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Report Produced: 11/09/2025 13:13 PM

Report Question ID Question Discussion Answer Year
20091030 MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10?

For cases diagnosed 2007 or later:

The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.

Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.

For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites.

 2009
20091027 MP/H Rules/Multiple primaries--Thyroid: How many primaries should be coded in a patient with a 4/5/08 left thyroid lobectomy diagnosis of follicular carcinoma followed by a 7/25/08 right thyroid lobectomy diagnosis of papillary carcinoma, follicular variant?

For cases diagnosed 2007 or later:

Rule M17 under Other Sites applies. These are separate primaries based on their ICD-O-3 histology codes. Follicular carcinoma is coded 8330. Papillary carcinoma, follicular variant is coded 8340. The histology codes are different at the third number. Rule M6 does not apply because these diagnoses are more than 60 days apart.

 2009
20091126 MP/H Rules/Multiple primaries--Vagina: How many primaries should be abstracted for a patient with a complex history of multiple occurrences of vaginal intraepithelial neoplasia (VAIN III) between 2001 and 2008 and invasive squamous cell carcinoma (SCCA) of the vagina diagnosed in 2006 and again in 2008? See Discussion. Patient had VAIN III in March of 2001. She had a partial vaginectomy and then continues to have laser surgery in 2002, 2003, 2005 and 2006 for recurrences. In 12/2006 she is diagnosed with SCCA of the vagina with microinvasion (new primary). Then in 2/2008 she has VAIN III again -- new primary according to rule M10 (more than 1 year later). An invasive SCCA of the vagina is again diagnosed in 9/2008. Is this another new primary per rule M15 (invasive after in situ)? Every instance in 2008 is called a recurrence, but we disregard that statement.

There are two primaries according to the information provided.

1. VAIN III March 2001.

2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ

For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease.

 2009
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
20091018 MP/H Rules/Multiple Primaries/CS Extension: How many primaries are to be accessioned when tumors are present bilaterally in the pleura and fallopian tubes? See Discussion.

For both pleura and fallopian tube, the MP/H rules indicate that bilateral involvement of these sites should be coded as multiple primaries. However, both of these sites have CS extension codes that classify the contralateral disease as regional extension.

Is a case described as a left sided pleural mesothelioma that has right sided pleural disease coded as one or two primaries? How is CS coded?

For cases diagnosed 2007 or later:

For a pleural or fallopian tube primary, if there is tumor(s) on the left and separate tumor(s) on the right and neither is stated to be metastatic from the other, abstract as multiple primaries according to rule M8 for other sites. If both sides are involved, but there is only one tumor, rule M2 for other sites applies and this is a single primary. Code each primary separately in CS.

 2009
20071077 MP/H Rules/Multiple Primaries/Histology--Colon: How many primaries should be reported and how is the histology field(s) coded if the left colon contains two adenocarcinomas and one mucinous adenocarcinoma arising in a villous adenoma and each has a different level of invasion? See Discussion. A patient had three tumors in the left colon including an 1) invasive well differentiated mucinous adenocarcinoma arising in tubulovillous adenoma with pericolonic subserosal fat invasion 8.5cm, 2) An infiltrative moderately differentiated colonic adenocarcinoma with invasion of muscularis propria 4cm and 3) an invasive moderately differentiated adenocarcinoma with invasion of muscularis propria, 1/69 nodes positive. The case was coded using rule M8 for one primary, but M10 contradicts; and H13 coding rule for histology 8263/3.

For cases diagnosed 2007 or later:

Assuming that all tumors are in the left colon, there are three tumors:

  • Mucinous adenocarcinoma arising in a villous adenoma

  • Colonic adenocarcinoma

  • Colonic adenocarcinoma

    • Multiple Primary Determination

    In the colon MP rules go to the multiple tumors module. Start with M3. Stop at M7 and abstract as a single primary.

    Histology Code

    Go to the histology coding rules, multiple tumors module, and start with H15. Stop at H20 which tells you to code the most invasive tumor. Tumor 1 is the most invasive according to the definition of most invasive in the 2007 SEER Manual, page C-271. Code 8263/3 [Adenocarcinoma in tubulovillous adenoma].

    		 2007
    		20071068 MP/H Rules/Multiple Primaries/Histology--Prostate: How many primaries should be abstracted and how should the histology field(s) be coded for a case in which the pathology specimen showed adenocarcinoma in 20% of the tissue and sarcoma in 50% of the tissue? See Discussion.

    Patient has TURP. The final path diagnosis is adenocarcinoma in 20% of tissue and sarcoma in 50% of tissue.

    Because it is unknown whether there is a single or multiple tumors, rule M1 (Other Sites) is used which states the case is to be abstracted as a single primary.

    Single invasive histology rules are followed to rule H16, but table 2 does not contain a mixed code for this situation, even though ICD-O-3 has a code 8933/3 for "adenosarcoma". Therefore, rule H17 is applied that states to use the highest code, which in this case would be 8800/3 [Sarcoma, NOS]. Is this correct?

    For cases diagnosed 2007-2014, code as two primaries, one adenocarcinoma and the other sarcoma.

    This is two tumors (adenocarcinoma and separate sarcoma) until proven otherwise. Do not code as adenosarcoma, as this is a gyn-specific diagnosis. Adenosarcoma of the prostate is not a recognized entity in the WHO classification of prostate tumors.

    		 2007
    		20110027 MP/H Rules/Multiple primaries/Histology--Thyroid: How many primaries and what histology(ies) are coded when a patient is diagnosed with a single papillary carcinoma in the left thyroid lobe and multiple foci of papillary microcarcinoma in the right thyroid lobe? See Discussion.

    Is the term papillary microcarcinoma being used to describe the size of the foci only, or are the right thyroid lobe lesions a different histologic type? Does rule M6 apply (single primary)? Or does rule M11 apply (multiple primaries)?

    Case summary: Left thyroid with 2.2 cm papillary carcinoma and right thyroid with "multiple microscopic foci of papillary carcinoma (papillary microcarcinoma) ranging from less than 1 mm to 2 mm in greatest dimension."

    Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary.

    For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult. The histology is the same in both lobes of the thyroid.

    The steps used to arrive at this decision are:

    Open the Multiple Primary and Histology Coding Rules manual. For a thyroid primary, use the Other Sites MP rules under one of the three formats (i.e., flowchart, matrix or text) to determine the number of primaries because the thyroid does not have site specific rules.

    Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.

    . This patient has multiple papillary carcinomas of the thyroid diagnosed simultaneously; no other rule applies, so this is a single primary. Abstract a single primary for this patient.

    Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.

    Start with the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, Rule H18. The rules are intended to be reviewed in consecutive order within the module from Rule H18 to Rule H31. You stop at the first rule that applies to the case you are processing.

    . Code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS [8260].

    		 2011
    		20120084 MP/H Rules/Multiple primaries/Histology: How many primaries are accessioned and how is the histology coded if a patient has a 1.2 cm hepatocellular carcinoma and a 7 cm hepatocellular carcinoma, solid, acinar and trabecular type? See Discussion. FINAL Diagnosis: 2 separate lesions of the liver 1)1.2 cm hepatocellular carcinoma and 2) 7 cm hepatocellular carcinoma, solid, acinar, and trabecular type.

    For cases diagnosed 2007 or later, accession a single primary, hepatocellular carcinoma [8170/3].

    The steps used to arrive at this decision are:

    Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text) and go to the Other Sites MP rules because liver does not have site specific rules developed.

    Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. There is one tumor with HCC and another tumor with a specific type of HCC.

    Hepatocellular carcinomas vary and often display different architectural patterns such as solid, acinar and trabecular.

    		 2012
    		20071009 MP/H Rules/Multiple Primaries/Laterality--Brain and CNS: How many primaries are to be abstracted and how is laterality to be coded for two meningiomas, one occurring at the midline and the other in the right termporal region? See Discussion. MRI of the brain shows two meningiomas: One is stated to be 'midline' (laterality code 9) and one is stated to be in the 'right' temporal region. The rules state if same site (C700), same histology & laterality is same side or one side unknown, then abstract as single primary. Based on this, the MRI findings would be one primary, but how should laterality be coded? For cases diagnosed 2007 or later, abstract two primaries. The lateralities of both meningiomas are known. Right (code 1) and midline (code 9) are different lateralities. 2007