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SEER Inquiry System - Report
Produced: 10/22/2025 2:09 PM
Question 20110050
Inquiry Details
References:
2010 SEER Manual. Appendix C
Question:
MP/H Rules/Multiple primaries: How many primaries are to be abstracted when a patient was initially diagnosed with epithelioid sarcoma in 2003, underwent multiple resections, radiation, and ultimately partial amputation of the limb in 2010, each with margins positive for residual epithelioid sarcoma? See Discussion.
Discussion:
In Dec. 2003 a patient was diagnosed with epithelioid sarcoma of the left palm. In Jan. 2004 the patient had an excision with skin graft and positive margins. Amputation was recommended but the patient chose radiation instead. In May 2006 the patient had a local excision positive for epithelioid sarcoma followed by an amputation of the thumb and index finger with positive margins. Then in April 2010, the patient had an amputation of the remnant of left hand up to the middle third of the forearm. Again, there was residual distal invasive tumor positive for epithelioid sarcoma.
Answer:
This is a single primary, epithelioid sarcoma of the left upper limb, diagnosed in 2003. The sarcoma progressed over the years and the patient was never free of disease -- positive margins were documented at each surgical event. Per the 2004 SEER Manual coding rules in place at the time of pre-2007 recurrences, they would not be multiple primaries according to Rule 5, exception 1.
The occurrence in 2010 is also not a new primary. The steps used to arrive at this decision are as follows.
Open the Multiple Primary and Histology Coding Rules manual. For a soft tissue primary, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites MP rules to determine the number of primaries because soft tissue primaries do not have site specific rules.
Start with the UNKNOWN IF SINGLE OR MULTIPLE TUMORS module, Rule M1. The rules are intended to be reviewed in consecutive order within the module that applies for this case. In this module there is only one rule.
. This patient was never disease free and it is unknown if this tumor was the same tumor (single tumor) or multiple tumors. Abstract a single primary for this patient.
