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Question: 20120092 Status

Source 1:   2007 MP/H Rules
Source 2:  

MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence?

7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.

3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and “there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence.”

Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a “recurrence” of the 7/12/2007 diagnosis after reviewing the slides?

For cases diagnosed 2007-2014, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007. The steps used to arrive at this decision are:

Step 1: Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.

Step 2: General Information Rule 7 states “Use the multiple primary rules as written unless a pathologist compares the present tumor to the “original” tumor and states that this tumor is a recurrence of cancer from the previous primary.”

Step 3: Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary.


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