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20091108 | MP/H Rules/Multiple Primaries--Lung: How do we apply the MP/H rules if a pathologist states a patient has multiple reportable primaries after he compares an October 2006 RLL lung specimen with a March 2009 RML lung specimen? See Discussion. | Patient had a right lung lobectomy (RLL) in Oct. 2006 diagnosed as adenocarcinoma. In March of 2009, two nodules in the right upper lobe were identified. Following a RUL wedge resection, the pathology report indicated: Two foci of M.D. adenocarcinoma with mixed mucinous and micropapillary and solid patterns. COMMENT: The present tumor is compared to the previous adenocarcinoma reviewed in 2006. Although there is some overlap in their appearance, the present tumor shows a much greater component of mucinous adenocarcinoma. Because there is some difference in the appearance, and the nodule is located in a separate lobe, this will be dictated as a separate lung primary. | For cases diagnosed 2007 or later, this is two primaries. MPH General Instructions tell us a pathologist may decide when there is recurrence when comparing the current tumor to a previous specimen. In this case, the pathologist did the comparison and documented that the second tumor is NOT a recurrence but a new primary. Histologies described by the terms "pattern" and "component" do not indicate a more specific type when applying the histology rules. The histology for the 2009 diagnosis is adenocarcinoma [8140/3]. Rule H3 applies. |
2009 |
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20091056 | MP/H Rules/Histology--Ovary: How is histology coded for an ovarian tumor diagnosed as an "ovarian clear cell cystadenocarcinoma"? See Discussion. | Final diagnosis for a resected ovary is ovarian clear cell cystadenocarcinoma. In applying the MP/H rules, rule H16 does not apply because cystadenocarcinoma is not included in Table 2. As a result rule H17 applies. Thus it appears the histology should be coded 8440. Cystadenocarcinoma is a specific histologic type and it is assigned the numerically higher histology code. This result differs from pre-2007 SINQ entry 20041045 that states: Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies. | For cases diagnosed 2007 or later: Assign code 8310 [Clear cell adenocarcinoma] according to rule H13. Ignore "cyst" when determining the histologic type for ovarian malignancies. For this case, the only histology is clear cell. The histologies for the common ovarian epithelial malignancies are serous, mucinous, endometrioid, clear cell, and transitional cell/Brenner. This clarification will be added to the rules in the next revision. |
2009 |
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20091069 | CS Extension--Bladder: How should this field be coded for a high grade urothelial carcinoma with "focal micropapillary features and invasion of lamina propria, with a note stating there is invasive carcinoma focally involving thin muscle bundles...difficult to distinguish whether muscularis propria or muscularis mucosae"? | This answer was provided in the context of CSv1 coding guidelines. The response may not be used after your registry database has been converted to CSv2.Assign CS Extension code 15 [Invasive tumor confined to subepithelial connective tissue (tunica propria, lamina propria, submucosa, stroma)]. The information provided confirms invasion of the lamina propria (code 15) but is not definitive enough to assign a code higher than 15. |
2009 | |
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20091061 | Multiplicity Counter--Head & Neck: How is this field coded when a patient has carcinoma in the same location as a previous primary but it is unknown if there was a disease-free interval? See Discussion. | Patient was diagnosed with squamous cell carcinoma, single tumor of the right true vocal cord in May 2008. Tumor was treated with radiation therapy and chemotherapy. Excision of right vocal cord mass in February 2009 shows squamous cell carcinoma. | Assign code 01 [one tumor only] for the example provided (see discussion). Given the information provided, there is no reason to suspect that the February 2009 diagnosis represents new tumor; therefore, it does not affect the multiplicity counter. It appears that this was the treatment plan for the original diagnosis in May 2008: radiation and chemo followed by excision of the mass. | 2009 |
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20091112 | Grade-Breast: How is this field coded for a breast tumor described as "intermediate nuclear grade"? See Discussion. | Guidelines for selecting grade for breast primaries prioritize nuclear grade right after B&R grade. The conversion table displays only numeric values for nuclear grade. How is grade coded for tumors in which nuclear grade is described by terminology? Does it make a difference if the tumor is invasive or in situ?
Example 1: Ductal carcinoma, intermediate nuclear grade. Example 2: Ductal carcinoma, high nuclear grade. Example 3: Ductal carcinoma, moderate nuclear grade. Example 4: DCIS, intermediate nuclear grade. |
Use the table on page C-607 of the 2007 SEER manual. The terms "low," "intermediate," and "high" appear in the column labeled "BR Grade." Use this column to determine the appropriate grade code when grade is described using these terms. If the grade of an in situ tumor is described using these terms, use the table to determine the appropriate code for the grade field. | 2009 |
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20091128 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a patient was diagnosed with breast carcinoma in 2001 and was subsequently diagnosed with a mammary carcinoma in a chest wall mass in 2008? See Discussion. |
Patient was diagnosed with invasive lobular carcinoma of the right breast in April 2001. Following modified radical mastectomy in May 2001, the patient was disease free. In December 2008 the patient was diagnosed with a right chest wall mass, invasive poorly differentiated mammary carcinoma with lobular origin. If this is a new primary in 2008, would we code the primary site to breast or chest wall? Please see I&R answers 25924, 22163 and 26155 with similar case scenarios that give two different answers. One response indicates coding this type of scenario as new primary to chest wall and the other two responses indicate this should not be a new primary because the chest wall is a metastatic site. The pathology report does not state that this is metastatic and it is unknown if there is breast tissue left behind at the chest wall. |
For cases diagnosed 2007 or later, this case is a single primary. The chest wall (NOS) is a metastatic site for breast cancer. There is no mention of residual breast tissue, so the 2008 diagnosis cannot be a new primary. "Chest wall" is an ambiguous term. It can mean the internal chest wall or the external chest wall. When the path report states that the "recurrence" is in residual breast tissue, this is most likely the external chest wall and the residual breast tissue is part of the breast not removed by the MRM. In contrast, skin or the chest wall, NOS, are regional metastases. |
2009 |
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20091012 | MP/H Rules/Histology--Head & Neck: If the final diagnosis states "see microscopic description," can the micro information be used to code the histology? See Discussion. | In regards to coding histology for 2007 and forward cases, we are instructed to use the final diagnosis, and any addenda or comments associated with the final diagnosis. We are not to use the microscopic description. However, we are seeing pathology reports with a final diagnosis that also includes the notation "see microscopic description" or "see description". Example: "Left Parotid: High grade carcinoma involving deep lobe with marginal extension. See description." The microscopic description goes on to describe the carcinoma in more detail, which includes a statement "consistent with the ductal type of primary parotid carcinoma." Can we use this microscopic description or not? | For cases diagnosed 2007 or later: When the final diagnosis indicates that the microscopic section contains the detailed diagnosis, use the microscopic description to code the histology. Otherwise, code from the final diagnosis only and not from the microscopic description. The final diagnosis is usually the pathologist's conclusion after consideration of the various choices listed in the microscopic description. The histology code should represent the pathologist's final conclusion. |
2009 |
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20091079 | Primary site--Bladder: What is the correct subsite for "interureteric ridge"? See Discussion. | Description: 4 mm nodule at base of bladder near interureteric ridge. | For this case, assign code C670 [Trigone of bladder]. The description for this case states that the tumor location is the base of the bladder. Base is a synonym for trigone. The interureteric ridge (or interureteric crest, or interureteric fold) is a fold of mucous membrane extending accross the bladder between the two ureteric orifices. The trigone is located below the interureteric ridge. |
2009 |
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20091106 | Multiple Primaries--Urinary: How many primaries should be coded for an 8/9/07 invasive transitional cell carcinoma of right ureter; 7/9/08 non-invasive urothelial carcinoma of bladder; 11/18/08 non-invasive urothelial carcinoma of left ureter; 6/20/09 invasive urothelial carcinoma of left ureter? | One primary. This is a good example of how the field effect occurs in the urinary system. From 2007 to 2008, Rule M8 says bladder and ureter tumors are not new primaries and would be documented as recurrences. Because other urinary sites are involved by 11/08 and by 06/09, do not make second primary of left ureter (Rule M4 does not apply). | 2009 | |
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20091122 | MP/H Rules/Multiple primaries-Brain: Does a glioblastoma multiforme following a low grade glioma (oligodendroglioma) represent a new primary? See Discussion. | In 2/08 patient underwent resection of tumor of right frontal lobe. Path diagnosis showed a low grade glioma, favor low grade oligodendroglioma (WHO grade II). In 02/09 biopsy of a left thalamic mass showed glioblastoma mutiforme. Per rule M6 glioblastoma multiforme following a glial tumor is a single primary. Per path diagnosis, the first tumor represented a low grade glioma. However, oligodendroglioma is not on the glial branch of chart 1 in the MP/H rules. |
For cases diagnosed 2007 or later, glioblastoma multiforme following oligodendroglioma are multiple primaries according to rule M8. Rule M6 does not apply. M6 applies only to glial tumors as listed in chart 1. Chart 1 is based on the WHO classification. The WHO classification separates oligodendroglial tumors from glial tumors. | 2009 |
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