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Report Produced: 09/21/2026 17:04 PM

Report Question ID Question Discussion Answer Cancer Site Category Data Item Category Year
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
20071101 Multiplicity Counter/CS Tumor Size: The Multiplicity Counter rule 6c states "Use code 99 when the tumor is described as diffuse". Is code 99 used in all circumstances when tumor size is coded to 998? See Discussion. The CS manual lists esophagus, stomach, familila/familial polyposis (colon), lung, and breast as the only circumstances when code 998 is valid. If this is correct, then if TS is coded to 998, then Multiplicity Counter must be 99. If the number of tumors is known, code the number in Multiplicity Counter. If the number of tumors is not known, assign code 99. If "diffuse" is the only information available to describe the tumor, assign code 99. N/A N/A 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
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
20071096 Multiplicity Counter--Prostate: How is multiplicity counter to be coded for a clinically inapparent prostate cancer for which sextant needle biopsy cores on left and right sides are positive for adenocarcinoma? See Discussion.

Prostate cancer typically presents as multifocal diffuse disease. The coding exercise in the MPH rules presentations coded prostate cancer as one tumor.

Reference: SEER Training Web Casts - Other Sites Rules Practicum

 Code the number of tumors present if known. This information can be taken from any part of the record, including imaging and prostatectomy. If the only information available is "diffuse," or "multifocal," assign code 99. Do not assume there are multiple tumors just beacause there are multiple biopsies. When there is no information about the number of tumors, code Multiplicity Counter to 99 and Type of Multiple Tumors to 99. Prostate N/A 2007
20071074 MP/H Rules/Multiple Primaries--Lung: How many primaries should be reported when an "adenocarcinoma" is discovered in one of several new nodules at the scar in a lung and it is less than a year after a wedge resection for a diagnosis of "bronchioalveolar adenocarcinoma" in the same lung? See Discussion.

In March 2006 patient diagnosed with bronchioalveolar adenocarcinoma [8250/3] and had wedge resection. In November 2006 a CT chest shows nodules at the scar suspicious for recurrence. In January, 2007, there was a biopsy of one of the nodules showing adenocarcinoma [8140/3].

Is this part of the original disease process diagnosed in March 2006 or should it be abstracted as a new primary based on 2007 MP/H rules (histology is different at the first 3 digits)?

For cases diagnosed 2007 or later:

Try to obtain more information/clarification on the 2007 diagnosis -- for example, is it metastasis?

Based only on the information provided for this case, the 2007 diagnosis is a separate primary.

Use the 2007 MP/H rules to assess the 2007 diagnosis. Begin with rule M3 in the multiple tumors section. Stop at rule M11, multiple primaries.

 Lung N/A 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
20071044

Date of Conclusive Terminology: Is there an applicable timeframe when coding this field?

There is no strict timeframe for Date of Conclusive Terminology. The diagnosis using conclusive terminology could be made any time following the diagnostic work-up.

The date of conclusive terminology is related to code 2 [ambiguous term followed by conclusive term] in the data item "Ambiguous terminology." Assign code 2 when a conclusive diagnosis is made 60 days or more after a diagnosis using ambiguous terminology. Record the date of the conclusive diagnosis in "Date of Conclusive Terminology."

 N/A N/A 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
    		20071028 MP/H Rules--Lung: Why the term "nodule" is not included as an equivalent term along with tumor, mass, lesion and neoplasm in the 2007 lung multiple primary rules?

    Answer revised July 2008

    For cases diagnosed 2007 or later:

    For the purpose of applying the Lung MP/H rules, the word "Nodule" can be used interchageably with "Tumor," "Mass," "Lesion" and "Neoplasm." HOWEVER, this does NOT apply to casefinding or staging.

    This revision will be added to the next version of the MP/H rules. Sinq question 20071028 will be revised.

    		 Lung N/A 2007