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SEER Inquiry System - Report
Produced: 12/23/2024 10:28 PM
Question 20110129
Inquiry Details
References:
2007 MP/H Rules
Question:
MP/H Rules/Histology--Lung: How many primaries are accessioned if a pathology report for a right upper lobectomy with a chest wall resection describes the disease as 1) two foci of poorly differentiated non-small cell carcinoma, 2) mixed adenocarcinoma and non-mucinous bronchioalveolar carcinoma, each present as a separate focus? See Discussion.
Discussion:
This case was abstracted as two primaries, adenocarcinoma, acinar and papillary types [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] per Rules M5 and M10. If this is reported as only two primaries, what is the stage for each tumor? The non-small cell tumors were the most invasive, but they were not a separate primary per Rule M10.
Final pathology diagnosis for a RUL lobectomy and chest wall resection: Carcinoma of the lung with the following features:
1. Non-small cell carcinoma, poorly differentiated (see comment). Two foci in same lobe: 10 cm and 3 cm (largest dimensions of each tumor). Invades pleura (PL3), main bronchus and chest wall invasion present.
2. Adenocarcinoma and bronchioloalveolar carcinoma (see comment). Histologic subtype: Acinar and papillary (adenocarcinoma); non-mucinous (BAC). Two foci in same lobe: up to 1.0 cm. Pleural invasion absent, chest wall invasion absent.
3. Metastatic carcinoma in 5/7 peribronchial LN's.
Two histologically distinct neoplasms identified in the lobectomy/chest wall resection specimen: Poorly differentiated non-small cell carcinoma, present as two foci; and adenocarcinoma and non-mucinous bronchioloalveolar carcinoma, each present as a separate focus.
Answer:
SEER will answer the question about the number of primaries to accession. Submit questions about stage to the CoC CAnswer Forum.
For cases diagnosed 2007 or later: Accession two primaries: a mixed adenocarcinoma, acinar and papillary types [8255/3] and a bronchioloalveolar carcinoma, non-mucinous [8252/3].
The steps used to arrive at this decision are:
Determine the histology code for each tumor prior to applying the Multiple Primary Rules to determine the number of primaries to accession. There are two non-small cell carcinomas, NOS; the histology code for these two tumors will be 8046/3. There is a single adenocarcinoma with acinar and papillary subtypes tumor, the histology for this tumor will be 8255. There is a single bronchioloalveolar carcinoma, non-mucinous subtype tumor; the histology for this tumor will be 8252/3.
Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Lung Multiple Primary rules to determine the number of primaries.
Start at the MULTIPLE TUMORS module, Rule M3, because this patient has multiple tumors. The rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] are multiple primaries.
Perform a second pass through the Multiple Primary rules to determine whether the two non-small cell carcinomas [8046/3] are multiple primaries or manifestations of the same primaries identified in Step 3.
Start at Rule M3 again because this patient has multiple tumors. Again, these rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's non-small cell carcinomas, NOS [8046/3] are a single primary when compared to the adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3]. Both of these histologies are more specific types of non-small cell carcinoma per the Lung Histology Groups and Specific Types Chart (Chart 1).
You can also apply Rule M10 for both non-small cell carcinoma, NOS [8046/3] compared to adenocarcinoma with acinar and papillary subtypes [8255/3] and non-small cell carcinoma, NOS [8046/3] compared to non-mucinous bronchioloalveolar carcinoma [8252/3].
