Report | Question ID | Question | Discussion | Answer | Year |
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20091127 | MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are to be accessioned for a patient with Neurofibromatosis 2 (NF2) who presents with meningiomas on the left and right side of the brain and multiple meningiomas of the spinal cord? See Discussion. |
We have a patient with NF2 who also has meningiomas diagnosed on the left and right side of the brain as well as multiple meningiomas of the spinal cord. Are the meningiomas all one primary (separate from the NF2): C70.9 and 9530/1? |
For cases diagnosed 2007 or later, this is four primaries. Report NF2 because it occurs with reportable neoplasms. Note: Report NF only once per patient. Per MP/H Benign CNS Rule M4, the meningiomas of the meninges/brain (C70.0) and meninges/CNS (C70.1) are multiple primaries. Code the meningiomas of the spine to the histology to 9530/1 [Multiple meningiomas] (Rule H6) because there are multiple tumors in the spine. Per Rule M5, the meningiomas of the right and left side of the brain are multiple primaries. Code of each to the histology 9530/0 [Meningioma, NOS] per Rule H2 because they are separate primaries (assuming there is one tumor on each side of the brain). |
2009 |
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20071117 | MP/H Rules/Histology--Brain: How many primaries are reported and what is the histology for a single brain tumor described as a low grade astrocytoma at the time of the initial partial resection and a low grade glioneuronal neoplasm at the time of the subsequent total resection? See Discussion. | On 4/20/07 a partial resection of a brain tumor is interpreted as low grade astrocytoma. Patient has a gross total resection on 8/13/07 with this diagnosis: low grade glioneuronal neoplasm (see comment). Comment: This case has been reviewed at ---. Dr. agrees with our interpretation (low grade glioneuronal neoplasm, possibly a dysembryoplastic neuroepithelial tumor). | For cases diagnosed 2007 or later, this is a single primary. A single tumor is always a single primary. Assign histology code 9400/3 [Astrocytoma, low grade]. This diagnosis was not revised or amended based on the later surgery. It is possible that the malignant component was entirely removed during the first surgery. |
2007 |
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20100054 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a pathology specimen reveals an infiltrating mammary carcinoma with mixed tubular and lobular features, 2.3 cm, low grade cribriform in situ ductal carcinoma, and Paget disease of the overlying skin with ulceration? See Discussion. | According to SINQ 20081134 the histology would be 8524 if this is one primary. | For cases diagnosed 2007 or later, this is a single primary.
In order to determine whether this case represents a single or multiple primary, you must first determine the correct histology code for the underlying tumor. Using rule H9, ignore the DCIS.
See Table 3 in the equivalent terms and definitions. Infiltrating lobular, tubular, and Paget are coded to a single histology code (8524/3). Our current multiple primary rules do not say infiltrating lobular and tubular and Paget are a single primary. This was an omission and will be corrected in a future revision. Thank you for bringing this omission to our attention. |
2010 |
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20091128 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a patient was diagnosed with breast carcinoma in 2001 and was subsequently diagnosed with a mammary carcinoma in a chest wall mass in 2008? See Discussion. |
Patient was diagnosed with invasive lobular carcinoma of the right breast in April 2001. Following modified radical mastectomy in May 2001, the patient was disease free. In December 2008 the patient was diagnosed with a right chest wall mass, invasive poorly differentiated mammary carcinoma with lobular origin. If this is a new primary in 2008, would we code the primary site to breast or chest wall? Please see I&R answers 25924, 22163 and 26155 with similar case scenarios that give two different answers. One response indicates coding this type of scenario as new primary to chest wall and the other two responses indicate this should not be a new primary because the chest wall is a metastatic site. The pathology report does not state that this is metastatic and it is unknown if there is breast tissue left behind at the chest wall. |
For cases diagnosed 2007 or later, this case is a single primary. The chest wall (NOS) is a metastatic site for breast cancer. There is no mention of residual breast tissue, so the 2008 diagnosis cannot be a new primary. "Chest wall" is an ambiguous term. It can mean the internal chest wall or the external chest wall. When the path report states that the "recurrence" is in residual breast tissue, this is most likely the external chest wall and the residual breast tissue is part of the breast not removed by the MRM. In contrast, skin or the chest wall, NOS, are regional metastases. |
2009 |
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20100095 | MP/H Rules/Multiple primaries--Kidney, renal pelvis: In a patient who was never disease free because of multiple recurrences of invasive transitional cell carcinoma of the bladder originally diagnosed in 2004, is an invasive high grade urothelial carcinoma of the renal pelvis diagnosed in 2010 a new primary? See Discussion. |
Patient has invasive TCC of the bladder diagnosed in 2004, and has never been disease free. In 2/18/10 a left renal pelvis wash showed urothelial carcinoma, high grade. On 4/7/10 a nephroureterectomy revealed high grade urothelial carcinoma with sarcomatous and squamous differentiation invading through pelvic wall and perihilar soft tissue. Is this a new renal pelvis primary? |
For cases diagnosed 2007 or later, the renal pelvis is a new primary per rule M7. M7 will be better explained in the revised MP/H rules, but the rationale is that no field effect was present for more than 3 years. Although the bladder CA continued to recur, there were no other organs involved until 2010. M7 is intended to make the renal pelvis a new primary because there was no field effect (no organs other than bladder involved) for more than 3 years. |
2010 |
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20130007 | MP/H Rules/Histology--Colon: What rule applies and how is histology coded if a colon tumor is composed of moderately differentiated adenocarcinoma and neuroendocrine tumor, grade 1 (G1)? See Discussion. |
Intestine, large -- moderately differentiated adenocarcinoma
Pathological stage: IIIA (T2 N1a Mx) -- Neuroendocrine tumor, G1
Addendum comment: The results of the immunochemical study are compatible with a neuroendocrine tumor, G1. |
For cases diagnosed 2007 or later, the correct histology code is 8244/3 [composite carcinoid]. The steps used to arrive at this decision are:
Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Colon Histology rules because site specific rules have been developed for this primary.
Step 2: Start at the SINGLE TUMOR module, rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at rule H9. Code the histology as 8244/3 [composite carcinoid] when the diagnosis is adenocarcinoma and carcinoid tumor.
Neuroendocrine tumor, grade 1 (G1) is synonymous with carcinoid tumor [8240/3] for the purpose of rule H9. |
2013 |
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20120087 | MP/H Rules/Histology--Kidney: How is the histology coded and what rule(s) apply for "cyst associated renal cell carcinoma," "cystic renal cell carcinoma," and "cystic renal cell carcinoma, clear cell type"? See Discussion.
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Per SINQ 20031008, these histologies were all coded as 8316/3 [cyst associated renal cell carcinoma]. What are the correct codes for these histologies using the 2007 MP/H Rules?
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For cases diagnosed 2007 or later, the correct histology code for both cyst associated renal cell carcinoma and cystic renal cell carcinoma is 8316/3. The histology code for cystic renal cell carcinoma, clear cell type is 8255/3.
The steps used to arrive at these decisions are:
Step 1: Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Kidney Histology rules because site specific rules have been developed for this primary.
Step 2: For the first histology, cyst associated renal cell carcinoma, start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H5. According to this rule you are to use Table 1 if you have a renal cell carcinoma and mention of a more specific renal cell type. To locate Table 1, go to Kidney under the Terms & Definitions section. Per Table 1, titled Renal Cell Carcinomas and Specific Renal Cell Types, "cyst associated" is a specific type of renal cell carcinoma. Code the histology to 8316/3 [cyst associated renal cell carcinoma].
Step 3: For the second histology, cystic renal cell carcinoma start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H5. As in the previous example you are to use Table 1 if you have a renal cell carcinoma and mention of a more specific renal cell type. Per Table 1 "cystic" is a specific type of renal cell carcinoma. Code the histology to 8316/3 [cystic renal cell carcinoma].
Step 4: For the third histology, cystic renal cell carcinoma, clear cell type, start at the SINGLE TUMOR module, Rule H1. The rules are intended to be reviewed in consecutive order within a module. Stop at Rule H6 which states you are to code histology to 8255 (adenocarcinoma with mixed subtypes) when there are two or more specific renal cell carcinoma types. To determine whether "clear cell" and "cystic" are types of renal cell carcinoma use Table 1 again. According to Table 1, both cystic and clear cell are specific types of renal cell carcinoma. Code the histology as 8255/3 [adenocarcinoma with mixed subtypes].
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2012 |
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20081090 | MP/H Rules: Does the presence of metastases affect the application of the MP/H rules? See Discussion. | Single lung tumors presenting in each lung but the patient also presents with bone mets? Would rule M6 apply? Or do the bone mets represent additional tumors? | For cases diagnosed 2007 or later, the MP/H rules do not apply to metastases. Ignore metastases when applying the rules. For the case above, use rule M6 and abstract as two primaries (right lung and left lung). The bone mets are ignored. |
2008 |
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20091028 | MP/H Rules/Multiple primaries/Cancer-directed treatment--Lung: Is a 2008 occurrence of non-small cell carcinoma in the left lower lobe following a 1998 occurrence of the same histology in the left lung to be counted as a new primary if the 1998 primary was treated with chemotherapy and/or radiation but not surgery? See Discussion. |
1998 diagnosis on non-small cell carcinoma treated with radiation and chemotherapy. In 2008, there is an abnormality in the LLL with brushings/washings positive for non-small cell carcinoma. According to the MP/H rules, M8 states this would be a new primary. However, in the document titled " Quality Improvement Meeting August 2008," found on the SEER website, it stated that because the patient never had surgery for the initial primary there is no evidence that the patient was ever disease free. Therefore, the occurrence of the latter tumor would not be a new primary (p. 7, "colon"). Does this answer pertain only to surgery or does it apply to any type of treatment? |
For cases diagnosed 2007 or later, the 2007 MP/H rules apply if the 2008 diagnosis is a new tumor. Was there any statement that the patient was free of disease (NED) after the chemo and radiation therapy? (A patient can be disease free without surgery). If there is no statement to the contrary, no mention of metastasis from the 1998 diagnosis, and no mention of disease between 1998 and 2008, follow lung rule M8 and abstract the 2008 diagnosis as a new primary. This lung case differs from the colon case discussed in the document titled "Quality Improvement Meeting August 2008." For the colon case, there was disease in 2003, 2005 and 2007. Based on the information provided, the 2007 diagnosis was not a new tumor because the patient was never free of disease. Therefore, the 2007 diagnosis is not a new primary. The number of reportable primaries was based on disease status over time, and was not based on the type of treatment given for the initial tumor (i.e., surgery or any other treatment modality). |
2009 |
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20071118 | MP/H Rules/Histology--Colon: What histology would be coded when the right colon demonstrates a combined adenocarcinoma and high grade small cell neuroendocrine carcinoma [forming the dominant component] arising in a villotubular adenoma and the liver biopsy demonstrates metastatic high grade small cell neuroendocrine carcinoma? | For cases diagnosed 2007 or later, start with rule H1 in the Single Tumor module. Stop at rule H4. Assign code 8263 [adenocarcinoma in tubulovillous adenoma]. Stop at the first rule that applies. Code histology based on a specimen from the primary site whenever available. |
2007 |