ID Question Answer
20091095 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.
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
are involved.

Note 4 pertains
to code 040, not to code 048.

20091094 Reportability: Are squamous cell
carcinomas arising in a condyloma of the
rectum reportable or should we assume
that the site is skin of anus or
perianal and not reportable?
Squamous cell carcinoma arising in a
rectal condyloma is reportable. Do not
assume the site is skin of anus or
perianal.
20091093 Race--How and when is Appendix D – Race
and Nationality Descriptions from the
2000 Census and Bureau of Vital
Statistics to be used? Please see
discussion.
Code the patient's stated race when
possible. Refer to Appendix D “Race and
Nationality Descriptions from the 2000
Census and Bureau of Vital Statistics”
for guidance.

Use the lists in
Appendix D when race is not stated but
other information is provided in the
medical record. The cases you provide
are good examples of the use of Appendix
D. They would be coded the same if the
descriptions were used in the medical
record or death certificate race fields.

20091092 MP/H Rules-Lung: What is the Diagnosis
Date, Diagnostic Confirmation and
histology for the left lung
mass?

Scenario: PET shows a 3 cm
mass in the left lung and a 2.9 cm mass
in the right lung. No reportable
terminology in PET. The right mass is
biopsied and shows adenoca. The left
mass is not biopsied. Based on rule M6,
this should be reported as two
primaries. No additional information in
medical record, pt expired.

For date of diagnosis, use the date of
the PET scan for both primaries. For
the left tumor, assign diagnostic
confirmation code 8 [Clinical diagnosis
only] and assign histology code 8000/3
[malignant neoplasm]. The left lung
mass is reported as a separate primary
because there is one tumor in each lung.
According to Rule M6, when there is one
tumor in the left lung and one tumor in
the right lung, each tumor is a separate
primary. Tumor and mass are equivalent
terms for purposes of the multiple
primary rules.
20091090 First course treatment--Leukemia:
Should an allogeneic stem cell
transplant for acute myeloid leukemia be
coded to 20 in the Hematologic
Transplant and Endocrine Procedures?
There is debate as to whether this
procedure should be coded as a 12 in
order to capture the allogeneic part of
the procedure.
Assign code 20 [Stem cell harvest (stem
cell transplant) and infusion as first
course therapy] for stem cell
procedures, even allogeneic procedures.
20091089 Histology--Hematopoietic: The final
diagnosis on a bone marrow biopsy was
"chronic lymphocytic leukemia with
plasmacytic differentiation." Is this
coded 9823/3, CLL/SLL or 9733/3, plasma
cell leukemia?
Assign histology code 9823/3 [Chronic
lymphocytic leukemia]. Plasmacytic
differentiation does not indicate a
plasma cell or plasmacytic leukemia.
20091085 MP/H Rules/Histology--Breast: What is
the correct histology code for this
breast cancer case? Final diagnosis
says, "Infiltrating duct carcinoma with
apocrine features." What rule is used?
See also discussion.
Assign histology code 8401/3 [apocrine
adenocarcinoma] according to rule H12.
Apocrine is a type of duct carcinoma,
see table 1. Code 8401 should be listed
in Rule H12. Apocrine should be removed
from table 3. These corrections will
appear in the 2010 version of the rules.
20091084 Primary site--Colon: How do you
determine the correct subsite when there
is conflicting information in different
reports? See discussion for case
example. In this case, the Operative
report seems more correct. Are there
priority rules for this for sites other
than Head and Neck?
Use the operative report information to
code primary site in this case. It is
more accurate. The operative report is
usually a better source of location
information compared to the pathology
report. The pathologist can only
reiterate the location as it was
reported to him/her. The 2007 SEER
manual states "Unless otherwise
instructed, use all available
information to code the site," page 69.
20091083 Grade/Cell indicator--Lymphoma: For
pathology that states "anaplastic large
cell lymphoma", is the grade code 4?
The SPCM states cell indicator codes
take precedence over
grade/differentiation codes for lymphoma
and leukemia cases.
For this case, since there is no cell
indicator information, code 9 [cell type
not determined] in the grade/cell
indicator field. Do not code grade for
lymphoma. For lymphoma and leukemia this
field is the cell indicator.
20091082 Behavior--Breast: What is the correct
behavior code for these 2 scenarios?

1. Path report for breast cancer
has final diagnosis as 'DCIS' but the
CAP protocol in the body of the report
says 'microinvasion seen,
T1mic.'

2. Path report says
'DCIS' in the final diagnosis and
microinvasion is identified in the
microscopic portion of the report, but
it is not in CAP protocol format and not
stated in the final diagnosis. These are
path reports from lab only cases (not
otherwise reported to the central
registry).

Code both scenarios /3 [malignant
(invasive)]. Information regarding
behavior is not limited to the final
diagnosis or the CAP protocol. See page
84 in the 2007 SEER manual:

Code
the behavior as malignant /3 if any
portion of the primary tumor is invasive
no matter how limited; i.e.
microinvasion.

20091081 Reportability/Histology--Brain and CNS:
Histology code 8825/1 (Inflammatory
Myofibroblastic Tumor) is not listed in
the ICD-0-3 Primary Brain and CNS
Site/Histology listing for reportable
Brain/CNS tumors. It seems this might be
a reportable tumor?
If the inflammatory myofibroblastic
tumor is primary in one of the sites
specified below and diagnosed 1/1/2004
or later, it is
reportable.

Reportable brain
and CNS tumors are any benign and
borderline primary intracranial and CNS
tumors with a behavior code of /0 or /1
in ICD-O-3 diagnosed 1/1/2004 and later,
of the following sites: Cerebral
meninges C700, Spinal meninges C701,
Meninges, NOS C709, Cerebrum C710,
Frontal lobe C711, Temporal lobe C712,
Parietal lobe C713, Occipital lobe C714,
Ventricle, NOS C715, Cerebellum, NOS
C716, Brain stem C717, Overlapping
lesion of brain C718, Brain, NOS C719,
Spinal cord C720, Cauda equine C721,
Olfactory nerve C722, Optic nerve C723,
Acoustic nerve C724, Cranial nerve, NOS
C725, Overlapping lesion of brain and
central nervous system C728, Nervous
system, NOS C729, Pituitary gland C751,
Craniopharyngeal duct C752, Pineal gland
C753.

20091079 Primary site--Bladder: What is the
correct subsite for interureteric ridge?
Description: 4 mm nodule at base of
bladder near interureteric ridge.
For this case, assign code C670 [Trigone
of bladder]. The description for this
case states that the tumor location is
the base of the bladder. Base is a
synonym for trigone. The interureteric
ridge (or interureteric crest, or
interureteric fold) is a fold of mucous
membrane extending accross the bladder
between the two ureteric orifices. The
trigone is located below the
interureteric ridge.
20091078 MP/H Rules--Head & Neck: Is the
following one or two separate primaries?
Originally diagnosed with an invasive
squamous cell ca. of the right
mandibular body (C06.9) in 2004, and
treated with surgery and radical neck
dissection. In 2007, patient was then
diagnosed with an invasive squamous cell
ca. of the left buccal mucosa (C06.0).
Please see discussion.
Based on the information provided, the
primary site code for the 2004 primary
should be C031 [mandibular gingiva,
lower alveolar mucosa, etc.]. The
2007 diagnosis would be a separate
primary according to rule M7 because the
patient was disease free following
treatment for the 2004 diagnosis. C031
and C060 are different at the third
character.
20091077 CS Site Specific Factor--Head & Neck:
Can SSF 1-6 be coded using clinical
information only, or does the source of
information for lymph nodes need to
pathological?
CS Site Specific Factors 1 through 6 for
head and neck sites may be coded using
either clinical or pathologic
information.
20091072 Histology--Brain and CNS: What histology
code is used for a rosette-forming
glioneuronal tumor of the fourth
ventricle?
Assign histology code 9505/1
[Ganglioglioma, NOS]. Rosette-forming
glioneuronal tumor of the 4th ventricle
is a new WHO entity. There is no
current ICD-O-3 code for this. The best
code available at this time is 9505/1.
20091069 CS Extension--Bladder: What is the
correct CS Ext code? Path states
“Iinfiltrating high grade urothelial ca
with focal micropapillary features and
invasion of lamina propria. NOTE -
There is INVASIVE CA FOCALLY INVOLVING
THIN MUSCLE BUNDLES...difficult to
distinguish whether muscularis propria
or muscularis mucosae.
Assign CS extension code 15 [Invasive
tumor confined to subepithelial
connective tissue (tunica propria,
lamina propria, submucosa, stroma)].
The information provided confirms
invasion of the lamina propria (code 15)
but is not definitive enough to assign a
code higher than 15.
20091068 Primary site--Bladder: What is the
appropriate subsite for “adjacent to the
bladder neck"?
Assign code C679 [Bladder, NOS]. It is
not possible to determine the location
of the tumor from the description. A
tumor that is "adjacent to bladder neck"
could be located in the trigone or on
the bladder wall (anterior, posterior or
lateral).
20091067 Grade--Bladder: In papillary urothelial
cancers of the the bladder most
pathology reports state low grade, high
grade, Grade II, Grade III, etc. Are
these terms used to code the 6th digit?
Please see discussion.
For NON-invasive bladder tumors, assign
code 9 [unknown] to the Grade field.
WHO grades are applied to urothelial
tumors ranging from dysplasia to
non-invasive urothelial carcinoma. For
invasive urothelial carcinoma, if terms
such as low grade, high grade, Grade II,
Grade III are used, assign the
appropriate code in the grade field.
See the 2007 SEER Manual instructions on
page C-844 for converting a three-grade
value to a SEER grade code.
20091066 Multiplicity Counter--Lung: How is this
field coded when there is no evidence of
the primary tumor? Please see
discussion.
Assign code 99 [Unknown].
20091065 Primary Site/CS Extension--Lymphoma:
How are these fields coded for a
non-Hodgkins lymphoma case with scans
that show non-specific parenchymal lung
nodules and a large mediastinal mass?
Please see discussion.
Assign code C779 [Lymph node, NOS]. In
this case, there is no statement that
lymphoma involves the lung.
"Nonspecific parenchymal lung nodules"
are not indicative of lymphoma
involvement. Consequently, this cannot
be assumed to be an extra-nodal
lymphoma. Additionally, it is not clear
whether or not the "borderline" pelvic
lymph nodes are invovled. If the
physician cannot provide more
information, follow instruction 4.e in
the SEER manual on page 72.
20091064 Radiation Sequence with Surgery--Head &
Neck- How is this field coded for a
tonsil primary diagnosed on 4/16/07 by a
regional lymph node FNA who later has
radiation start on 5/8/07 and a 7/30/07
tonsillectomy with neck dissection?
The best way to handle this situation is
to assign code 2 [Radiation before
surgery] in Radiation Sequence with
Surgery. Code 2 provides the best
description of the sequence of events in
this case. Radiation was delivered
prior to the resection of the primary
site.
20091062 CS Site Specific Factor--Head & Neck:
How is Site Specific Factor 2 field
coded when the pathologist describes
regional lymph nodes as “matted”?
Please see discussion.
"Matted" is not a synonym for "Fixed" in
the CS schema for Head and Neck.
"Matted" is not indicative of
extracapsular extension for the Head and
Neck schema.
20091061 Multiplicity Counter--Head & Neck: How
is this field coded when a patient has
carcinoma in the same location as a
previous primary but it is unknown if
there was a disease-free interval?
Please see discussion.
Assign code 01 [one tumor only] for the
example provided (see discussion).
Given the information provided, there is
no reason to suspect that the February
2009 diagnosis represents new tumor;
therefore, it does not affect the
multiplicity counter. It appears that
this was the treatment plan for the
original diagnosis in May 2008:
radiation and chemo followed by excision
of the mass.
20091060 MP/H Rules- Head and Neck: How many
primaries are to be accessioned for a
case in which a second tumor occurs in
an area previously involved by direct
extension from a prior primary located
in an adjacent site? Please see
discussion.
The May 2008 diagnosis is not a new
primary. Base of tongue involvement was
originally present in August 2007. The
May 2008 diagnosis does not represent
new tumor. The 2007 rules apply to new
tumors only; therefore, the 2007 rules
do not apply to this case.
20091059 CS Tumor Size--Breast: How is this
field coded for DCIS that is present in
scattered small foci over five of eight
slides, and the greatest aggregate
dimension measures 0.5 cm? Please see
discussion.
Assign code 005 [0.5 cm] in this case.
According to the general instructions
for CS tumor size, it is acceptable to
code an aggregate size stated by the
pathologist (see instruction 4.i).
20091058 MP/H Rules--Kidney: How is histology
coded when it is described in the
pathology report as “Histologic type:
Clear cell (conventional) renal cell
carcinoma. Percent of sarcomatoid
component: 10 %”? Please see
discussion.
Assign code 8310 [clear cell
adenocarcinoma] according to rule H5.
Renal cell, clear cell and sarcomatoid
are mentioned in the diagnosis.
Sarcomatoid is refered to as a
component. Component is not one of the
terms listed in rule H5 that indicate a
more specific type. Ignore sarcomatoid
in this case. Use table 1 to identify
clear cell as a specific renal cell
type. Code the specific type (clear
cell) according to rule H5.
20091057 CS Site Specific Factor--Lymphoma: Can
the term “intermediate risk” be used to
code IPI score? Please see discussion
Code SSF 3 for lymphoma based on the IPI
score stated in the record. Do not
attempt to interpret statements or terms
in order to assign a code to SSF 3. If
no further information is available for
this case, code SSF 3 999 [Unknown].
20091056 MP/H Rules/Histology--Ovary: How is
this field coded for an ovarian tumor
diagnosed as an “ovarian clear cell
cystadenocarcinoma”? Please see
discussion.
Assign code 8310 [Clear cell
adenocarcinoma] according to rule H13.
Ignore "cyst" when determining the
histologic type for ovarian
malignancies. For this case, the only
histology is clear cell.

The
histologies for the common ovarian
epithelial malignancies are serous,
mucinous, endometrioid, clear cell, and
transitional cell/Brenner. This
clarification will be added to the rules
in the next revision.

20091055 Date therapy initiated/Systemic/Surgery
Sequence--Breast: How are these fields
coded when a patient has chemotherapy
after a sentinel lymph node biopsy and
has a lumpectomy after completing
chemotherapy? Please see discussion.
For this case, code Date Therapy
Initiated to the date of the sentinel
lymph node biopsy [04102008]. Assign
code 3 [Systemic therapy after surgery]
in Systemic/Surgery Sequence.
20091054 First course treatment--Liver: Is
planned therapy considered to be second
course therapy if it is administered
after documented progression of disease?
Please see discussion.
In this case, neither the
chemoembolization nor the liver
transplant are part of the first course
of therapy. The documented treatment
plan was changed after disease
progression. Chemoembolization was not
part of the original treatment plan.
First course therapy ends at this point.
20091049 MP/H Rules--Lung/Breast: Can we assume
that a current tissue specimen is a
recurrence of previous primary if a
pathologist states that he has compared
the specimen with the slides from the
prior tumor and concludes that the
current tumor is “similar” to a previous
tumor? Please see discussion.
All pathologists do not use words in the
same way. Therefore, we will not
provide a list of specific words to
accept or not to accept in order to
determine recurrence. Do not base your
decision about recurrence on words such
as "similar," or "resembles." If the
pathologist believes two or more tumors
are the same or believes one is a
recurrence of another after comparison,
accept it. When pathologists believe
that two or more tumors are not the same
or believe that one is not a recurrence
of another, there is usually a strong
statement indicating that opinion.
20091046 CS Lymph Nodes/CS Site Specific
Factor--Melanoma: When CS lymph nodes
is coded 13, 14 or 15, why must CS SSF 3
be coded 000? See discussion.
When CS lymph nodes is coded 13-15, SSF
3 must be coded 000. Follow the
instruction in the SSF 3 Note: Use code
000, No lymph node metastases, if ...
there are satellite nodules or
in-transit metastases, but no regional
lymph node metastases, i.e., CS Lymph
Nodes is coded 13-15.

For this
case, assign CS lymph node code 15
[Satellite nodule(s) or in-transit
metastases greater than 2cm from primary
tumor WITHOUT regional lymph node
involvement or involvement of regional
nodes not stated]. The arm lesion is
more than 2cm from the leg lesion.

20091045 CS Tumor Size/CS Site Specific
Factor--Breast: Regarding SEER Edit
IF218, when tumor size is unknown, but
it is known that both in situ and
invasive components are present, how
should CS tumor size and SSF6 be coded?
Please see discussion.
Code CS tumor size 990 [Microinvasion;
microscopic focus or foci only, no size
given; described as less than 1 mm] and
CS SSF6 050 [Invasive and in situ
components present, size of entire tumor
coded in CS Tumor Size because size of
invasive component not stated AND
proportions of in situ and invasive not
known].

This combination of
codes captures the information available
for this case.

20091040 MP/H Rules/Histology--Breast: Which
histology code, 8050 or 8260, is used
for an infiltrating papillary carcinoma
of the breast? There is no mention of
ductal or adenoca in the path report.
Assign histology code 8503 [Papillary
adenocarcinoma]. Rule H14 applies.

ICD-O-3 code 8050 does not apply
in this case. Refer to the numeric
listing in ICD-O-3. 8050 is a squamous
cell neoplasm. Papillary carcinoma of
the breast is NOT a squamous cell
neoplasm. It is a neoplasm of the
breast parenchyma - ducts, lobules or
connective tissue. 8503 is the correct
code in this case.

20091039 CS Tumor Size--Lung: Per SPCSM 2007
'Coding Instructions for CS Staging Data
Items-CS Tumor Size' item 5c states that
code 998 (diffuse, entire lung) for lung
& main stem bronchus takes precedence
over any mention of size. Does this
statement also apply to code 997
(diffuse, entire lobe) for lung and main
stem bronchus or would a stated tumor
size be used over code 997?
Code the stated tumor size rather than
997. Code 997 does not take presidence
over tumor size at this time.
According to CoC, the instructions on
pI-27 5c are to alert the user to
special circumstances. Code 997 isn't
included because it isn't diffuse for
all of the sites listed. The
site-specific rules and codes in the
schema always take precedence. Further
instructions and clarifications will be
added to the lung schema pII-317 in the
next version of CS.
20091021 Behavior/Reportability--GIST: Our
pathologists NEVER use the term
Malignant to describe GIST. How can we
get SEER to address this issue? Please
see discussion.
Do not report the case to SEER if it
does not satisfy the criteria for
reportability. According to the current
reportability criteria, malignant GIST
(8936/3)is reportable to SEER. GIST
coded to 8936/0 or 8936/1 is not
reportable. If your pathologist will
not indicate "malignant" or "benign,"
code 8936/1 applies according to ICD-O-3
and, therefore, these are not reportable
to SEER.
20081126 MP/H Rules--Brain and CNS: Are stigmata
of neurofibromatosis in the brain
considered to represent reportable
neurofibromatosis lesions? Please see
discussion.
Accession NF (9540/1) when there is CNS
tumor -- a glioma or some other
intracranial/intraspinal tumor, or one
of the "stigmata" on MRI or some other
CNS study. Do NOT accession NF (9540/1)
when there is only peripheral
nerve/nervous system involvement.
Accession the neurofibromatosis itself
only once per patient. Accession any
initial neoplasm in the CNS separately.
Abstract and code any subsequent CNS
neoplasms according to the multiple
primary brain rules. Accession three
primaries for the case described
above. 1. Neurofibromatosis (C729
9540/1) 2. Optic nerve glioma (C723
9421/3)--> see below. 3. Hypothalamus
glioma (C710 9380/0)

--> Optic
nerve gliomas associated with NF are
pilocytic astrocytomas. Code pilocytic
astrocytoma as 9421/3 in North America.

20071015 CS Lymph Nodes/CS Mets at Dx--Melanoma:
How are these fields coded if a sentinel
lymph node biopsy reveals no malignancy
but there is an aggregate of melanoma
cells in the lumen of a large vein
immediately adjacent to the lymph nodes?
This question was answered by the
CoC:

Do not count this as
regional metastatic disease since there
is no evidence it is an established
tumor. Stage this as a N0.