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SEER Inquiry System - Report
Produced: 06/07/2025 6:07 AM
Question 20110046
Inquiry Details
References:
Subject matter expert
Question:
MP/H Rules/Multiple primaries--Stomach: If there is no statement of recurrence, how many primaries are to be abstracted when a patient is diagnosed with multiple gastric carcinoid tumors between 12/2003 and 3/2009? See Discussion.
Discussion:
Are the multiple primary rules applicable when a patient has multiple gastric carcinoid tumors? The patient was diagnosed with carcinoid tumors starting in 12/2003 through 3/2009. According to the 2004 SEER Manual, rule 5, if a tumor with the same histology is identified in the same site at least two months after the original diagnosis, this is a separate primary. The physician does not indicate that the pre-2007 carcinoid tumors were recurrent. The patient does not have familial polyposis syndrome. Should each of the following tumors be a separate primary?
12/2003 - Gastric Polyp Removal - Path: Gastric carcinoid tumor
05/2004 - Stomach body polyp removal - Path: Carcinoid Tumor (endocrine cell tumor)
09/2004 - Single polyp in body removal - Path: Gastric carcinoid
03/2005 - Multiple gastric body polyps removed - Path: Carcinoid tumor
07/2005 - 3 small polyps in fundus removal - Path: Carcinoid tumor
02/2007 - Localized nodularity in lesser curvature - Path: Carcinoid (neuroendocrine) tumor
03/2009 - Stomach body polypectomy - Path: Carcinoid tumor
Answer:
Code as a single primary. The histology is carcinoid.
Our expert pathology consultant replied as follows: "This patient clearly has a condition driving the proliferation of neuroendocrine cells. Possibilities include hypergastrinemia from a gastrinoma or from response of antral gastrin cells due to achlorhydria from long standing chronic atrophic gastritis, or multiple endocrine neoplasia (MEN1) syndrome (genetically driven). How should these cases be coded given we do not have a way to code the inciting situation. (I suspect the gastroenterologist knows what it is, but we haven't obtained that information.) We do not have an ICD-O-3 code for the underlying condition, MEN1 or hypergastrinemia. Therefore, the only choice is to code the resulting tumor, carcinoid [8240/3]."
