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Report Produced: 09/21/2026 17:50 PM

Report Question ID Question Discussion Answer Cancer Site Category Data Item Category Year
20071038 MP/H Rules/Histology--Brain and CNS: Is it generally correct that the code for PNET [9473/3] should be used to code tumors arising in the brain and spinal cord, and the code for pPNET [9364/3] should be used to code tumors arising in the bone and soft tissue? See Discussion.

The terms and definitions for "Brain" in the 2007 MP/H rules distinguish between pPNET and PNET. Is it correct even when the diagnostic terminology alone would lead to other coding, such as "PNET" used to diagnose a soft tissue mass in the chest and "neuroectodermal tumor" used to diagnose a brain mass?

Should additional rules be added to both "Brain" and "Other Sites" to enforce this distinction?

For cases diagnosed 2007 or later:

Yes. Assign code 9473/3 for tumors arising in the brain and spinal cord and assign code 9364/3 for tumors arising in the bone and soft tissue.

Clarification and reinforcement of this distinction will be added to the "Other sites" terms and definitions with the first revision to the MP/H rules.

 Brain and CNS Histology 2007
20071056 Reportability/Terminology--Prostate: Is the diagnosis of "atypical glands suspicious for adenocarcinoma" sufficient to report a prostate cancer if a note states that there is "insufficient atypia to establish a definitive diagnosis of malignancy"? See Discussion.

Date of report is July 2005. One positive specimen of 12.

Specimen 6: Diagnosis = Prostate tissue with a small focus of atypical glands suspicious for adenocarcinoma. Note. There is insufficient cytologic and/or architectural atypia to establish a definitive diagnosis of malignancy. Negative basal cell staining with cytokeratin... in atypical glands is consistent with the diagnosis of suspicious for adenocarcinoma. In addition, the diagnosis is suppported by a positive staining for alpha-methyl COA racemase (P504S), a recently discovered marker that is preferentially expressed in prostate cancer...

This case is reportable. The diagnosis states "suspicious for adenocarcinoma." "Suspicious for" is a reportable ambiguous term.

The additional stains supported this "suspicious" diagnosis. A more definitive diagnosis could not be made based on this specimen.

 Prostate N/A 2007
20071099

MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion.

Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma."

This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code?

For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma.

"Components" is not a term indicative of a more specific histology. See note under rule H5.

 Lung Histology 2007
20071061 Histology--Melanoma: How is a "malignant melanoma arising in a melanocytic nevus" coded?

The histology code is 8720/3 [malignant melanoma, NOS].

There is no specific code for melanoma arising in melanocytic nevus. According to our pathologist consultant, this is likely because nevi are so common, melanoma arising in association with them is common and appears to have no bearing on prognosis or treatment. Most pathologists do not include the nevus in the diagnosis of melanoma, even when they see it.

Code melanomas arising in melanocytic nevi to the appropriate melanoma code, probably 8720, 8721, or 8743 in most cases.

 Melanoma Histology 2007
20071111 MP/H Rules/Histology--Lung: How many primaries should be abstracted when a patient has an adenocarcinoma with bronchioalveolar-like features in the right upper lobe, adenocarcinoma in the right middle lobe and non-small cell carcinoma with clear cell features in the right lower lobe? See Discussion.

A RUL lung wedge resection and RML and RLL lobectomies were performed. The RUL resection showed invasive adenocarcinoma with bronchioalveolar-like features. Tumor size 9x.9x.8cm. The RLL lobectomy showed invasive non-small cell carcinoma with clear cell features. Tumor size 4.1x2.5x1.8cm. The RML lobectomy showed invasive adenocarcinoma. Tumor size 3.0x1.6x2.2cm.

Comment: Essentially three invasive tumors and a focus of bronchioalveolar carcinoma were identified in 3 specimens. All of the tumors appear somewhat histologically different. The larger tumors in the right upper and middle lobe were somewhat similar but still appear histologically different and therefore the pathologic staging is done based on all tumors being separate. The pathologic staging for this case is pT2(4) pN0 pMX.

What histology code and what site code are to be used on each abstract?

For cases diagnosed 2007 or later:

Abstract two primaries:

  1. C349 with histology coded to 8140 - invasive adenocarcinoma (RUL and RML)

  • C343 with histology coded to 8310 - invasive non-small cell carcinoma with clear cell features (RLL)

    • First, determine the number of tumors. There are three separate tumors in right lung in the example above:

    • RUL: invasive adenocarcinoma, bronchioalveolar-like features (8140, "-like" is not on the list of ambiguous terms used to code histology)

  • RLL: invasive non-small cell carcinoma with clear cell features (8310)

  • RML: invasive adenocarcinoma (8140)

    • Because there are three tumors, begin with rule M3 in the Multiple Tumors module. Stop at rule M11, multiple primaries for the tumor in the RLL (8310) compared to the tumors in the RUL and RML (8140 and 8140).

    Now evaluate the tumors in the RUL and RML using the multiple primary rules. Start at rule M3 and stop at rule M12, single primary.

    		 Lung N/A 2007
    		20071069 First Course Treatment--Melanoma: How and where is the excision for an in-transit metastasis coded if the in-transit metastasis is coded in CS Lymph Nodes? See Discussion. Excision of skin of scalp nodule reveals in transit metastasis of melanoma. Patient also has lung metastasis and begins systemic treatment. No primary tumor identified. Code the excision in Surgical Procedure of Other Site because no primary tumor was identified. Melanoma First course treatment 2007
    		20071114 Ambiguous Terminology/Date of Diagnosis: How would you code the diagnosis date when the body of an imaging report uses reportable ambiguous terminology while the final impression in that same report uses non-reportable ambiguous terminology? Would you code the diagnosis date to the date of the scan or to the subsequent biopsy date that confirmed a malignancy? See Discussion. Within the body of a mammogram report, the radiologist stated, "diffuse inflammatory tissue throughout the rt breast w/ large rt axillary lymph nodes, consistent with an inflammatory carcinoma of rt breast." His final impression, however, said "extremely suspicious rt breast w/ extremely dense breast parenchyma and adenopathy in axilla, suggesting an inflammatory carcinoma." The patient then went on to have a biopsy, which was indeed positive for cancer.

    Accept the reportable ambiguous terminology from the body of the mammogram. Record the date of the mammogram as the date of diagnosis.

    The guidelines on page 4 of the 2007 SEER manual addressing discrepancies within the medical record can be applied to discrepancies within one report.

    The instructions are:

    If one section of the medical record(s) uses a reportable term such as

    apparently and another section of the medical record(s) uses a term that is not on the reportable list, accept the reportable term and accession the case.

    		 N/A Date of diagnosis 2007
    		20071124 Multiplicity Counter-Breast: The general instructions say to ignore separate microscopic foci when determining when to use the single tumor or multiple tumor modules. Do these instructions apply if sizes are given for the foci? See Discussion. For instance, would a 1.2 cm breast tumor with 3 scattered microscopic foci ranging from 2-4 mm be treated as multiple tumors (4), or as a single tumor? If the microscopic foci are measured and listed as part of the diagnosis, they should be counted as multiple tumors. N/A N/A 2007
    		20071106

    MP/H Rules--Bladder: Does rule M6 mean that any combination of tumors with the histologies 8050, 8120-8124, or 8130-8131 are the same primary regardless of the amount of time between tumor occurrences? See Discussion.

    Many interpret Rule M7 to mean when separate occurrences of TCC of the bladder are diagnosed more than 3 years apart, it is reportable as a second primary. However, doesn't Rule M6 mean that if the histology is any combination of 8050, 8120-8124 or 8130-8131 for tumors diagnosed more than 3 years apart, they are reported as a single primary?

    For cases diagnosed 2007 or later:

    Papillary, transitional cell and/or papillary transitional cell carcinomas of the bladder are a single primary using Rule M6. Rule M6 includes diagnoses within 3 years of each other AND diagnoses more than three years apart for the histologies listed. If rule M6 applies to your case, stop. Do not continue on to Rule M7.

    		 Bladder N/A 2007
    		20071046 Ambiguous Terminology: Why was 60 days chosen for ambiguous terminology?

    The Histology Task Force approved a 60 day time frame for ambiguous terminology.

    The majority of cases are first identified by ambiguous terminology; for example, a patient has a mammogram that shows a lesion suspicious for cancer. That first indication of cancer prompts a work-up to either confirm or rule-out the cancer diagnosis.

    The data item "Ambiguous terminology" is not intended to capture information on this routine method of detecting and diagnosing cancer. The 60 day time frame should keep these cases out of the ambiguous terminology data item.

    The data item is intended to identify those cases where the cancer diagnosis is NOT confirmed during the work-up, but the case is still entered into the database. For example a patient who has a TRUS because of elevated PSA. The pathology from the TRUS says "Suspicious for adenocarcinoma of the prostate." The physician only documents that the patient is to return in 6 months for another PSA and TRUS. The registrar would enter this case into the data base because the word "suspicious" is on the ambiguous terminology list.

    		 N/A N/A 2007