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Question: 20130072 Status
Final

References
Source 1:   2007 MP/H Rules
pgs:  
Notes:  
Source 2:  
pgs:  
Notes:  


Question
MP/H Rules--Lung: Please reveiw the path report below and advise me on how many cases to abstract. Our tumor board has staged this as two separate primaries and is treating as such, and not considering the second focus metastatic even though it is the same histology.

Lepidic is not in our ICD-0 manual. Is Lepidic a new term for histology? See discussion.

Discussion
DIAGNOSIS

LUNG, RIGHT LOWER LOBE, WEDGE EXCISION (A):

- INVASIVE MODERATELY DIFFERENTIATED ADENOCARCINOMA WITH FOCAL Lepidic PATTERN (pT1a, pN0)

(SEE TEMPLATE).

- EMPHYSEMA.

RIGHT LOWER LOBE, COMPLETION LOBECTOMY (F):

- SEPARATE FOCUS OF WELL DIFFERENTIATED ADENOCARCINOMA WITH Lepidic pattern (<4 MM)

(SEE COMMENT)

MICROSCOPIC DESCRIPTION

COMMENT: The block F7 shows a microscopic focus of adenocarcinoma with lepidic growth pattern. This most likely represents a separate primary tumor since the stapled margins were all negative for involvement. This focus measures less than 0.4 cm.

..Tumor focality: most likely two separate primary tumor nodules Histologic type: adenocarcinoma, mixed type (NOS and lepidic type) Histologic grade (if applicable): moderately differentiated for main tumor and well differentiated for the smaller one

Answer
This is one primary per Rule M12.

There are two tumors in the right lower lobe with the same histology. Per Note 2 under Rule M12, all cases covered by Rule M12 are the same histology. Keep in mind that physicians follow different "rules". Even though they are considering this two primaries, the MP/H rules instruct you to code one primary.

We have received quite a few questions about lepidic. Below is the general definition that we are providing. We will be adding this to the 2015 MP/H revision: "Lepidic" is a growth pattern meaning that tumor cells are growing along the alveolar septa. It is characteristic of bronchioloalveolar carcinoma (BAC), but not diagnostic of it; the diagnosis of BAC also requires no stromal, vascular, or pleural invasion. Lepidic growth may be seen in other adenocarcinomas, including metastases to lung from other sites. It is not considered a type/subtype of adenocarcinoma. For lepidic lung neoplasms, code the histology indicated, for example BAC.

History


Last Updated
06/14/2013

Date Finalized
07/11/2013