clark's level II, ulceration is absent, regression is present.

Example 2: Punch biopsy showed malignant melanoma, Clark's level II, 0.34-mm maximum depth of invasion, with apparent regression.

Example 3: Skin biopsy showed lentigo maligna undergoing regression.

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.

For tumors diagnosed prior to 2007:

Regression does not affect CS staging for cutaneous melanoma. "Malignant melanoma, regressing" [8723] is coded only when it is the final diagnosis. Do not use code 8723 for the examples above.

According to our pathologist consultant:

Melanoma can occasionally undergo "spontaneous" regression -- the tumor can become smaller, and in some cases even disappear. This phenomenon is likely due to an increased immune response on the part of the "host" (person with the melanoma). This is noted occasionally in patients with metastatic disease which gets smaller, or even disappears. We think this is also what has happened in patients who get diagnosed with metastatic melanoma, say in a lymph node, but have no primary tumor, though sometimes give a history of a skin lesion which came and then went away, or a skin lesion which was not submitted for pathological examination. In addition, we (pathologists) occasionally see biopsies which have melanoma as well as the presence of the immune reaction to it, and once in a while, the immune reaction with little or no evidence of residual melanoma.

The College of American Pathologists says that regression of 75% or more of the melanoma carries an adverse prognosis.

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.

 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
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
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
20051063 Primary Site/CS Tumor Size/CS Extension--Lung: How are these fields coded when a chest CT for lung cancer documents multiple masses in different lobes of the lung? See Discussion.

Example

Chest CT: "Almost complete consolidation of RUL and superior segment of RLL, highly suspicious for malignancy and represents primary bronchogenic carcinoma until proven otherwise. Multiple pulmonary masses bilaterally consistent with metastatic disease."

The physician describes multiple masses throughout RLL and LLL of lung suspicious for met disease, particularly lesion in LLL measuring 2.5 cm. The 2 cm mass in right lung abuts pleura, another mass in RLL measures 2.5 cm, smaller nodules in RLL and another 1 cm lesion abuts the pleura. Bx of a rt supraclavicular LN is positive for met carcinoma c/w lung primary.

Would primary site be coded to RLL because the scan states that the lesions on the right side represent primary bronchogenic carcinoma until proven otherwise and the 2.5 cm lesion in the RLL is the location of the largest tumor on the right? Or should site be coded to right lung, NOS and size to unknown because there is no clear statement as to which lesion on the right represents the primary tumor? If the site is lung, NOS, would CS Extension be coded to 65 to describe the multiple nodules in the RLL?

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.Based on the information provided:

Code primary site C349 [Lung]. Code laterality 1 [Right]. Code CS Tumor Size 999 [Unknown]. Code CS Extension 65 [Separate tumor nodules, same lobe]. Code CS Mets at Dx 39 [Separate tumor nodule in contralateral lung].

 2005
20051092 CS Extension--Kidney: When an incidentally found 5 cm mass discovered on a CT scan during a work-up for colon carcinoma is stated to be consistent with renal cell ca, should the case be staged as localized or unknown when no other information is available related to a work-up for the kidney primary?

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 what is known. In the example above, the tumor size and the extension are known and can be coded. The information is limited, but not completely missing.

Code what you DO know rather than coding nothing. Any metastases from the kidney would have been discovered during the workup of the rectal cancer.

 2005
20051093 CS Lymph Nodes/Scope of Regional Lymph Node Surgery--Prostate: When prostate cancer is an incidental finding at cystoprostatectomy for bladder cancer, is the pelvic lymph node dissection coded for the prostate as well as the bladder?

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.

Yes, the pelvic lymph node dissection is coded as regional lymph node surgery for both primaries and the nodes are counted in collaborative staging for both primaries. The examination of the pelvic lymph nodes is relevant to both the bladder and the prostatic primaries.

 2005
20051135 2004 SEER Manual Errata/CS Tumor Size--Can the Determining Descriptive Tumor Size information, on page 6 in the SEER EOD Manual, January 1998, be used to code descriptive tumor size in Collaborative Stage?

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 instructions in the CS Manual, Appendix 1, page 62. This information will be added to the 2004 SEER manual in the next update.

Do not use the Determining Descriptive Tumor Size information from EOD for CS Tumor Size.

 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