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Report Produced: 04/25/2026 16:02 PM

Report Question ID Question Discussion Answer Year
20150067

MP/H Rules/Histology--Kidney: What is the correct histology for this diagnosis? See discussion.

Procedure: Nephrectomy

Laterality: Left

Tumor type: SOLID VARIANT RENAL CELL CARCINOMA

Nuclear grade: High grade (3/4)

Histologic grade: Poorly differentiated

Pattern of growth: Solid

Tumor size: 5x4.5x4cm

Local invasion: Present

Renal vein invasion: None

Surgical margins: Negative

Non-neoplastic kidney: Unremarkable

Adrenal gland: Not submitted

Lymph nodes: Not present

Pathologic stage: T1b

There are solid sheets of tumor cells without papillary structure. The tumor stains positive for Pax-2, negative for Ecadherin, P63 and CK7, consistent with renal cell carcinoma, solid variant.

Assign histology code 8312, renal cell ca, NOS. There is no specific code for the solid variant of renal cell carcinoma.

2015
20150011

Surgery Primary Site--Breast: Please clarify how to code both simple mastectomy with tissue expander and AlloDerm reconstruction, and simple mastectomy with tissue expander (NOS). See discussion.

There are multiple SEER Notes in the Breast Surgery Codes of Appendix C instructing us to code tissue expanders as reconstruction but none address the type of reconstruction to be coded.

1. Is a tissue expander always equivalent to Implant reconstruction?

2. Is AlloDerm always equivalent to Tissue reconstruction?

3. Is the combination of AlloDerm and tissue expander always equivalent to Combined (tissue and implant) reconstruction?

Do not code AlloDerm as either a tissue or implant reconstruction, it is a graft material that usually accompanies implant reconstruction. Placement of a tissue expander is an indication of planned reconstruction. Additional information is needed to determine whether the reconstruction involves tissue or implant.

1. A tissue expander is not always equivalent to Implant reconstruction

2. AlloDerm is not equivalent to tissue reconstruction

3. The combination of AlloDerm and tissue expander is not equivalent to combined (tissue and implant) reconstruction

2015
20150050

Reportability: Is penile intraepithelial neoplasia, differentiated type, reportable? See discussion.

Foreskin circumcision shows: Penile intraepithelial neoplasia, differentiated type (differentiated PeIN). If reportable, how would the histology and behavior be coded? Is this behavior /2?

For cases diagnosed 2018 and later

Differentiated penile intraepithelial neoplasia (differentiated PeIN), is reportable (8071/2).

Please note: Penile intraepithelial neoplasia, grade 3 (PeIN 3) is also reportable to SEER (C600-C609, 8077/2).

 2015
20150041

MP/H Rules/Multiple primaries--Breast: Does rule M10 apply in this situation?

L breast biopsy = INVASIVE DUCTAL CARCINOMA

L breast simple mastectomy = 2.0 cm INVASIVE DUCTAL CARCINOMA with an incidental finding of separate 1.0 cm INVASIVE LOBULAR CARCINOMA; pathologist specifically states the tumors are morphologically different. The tumors are both pure Ductal/pure Lobular.

Yes, Breast rule M10 applies. This case is a single primary.

Follow the MP/H rules even though the "pathologist specifically states the tumors are morphologically different" so that situations like this are reported consistenty accross cancer registries, regions, and states for consistent national reporting.

2015
20150059

Primary Site--Liver: What is the topography code for combined hepatocellular carcinoma/cholangiocarcinoma (M-8180/3) especially when there is no documentation that intrahepatic bile duct is the tumor site? Reports usually just indicate a liver mass(es) but since the intrahepatic ducts are within the liver, is the code C221 due to the cholangiocarcinoma component, thus making the case stageable?

If there is no further information about where the cancer originated, assign C220. Use ICD-O-3 as the source for coding topography. The topography code associated with combined hepatocellular and cholangiocarcinoma (8180/3) is C220 when there is no other information available, according to ICD-O-3.

2015
20150009

Multiple Primaries/Behavior--Lung: When a patient has an invasive lung primary, how do in situ tumors of the lung affect the determination of multiple primaries? See discussion.

How many primaries should be reported when a 12/19/14 RUL lung wedge resection shows: 2.0 cm invasive adenocarcinoma (8140/3) and an additional RUL wedge resection during the same procedure shows: multifocal adenocarcinoma in situ (bronchioloalveolar carcinoma), non-mucinous type (8252/2) size: 1 mm – 2 mm; followed by a 2/12/15 left upper lobectomy also showing Adenocarcinoma, invasive at several foci, with a prominent bronchioloalveolar (in situ) component….tumor focality: multifocal (10 cm mass, 6 cm mass and numerous smaller foci)?

Most often when the invasive tumor and the in situ component are in the same lung and are the same histology, rule M12 (example 3) applies and this is a single primary. If the first wedge resection included part of the tumor and the in situ was not separate from the tumor, it is a single primary. We suspect that the margins were positive on the first wedge specimen which prompted the second wedge resection where the in situ was found. In addition, terminology for lung malignancies is undergoing change: what was called BAC (invasive) is now called adenocarcinoma in situ.

 2015
20150008

Reportability--Heme & Lymphoid Neoplasms: Is idiopathic hypereosinophilia reportable? Must the diagnosis include the word 'syndrome'?

Idiopathic hypereosinophilia is not reportable.

Hypereosinophilic syndrome is a different entity and is a synonym for chronic eosinophilic leukemia.

2015
20140078

Surgery of Primary Site--Bladder: Is any mention of cautery in the gross description of pathology for a TURBT specimen sufficient to code 22 (excisional biopsy with electrocautery), or does there need to be a statement in the operative report that electrocautery was performed? See discussion.

Often, pathology for TURBT with non-invasive papillary TCC includes a gross description with a variety of cautery descriptions. For example, "received are three cautery roughened gray-pale pink tissue fragments.” However, the operative report is documented as a "TURBT" with no further description of the procedure.

Assign code 22 when cautery is mentioned n the gross description of pathology for a TURBT specimen.

2014
20140027

MP/H Rules/Histology--Bladder: What is the correct histology for the following bladder case and how do you determine? See discussion.

8/1/10 CYSTOSCOPY -- MULTIPLE BLADDER TUMORS INVOLVING POSTERIOR WALL, DOME & BLADDER NECK AREA. LARGEST WOULD BE MORE THAN 5 CM IN SIZE. 8/17/10 path -- BLADDER TUMORS:PAPILLARY TRANSITIONAL CELL CARCINOMA OF urinary bladder, GRADE III. ONE FRAGMENT OF TISSUE SHOWS NECROTIC CHANGE WITH APPARENT TRANSFORMATION TO A HIGH GRADE SARCOMATOID VARIANT W ITH EXTENSIVE SUBMUCOSAL INVASION & FOCAL AREA SUGGESTIVE OF ANGIOLYMPHATIC INVASION NOTED. MAJORITY OF TUMOR APPEARS CONFINED TO MUCOSAL SURFACE W ITH NO OTHER AREAS OF DEFINITIVE SUBMUCOSAL INVASION FOUND.

Code 8122/3 (UC/TCC, Sarcomatoid). Rule H5 and Table 1 apply.

This is based on the information provided: Transitional Cell Carcinoma with sarcomatoid variant, and Table 1 in Terms and Definitions for "Ureter/Renal Pelvis/Bladder".

2014
20140022

MP/H Rules/Kidney, renal pelvis--How many primaries are there for this case? Should we stop at rule M8 making this all one primary (C689) even though there were right and left renal pelvis tumors? Rule M3, which contains laterality, does not apply because there is also a bladder tumor. See discussion.

Kidney: originally diagnosed 12/21/2011 with right renal pelvis high grade papillary urothelial cancer. Status post right nephrectomy. Then on 01/10/2013 diagnosed with low grade papillary urothelial cancer of the bladder. 01/21/2013 diagnosed with left renal pelvis urothelial carcinoma iIn situ. Path report stated this may represent a hgh grade papillary urothelial cancer – unable to confirm due to specimen size. On 01/24/2013 left periaortic lymph node biopsy revealed poorly differentiated carcinoma consistent with prior diagnosed right renal pelvis high grade urothelial cancer. Neither the bladder nor the left renal pelvis tumor was compared to the previous right renal pelvis tumor. Also has bone mets.

Abstract this case as a single primary.

First, apply the MP/H rules to compare the 2013 bladder tumor to the 2011 renal pelvis tumor. Rule M8 applies, this is a single primary. Next, apply the MP/H rules to compare the 2013 in situ renal pelvis tumor to the 2011 renal pelvis tumor. Rule M8 applies, this is a single primary. As you correctly pointed out, Rule M3 for bilateral renal pelvis tumors, does not apply because there is also a bladder tumor in this case.

2014