MP/H Rules/Histology--Esophagus: Biopsy
of esophagus - path report states
"adenocarcinoma, intestinal type".
There is no evidence of a gastric tumor
in scans or EDG. There is a rule for
colon to disregard "intestinal type" and
code to adenocarcinoma (8140) but no
rule for esophagus. How should histology
for this esophageal case be coded?
Follow MP/H Other Sites Rule H11 and
code 8144/3 [Adenocarcinoma, intestinal
type]. Adenocarcinoma, intestinal type,
is called that because it resembles the
normal pattern of adenocarcinoma seen in
the large intestines. It is not an
indication of the location of the
adenocarcinoma. We find that it is not
uncommon in the sinuses, stomach, lungs,
cervix, and many other organs.
Terminology--Prostate: Text from
prostate biopsy states "highly
suspicious for but not diagnostic of
adenocarcinoma suggest another biopsy"
Is this case reportable?
Do not report. "Not diagnostic of"
means that while the pathologist is
seeing some features that resemble
cancer, there are not enough features to
feel comfortable making an
unquestionable diagnosis. Watch for
another biopsy of the patient in the
next 3-6 months. The statement "not
diagnostic of" overrules the "highly
MP/H Rules/Histology--Thyroid: What is
the correct histology for these thyroid
tumors? In each case, the path report
reads, "Papillary sclerosing carcinoma."
In one case, the results are in CAP
protocol format and next to
'Encapsulation of tumor' it says 'No.'
In the other case, it is not in CAP
format, but the microscopic description
says, 'encapsulation of tumor - no.' Is
the correct code 8350?
Code 8350 [Nonencapsulated sclerosing
carcinoma] per MPH Other Site Rule H11.
The definition for 8350 in the
Morphology section of ICD-O-3 includes
nonencapsulated as well as diffuse
sclerosing papillary carcinoma. When
the pathologist states 'No' for
encapsulated, that means
MP/H Rules/Histology--Melanoma: Path:
Melanoma in situ, lentiginous type, skin
rt lower leg. Is this the same as acral
lentiginous melanoma (8744)? To code to
8744, do we specifically have to see the
word "acral" lentiginous melanoma?
Please see discussion.
In researching this, acral lentiginous
melanoma is observed on the palms, soles
and under the nails.
Assign 8742/2 [lentigo maligna] to
"melanoma in situ, lentiginous
type." Acral lentiginous melanoma is
not the same as melanoma, lentiginous
type. "Acral lentiginous melanoma,"
8744, should be used only if the report
states acral lentiginous melanoma or
malignant melanoma, acral lentiginous
Acral lentiginous melanoma
MP/H Rules/Histology: Final diagnosis
from a partial vulvectomy says, "vulvar
intraepithelial neoplasia III, basaloid
type." Is this VIN III (8077/2) or
basaloid squamous cell carcinoma (8083
and change the bevavior code from 3 to
2)? Which Histology rule applies? It
seems to me that H4 and H6 both lead to
Assign 8077/2 [Squamous intraepithelial
neoplasia, grade III] for VIN III
diagnoses, regardless of the type.
According to the WHO Classification of
Tumours(page 319), "VIN is predominately
of the warty or basaloid types..." Use
the multiple tumors module to determine
the histology code for VIN. Rule H21
Histology--Lymphoma: If two different
histologies of the same type of Lymphoma
(two different histologies for NHL:
DLBCL 9680/3 + Mantle Cell Lymphoma
9673/3) occur in the same time in
different lymph nodes, how do we code
the histology, and what would be the
sequence number if this would be
considered as multiple primaries?
Please see discussion.
I understand that if both HL and NHL
histology existed at the same time, this
will be one primary only and histology
code would be composite lymphoma
It is important to note for this case
that the two different types of NHL
occurred in different lymph nodes; one
type in one lymph node and the other
type in another lymph node.
Assign the lower
MP/H Rules/Multiple primaries--Breast:
When an in situ diagnosis is followed by
an invasive diagnosis in the same breast
1.5 years later, is it a new primary?
Pt had a core bx 1/07 that showed DCIS.
Pt refused resection, followed by chemo
and/or XRT. A year and a half later
(6/08) the pt returns for a MRM which
shows infiltrating duct ca and positive
LNS. The 6/08 information came in as
a Correction Record. The comment in the
Correction Record stated “Per MD, pt
didn’t see any urgency and delayed
surgery 1.5 year after diagnosis. The
patient did not have any rx in that time
period. Not specifically stated that pt
had progression – only info is that pt
had no adenopathy 1/07 and then 6/08 had
positive LNS. Is the 6/08 a new
Abstract the 6/08 invasive diagnosis as
a separate primary according to rule M8.
Rule M8 applies whether or not the
later diagnosis in this case is
progression of disease.
CS Site Specific Factor--Prostate:
Please clarify how SEER registries
should use code 40 for site-specific
factor 3 on prostate cases. Please see
Discussion: The 6/11/09 NAACCR Webinar
on prostate cancer pointed out that SSF
3 code 40 refers the registrar to Note
4, which states "when the apical, distal
urethral, bladder base, or bladder neck
margins are involved and there is no
extracapsular extension, use code 040."
The webinar went on to say that code 40
ONLY applies to these specific margins,
and that if other margins are involved
(for example, the 'right lateral
margin'), we should not use code 40. Is
this consistent with SEER's
interpretation of Note 4? Are we to
ignore involvement of margins other than
those specified in Note 4, and
consequently code SSF 3 within the
000-032 range? Would this also apply to
code 048 (extracapsular extension and
Yes, SEER agrees. Code SSF3, code 040
per page C-740 of 2007 SEER manual
exactly as stated in Note 4. According
to the Inquiry and Response System of
the CoC, Note 4 lists specific margins
that were once thought to have a
prognostic impact. Code 040 in SSF3
should be used only when those margins
Note 4 pertains
MP/H Rules/Histology--Breast: How is
histology coded? Right breast simple
mastectomy, path: 2.5 x 1.5 x 1.5 cm
metaplastic carcinoma with; the
sarcomatous component is high grade
sarcoma with focal areas of osteoid
formation. The epithelial component is
predominantly grade 2 DCIS.
Assign code 8575 [Metaplastic carcinoma,
NOS]. Metaplastic carcinomas often
include mixtures of epithelial carcinoma
with sarcoma, for example.
Reportability--Appendix: Does the
statement of "metastatic" make this
reportable? Low-grade appendiceal
mucinous neoplasm; Lt ovary, cul-de-sac,
omentum, and small bowel: Metastatic
low-grade appendiceal mucinous neoplasm.
Per pathologist this is a borderline
tumor of the appendix.
Borderline tumors (other than brain and
CNS) are not reportable to SEER. In the
case of borderline tumors, the term
"metastatic" does not automatically make
them reportable. When the "metastatic
deposits" are also borderline, the case
is not reportable. For this case in
particular, the "metastases" are
actually (benign) implants and not
malignant or invasive mets.
Surgery of Primary Site/Scope Regional
LN Surgery--Breast: When a sentinel
lymph node dissection that removes
one-to-three axillary lymph nodes and a
total/simple mastectomy is done what
breast surgery is coded? 41 for primary
site - Total/simple mastectomy 2 for
scope of lymph node surgery or 51 for
primary site surgery - MRM 2 for scope
of lymph node surgery Thank you
Assign code 41 [Total (simple)
mastectomy, NOS WITHOUT removal of
uninvolved contralateral breast] for
surgery of primary site. Assign code 2
[Sentinel lymph node biopsy] for scope
of regional lymph node surgery. Code 41
applies to a total/simple mastecomy with
any number of sentinel lymph nodes
removed -- as long as all of the nodes
removed are designated as sentinel
Reportability/MP/H Rules--Brain and CNS:
Is the following brain tumor reportable?
Large posterior fossa mass: Epidermoid
tumor. If reportable, what histology
code do we use? Please see discussion.
12/18/08: CT brain: large left post
fossa mass with marginal & internal
calcification & low density. This may be
epidermoid or dermoid tumor. 12/20/08:
CT Brain with contrast: Findings most
compatible with an epidermoid or dermoid
tumor. 12/20/08: L-sided
craniotomy & partial lateral approach
for tumor resect: identified cerebellum,
tumor taken out in piecemeal & dissected
down to foramen magnum. Some tumor left
stuck down. 12/20/08 path: Left CP angle
tumor: Epidermoid tumor with focal minor
chronic inflammation. Note: lesion shows
copious dry keratin content ovai[cut
off] a simple sq lining with no obvious
skin adnexal structure. Final diagnosis:
dermoid/epidermoid tumor of midline post
fossa (chart notes).
This is not reportable. It is a
malformation, not a tumor, according to
our expert consultant.
CS Lymph Node--Head and Neck: How is
this field coded when a positive neck
FNA is followed by a neck dissection
that contains one of seventeen positive
lymph nodes? See discussion.
The primary site is the right tongue.
The patient underwent FNA of a right
neck mass that was positive for squamous
cell carcinoma. Subsequent right
modified radical neck dissection showed
1 out of seventeen nodes positive for
metastatic carcinoma. For head and neck
primaries, the CS LN codes 10-19
represent a single positive ipsilateral
regional node. Codes 20-29 represent
multiple positive ipsilateral nodes.
If the neck dissection included the area
of the positive FNA, count only the
positive nodes from the dissection.
Avoid double-counting a positive node
for both an FNA and a dissection. In
the unlikely event that the dissection
did not include the area of the positive
FNA, add one positive node to the count
from the dissection.
Multiple primaries--Hematopoietic, NOS:
How should the following case be
accessioned? February 2003:
plasmacytoma of the sinus June 2003:
plasmacytoma of the alveolar ridge July
2003: plasmacytoma of the skin June
2004: multiple myeloma What is the
correct diagnosis? If this represents a
transformation of plasmacytomas to
multiple myeloma, will the information
on multiple myeloma be available for
statistical and research purposes?
Accession this case as plasmacytoma
diagnosed in Feb. 2003. Each of the
subsequent diagnoses are not abstracted
as new primaries. They are the "same,"
one primary only, according to the
Definition of Single and Subsequent
Primaries for Hematologic Malignancies
(the tri-fold heme table). The 2003
diagnosis is a classic example of
extraosseous plasmacytoma (9734/3).
Plasmacytoma and multiple myeloma
would be two primaries in the new
hematopoietic rules taking effect in
CS Lymph Nodes--Ovary: For an ovarian
primary, how are lymph nodes removed
from “colon tissue” during a modified
posterior pelvic debulking coded? Are
they considered regional or distant. If
regional, what is the appropriate CS LN
Pericolonic lymph nodes are "regional"
lymph nodes for an ovarian primary. If
you do not have enough information to
assign codes 12-30, assign code 50
[Regional lymph nodes, NOS].
CS Mets at DX--Ovary: Regarding
carcinomatosis; is it always captured in
CS Mets? Can the term carcinomatosis be
used to describe peritoneal implants as
well? Please see discussion.
1/18/06: CT guided biopsy of
abdominal mass & ant peritoneum nodule.
Extensive carcinomatosis affecting the
paracolic gutters, liver surface &
pelvis. 6 cm tumor mass was visibly
engulfing the small bowel & tube; poorly
differentiated adenoca, mullerian
derived, shows attributes of clear cell
ca, high grade (FIGO III), 2.5 cm size.
does not involve fallopian tube. R&L
abdominal wall & mesentery, mets
adenoca. CA 125= 17 OP TEXT: 1/18/06:
CT guided bx of abdominal mass & ant
peritoneum nodule. extensive
carcinomatosis affecting the paracolic
gutters, liver surface & pelvis. 6 cm
tumor mass was visibly engulfing the
small bowel 5/31/06: tumor debulking
with right salpingo-oophorectomy. Final
DX: Poorly differentiated adenoca,
clear cell type, rt ovary (FIGO III),
stage IV per MD
In the case of ovarian cancer, the term
carcinomatosis may refer to peritoneal
implants, especially when the implants
are numerous. It does not refer to
distant metastases in this
context. This issue has been forwarded
to the CS version 2 committee.
MP/H Rules/Histology--Melanoma: Please
clarify what we should code when we see
the term 'spitz or spitzoid' in
association with melanomas. Please see
Path reports often diagnose "melanoma
with spitzoid features." There is no
code for this in ICD-O-3. Would it be
considered melanoma NOS with a specific
type for MP/H rule H9 (with features
of...), or would we stop at H3? Could
the matrix principle apply, changing
8770/0 (one of the synonyms is Spitz
nevus) to 8770/3 (although no Spitz
synonyms are specifically listed under
this code)? What if the path report
says "melanoma arising in a Spitz
Assign code 8720/3 [Malignant melanoma]
for melanoma with Spitzoid features,
Spitzoid variant of nevoid melanoma,
melanoma arising in Spitz nevus, or
Spitzoid melanoma. The WHO
Classification of Tumors groups these
with Nevoid melanomas and codes them to
8720/3. According to WHO, "Nevoid
melanoma is a subtype of malignant
melanoma of the skin that is distinctive
in that the primary lesion mimics many
of the architectural features of a
common compound or intradermal nevus ...
or a Spitz nevus... These lesions are
defined not as atypical nevi, but as
melanomas because they involve the
dermis and have the potential for
Reportability--Skin: Skin appendage
carcinoma (8390/3) is reportable to
SEER, but is "focal skin appendage
differentiation/tumor"? Please see
Path report states "basal cell carcinoma
of skin of lip with focal skin appendage
differentiation...the BCCA is completely
excised and the majority of the skin
appendage tumor appears excised."
The histology code for basal cell
carcinoma with skin appendage
differentiation is 8098/3. Basal cell
carcinomas (8090-8110) are not
reportable to SEER. Skin appendage
tumors are not reportable to SEER unless
stated to be carcinoma or stated to be
malignant. According to our
pathologist consultant, basal cell
carcinoma with focal skin appendage
differentiation is basal cell carcinoma
which exhibits adnexal (appendage)
features, but it is still considered
basal cell carcinoma. The case
example above is not reportable to SEER.
Surgery of Primary Site--Breast: How
many lymph nodes must be removed to code
a Modified Radical Mastectomy? If a
mastectomy was done with 1 sentinel
lymph node excised, is this coded 51 or
Assign code 41 [Total (simple)
mastectomy...] for a simple mastectomy
with removal of one or more sentinel
lymph nodes. As long as the nodes
removed are designated sentinel, use
code 41 for a simple mastectomy.
CS Lymph Nodes--Breast: Now that code
50 [fixed/matted ipsilateral axillary
LNS, NOS] is obsolete, how is this field
coded for a case in which there are
clinically matted lymph nodes, no
neoadjuvant therapy, and no lymph node
size on the available pathology report?
From the American College of Surgeons:
The pathologic information always takes
precedence over the clinical information
when there is no neoadjuvant therapy.
The size reference is that this is not
ITC or micromets. Clinically, I don't
think you can have fixed or matted nodes
that aren't greater than micromets. This
would be coded to 52. The mapping for
all of these codes is not taken from
this, but from the value of SSF3 per the
note at the bottom of the table. See CS
Lymph Nodes note 2.
Multiple primaries--Lymphoma: Is
mediastinal large B-cell lymphoma
followed by classical Hodgkin lymphoma
reportable as one or two primaries?
Please see discussion.
Diagnosed 06/06/2006 with mediastinal
large B-cell lymphoma, 9679/36. On
05/10/2007, another mediastinal lymph
node biopsy done and the diagnosis was
recurrent malignant lymphoma, classical
Hodgkin's. A Hematopatholgy Consultant
states, "it appears likely that the
preceding mediastinal diffuse large
B-cell lymphoma and the current
classical Hodgkin's lymphoma are
clonally related and represent different
manifestations of the same entity. One
might also place this in the spectrum of
'mediastinal gray zone lymphoma'
described by Dr. Jaffee and colleagues."
Report this case as two primaries.
Report non-Hodgkin lymphoma followed by
Hodgkin lymphoma as separate
According to the
Table of Single and Subsequent Primaries
for Hematologic Malignancies,
mediastinal large B-cell lymphoma and
Hodgkin disease are "D" - Different
Histology--Head & Neck: How do you code
histology for a myofibroblastic sarcoma
of the soft tissue of the head and neck?
Assign code 8825/3 [Myofibroblastoma,
malignant]. According to the WHO
Classification of Soft Tissue Tumors,
"Low grade myofibroblastic sarcoma
represents a distinct atypical
myofibroblastic tumor often with
fibromatosis-like features and
predilection for the head and neck."
Also called myofibrosarcoma.
CS Tumor Size: Is a 5.5 mm tumor coded
as 005 or 006? Please see discussion.
We interpret the CS Manual general
instructions to indicate to ONLY round
up to 001 when the tumor size is stated
to be 0.1 to 0.9mm.
Code CS tumor size 006. Because only
whole numbers in mm can be collected,
basic mathematical principles are used
for rounding; 1-4 round down, 5-9 round
CS Tumor Size: Can an 'ulcerated mass'
be used to code CS tumor size? Please
see discussion below.
The CS Manual (p. 26, 4.a.) states do
not code the size of the polyp, ulcer or
cyst. However it states that a 'cystic
mass' can be used to code TS if it is
the only size given. Scopes Text:
'ulcerated' mass based at anal verge &
ext 3-4 cm up into rectum.
Do not code CS Tumor size using the size
of an ulcerated mass.
I & R System
College of Surgeons.
Reportability/Date of Diagnosis--Ovary:
Is a patient considered SEER reportable
in 2001 or 2003 if she presented with a
diagnosis of papillary serous tumor of
low malignant potential [borderline
tumor] per the 5/2001 surgery but at the
time of the planned second look
laparoscopic surgery is stated to have
Stage 3A ovarian cancer?
A patient was seen in 5/2001 for large
pelvic mass growing from right ovary.
After TAH and USO and partial
omemtectomy, path diagnosis was
papillary serous tumor of low malignant
potential (borderline tumor),
unruptured. Right ovary and omental
implant have identical histologic
appearance, except the psammoma body
formation and the ovary does
Patient does not return
for lap as planned in 6-12 months. In
1/03 she returns to hospital with
abdominal pain and has debulking,
hemicolectomy and Hartmann's procedure.
1/03 Path report "metastatic papillary
serous adenoca." Chart now says "History
of stage 3A ovarian cancer."
Yes, this case is reportable in 2003.
Malignancy was confirmed in 2003. The
diagnosis made in 2001 is not reportable
for that year, and was not reviewed or
revised according to the information