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SEER Inquiry System - Report
Produced: 05/10/2025 2:11 PM
Question 20180093
Inquiry Details
References:
#1: Solid Tumor Rules. Lung, 10/12/2018
#2: 2018 ICD-O-3 New Terms, Behaviors, Codes. Updated 8/22/18
Question:
2018 Solid Tumor Rules/Multiple primaries--Lung: What is the histology and number of primaries for a lung case diagnosed in 2018 with adenocarcinoma with acinar predominant pattern on biopsy, and subsequent lobectomy showing adenocarcinoma with solid growth pattern and separate adenocarcinoma with lepidic predominant pattern? Should this be coded as one primary with an adenocarcinoma, NOS (8140/3) histology since we cannot use pattern or predominant, based on the histologic type listed in the synoptic report, and the fact it states synchronous primary tumors in the same lobe. See Discussion.
Discussion:
02/18 RUL biopsy: Moderatley differentiated adenocacarcinoma with acinar predominant pattern
04/18 RUL lobectomy: 6.5cm poorly differentiated adenocarcinoma with solid growth pattern and 1.1 cm separate adenocarcinoma with lepidic predominant pattern
Synoptic report:
Procedure: Lobectomy
Specimen Laterality: Right Tumor
Tumor Site: Upper lobe
Histologic Type: Invasive adenocarcinoma, solid predominant
Tumor Size: 6.5 Centimeters (cm)
Tumor Focality: Synchronous primary tumors in same lobe
Lymph Nodes Number of Lymph Nodes Involved: 0
Number of Lymph Nodes Examined: 12
Nodal Stations Examined: 4R: Lower paratracheal; 8R: Para-esophageal (below carina); 10R: Hilar; 7: Subcarinal
Pathologic Stage Classification (pTNM, AJCC 8th Edition)
Primary Tumor (pT): pT3
Regional Lymph Nodes (pN): pN0
Answer:
This is a single primary per Lung rule M7. First determine the histology for each tumor. Both tumors are coded 8140/3 because the histologies are a PATTERN. Reference: Coding Multiple Histologies (precedes histology rules) Instruction 2 says do not code pattern . If the word pattern was not in the diagnosis, you would code the specific histology.
History:
Answer corrected as above on 3/12/2019.
Previous answer: This is a single primary. Per H14, code the histology to the subtype/variant: 8551/3. Based on the information provided, there is one tumor with adenocarcinoma, acinar predominant (coded to 8551/3 per Table 3), and two tumors coded to adenocarcinoma (8140/3- disregard the histology with pattern as a descriptor). Solid Tumor Rules for Lung, Rule M7 applies: there are multiple tumors in the same lung with NOS and a subtype variant.
When developing the histology tables and rules, we made sure to include terminology used and approved by the College of American Pathologists (CAP). Table 3 has been updated to include four new terms that are variants of adenocarcinoma.
