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Report Produced: 11/21/2025 06:42 AM

Report Question ID Question Discussion Answer Year
20061131 CS Lymph Node Examined--Lung: How is this field coded when a mediastinoscopy and lobectomy are performed and the pathology report indicates multiple lymph node fragments were removed as biopsy specimens and the lobectomy specimen revealed 3 interlobar lymph nodes?

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 the CS Lymph Node Examined field to 98 [number unknown] because the biopsy information is not clear and as a result you do not know how many lymph nodes were examined.

 2006
20061094

Ambiguous terminology: Does the phrase "considered to be" represent ambiguous terminology when modifying a reportable term?

A tumor considered to be malignant is reportable. "Considered to be" is an UNambiguous term.

 2006
20061080 Histology (Pre-2007): Is histology for an anorectal biopsy of "Cloacogenic carcinoma (squamous cell carcinoma with basaloid features)" coded to 8124/3 [Cloacogenic carcinoma] or 8083/3 [Basaloid squamous cell carcinoma]?

For tumors diagnosed prior to 2007:

Code histology to 8124/3 [Cloacogenic carcinoma]. These are squamous cell carcinomas of basaloid type that are found in the cloacogenic (transitional) zone of the anal canal.

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.

 2006
20061018 Multiple Primaries (Pre-2007)--Brain and CNS: Is neurofibromatosis a separate and distinct primary in the presence of a longstanding glioma? Does the following show one or two primaries? See Discussion. MRI of Brain: 1. Findings compatible with left optic nerve glioma. 2. Stable enhancing focus in left temporal white matter. Lack of interval change since Dec 2000 suggests a white matter finding typical of neurofibromatosis and makes more aggressive processes such as astrocytoma less likely. Small aneurysm can not be excluded.

For tumors diagnosed prior to 2007:

Neurofibromatosis and glioma would be separate brain/CNS primaries.

However, there is only one primary in the case example above: Glioma, left opic nerve. "...suggests a white matter finding typical of neurofibromatosis" is not reportable. "Suggests" is not a reportable term. Therefore, in this example neurofibromatosis is not reportable unless there is a more definitive statement in the record.

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.

 2006
20061119 Reportability--Breast: Is a biopsy proven squamous cell carcinoma of the breast nipple reportable if a subsequent areolar resection shows foreign body granulomatous reaction to suture material and no evidence of residual malignancy in the nipple epidermis? Yes, this case is reportable. The primary site is C500 [nipple]. There was a diagnosis of malignancy on 2/15/06: "Positive for malignancy." Even though no residual malignancy was found in the later specimen, that does not disprove the malignancy diagnosed on 2/15/06. 2006
20061093 Ambiguous Terminology--Breast: Is a stereotactic biopsy that is "focally suspicious for DCIS" reportable if it is followed by a negative excisional biopsy? See Discussion.

Per the 2004 SEER manual page 4, 1.a, the case is reportable based on the ambiguous term "suspicious" for DCIS.

Per the 2004 SEER manual page 4, 1.c, use these terms when screening diagnoses on pathology reports, operative reports, scans, mammograms, and other diagnostic testing other than tumor markers.

Note: If the ambiguous diagnosis is proven to be not reportable by biopsy, cytology, or physician's statement, do not accession the case.

 Do not accession this case. The needle localization excisional biopsy was performed to further evaluate the suspicious finding found on stereotactic biopsy. The suspicious diagnosis was proven to be false. 2006
20061091

Reportability--Ovary: Is an "aggressive adult granulosa cell tumor with one of two lymph nodes positive for metastatic granulosa cell tumor" reportable?

Malignant granulosa cell tumor is reportable. The case described above is malignant as proven by metastasis to the lymph node.

 2006
20061024 Histology (Pre-2007)--Kidney: How is a "mucinous tubular and spindle cell carcinoma" coded? See Discussion. Literature search results: "The new WHO-classification of renal tumors includes new subtypes, one of which is the mucinous, tubular, and spindle cell carcinoma. Many of these tumors had been previously diagnosed as sarcomatoid carcinoma. There are areas of cord-like growth and spindle cell configuration, sometimes with a clear cell appearance."

For tumors diagnosed prior to 2007:

Code histology to 8255 [Adenocarcinoma with mixed subtypes]. ICD-O-3 does not have a code specific to this combination histology. 8255 is the best code available.

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.

 2006
20061142 Multiple Primaries (Pre-2007)/Histology (Pre-2007)--Skin: How many cases are to be abstracted and how is the histology field(s) coded for cases in which a fibrosarcoma arises in or transforms from a dermatofibrosarcoma protuberans? See Discussion.

1. If the fibrosarcoma occurs after DFP, and is called metastatic, is it a recurrence or is it a new primary? Example: Pt diagnosed in 7/05 with a high grade fibrosarcoma arising in a dermatofibrosarcoma protuberans. The path indicated "The presence of high grade fibrosarcoma, the extent of the tumor necrosis and the mitotic rate are all adverse prognostic findings that indicate a significant risk for mets." The patient had a recurrence in 8/06 called a low grade fibrosarcoma mets from prev." The DFP code is 8832/3 and a fibrosarcoma code is 8810/3. Our pathologist feels that the fibrosarcoma is a more aggressive tumor so should the case be coded to the 8810/3.

2. If DFSP has areas of fibrosarcoma, should it be coded to the latter because it is more aggressive? Example: Skin and subcutaneous tissue reads: Low grade sarcoma - tumor extends to margin. Comment: "Although the predominant pattern of this tumor is consistent with dermatofibrosarcoma protuberans, focal presence of hypercellularity and increased mitotic figures suggest transformation to Grade I fibrosarcoma. This progression, although focal, carries an increased risk of mets over classic DFSP. Code to 8810/31?

For tumors diagnosed prior to 2007:

Code histology to 8832/3 [Dermatofibrosarcoma protuberans] for both cases. DFSP with transformation to fibrosarcoma and DFSP with areas of fibrosarcoma are coded to 8832/3.

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.

 2006
20061063 CS Extension--Lung: Do notes 6A and 6B in the 2004 SEER manual offer conflicting instruction for determining the significance of pleural effusion for this primary site? See Discussion.

1. Is note B to be used to modify or change what note A states?

Does note B state -- If a pleural fluid bx(s) is negative; but the fluid is bloody and/or is an exudate, and clinical judgment indicates the effusion is related to tumor -- use code 72?

If a pleural effusion is biopsied should the pathology report state the color of the pleural fluid or is an exudate? (Training issue)

2. Do the following clinical findings impact the clinical evaluation of involvement for a pleural effusion? If yes, why? (Training issue(s))

a. Heart problems?

b. The location of the pleural effusion?

i. Bilateral pleural effusion is noted; tumor in Rt or Lt lung only?

ii. Bilateral pleural effusion is noted; tumor in both lungs?

iii. Pleural effusion is noted on the opposite side from the tumor?

iv. Pleural effusion is on same side as the tumor?

SUPPORTING CS MANUAL DOCUMENTATION

Note 6: Pleural Effusion.

A. Note from SEER manual: Ignore pleural effusion that is negative for tumor. Assume that a pleural effusion is negative if a resection is done.

B. Note from AJCC manual: Most pleural effusions associated with lung cancers are due to tumor. However, there are a few patients in whom multiple cytopathologic examinations of pleural fluid are negative for tumor.

In these cases, fluid is non-bloody and is not an exudate. When these elements and clinical judgment dictate that the effusion is not related to the tumor, the effusion should be excluded as a staging element and the patient should be staged T1, or T2, or T3.

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.

1. Note B does not modify or change note A. Note B is explaining when an effusion should not be used to determine the stage. Pleural effusions are evaluated by cytology, not biopsy.

2. If relevant, the clinician should document the fact in the medical record. Heart problems can cause non-malignant pleural effusions (that are disregarded for staging). Pleural effusion will almost always be around the lower lobes due to gravity, but may envelop an entire lung. Pleural effusions can be unilateral or bilateral regardless of the location of the tumor, but are usually on the side where the tumor is.

 2006