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20091114 | MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion. | Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis. | For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis. | 2009 |
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20081055 | MP/H Rules--Melanoma: How many primaries are represented if subsequent to a diagnosis of malignant melanoma of skin of left thorax in April 2006, a metastatic melanoma is discovered in the soft tissue of the abdomen and in the skin and subcutaneous tissue of the groin in late 2007? See Discussion. | 4/20/06: skin left lateral thorax, excision: Pedunculated malignant melanoma, 0.5 CM in height, Clark's level 3, Breslow depth 0.5 CM, superficial ulceration noted. No host response. Margins clear. 6/19/06: Four sentinel LNs negative. Interferon therapy. 10/30/07: FNA of soft tissue, left lower abdomen: consistent with metastatic melanoma. 12/20/07 A) sentinel lymph node, left groin, biopsy: No morphologic or immunophenotypic findings support for metastatic melanoma (see comment). B) skin and subcutaneous tissue, left groin, excisional biopsy: Metastatic malignant melanoma (see comment). Lymphovascular invasion identified. Margins free of melanoma. Melanoma 1.5 MM from the closest designated deep margin and 5 MM from the designated 6:00 margin. C) skin, left groin/additional inferior margin, excisional biopsy: No significant histopathologic abnormality. No evidence of villus or melanoma or malignancy. Comment: A 0.8 cm metastatic nodular melanoma is present in the adipose tissue. The underlying skin is unremarkable. There is no evidence of ulceration, melanocytic lesion, melanoma in situ, or regression of melanoma. Block A1 is sent for immunohistochemical studies. The immunophenotypic findings provide no support for metastatic melanoma in lymph node. Please see the immunohistochemical study. The primary MD states "Recurrent intransit mets, left groin." |
For cases diagnosed 2007 or later, this is a single primary, melanoma of the thorax 4/20/06. The subsequent reports mention metastases, but do not document another primary. Do not count metastatic lesions as new primaries. | 2008 |
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20071042 | MP/H Rules/Multiple Primaries--Breast: How many primaries are to be abstracted when two tumors occur in one breast and both are ductal with the smaller tumor representing tubular carcinoma [variant]? See Discussion. | Right breast partial excision: Two invasive foci, one measuring 0.2cm and the second measuring 0.5cm. Both lesions are ductal carcinoma with the smaller representing tubular carcinoma (variant). The breast histology table does not list tubular as a type of ductal, however, the pathologist states ductal carcinoma, tubular variant. |
For cases diagnosed 2007 or later, this is two primaries of the right breast, using the 2007 MP/H rules. For the purposes of the 2007 rules, tubular is not a specific type of duct. Duct carcinoma (8500) and tubular carcinoma (8211) are different at the second digit of the histology code. Rule M12 applies, making these separate primaries. | 2007 |
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20081130 | MP/H Rules--Breast: What histology code is used for lobular with focal ductal features? Do we ignore the focal features and code as lobular or do we use the combination code for duct and lobular? | For cases diagnosed 2007 or later, use rule H14 and assign code 8520 [lobular]. Ignore histologies described as "focal," "foci," or "focus." This instruction will be added to the next version of the MP/H manual. | 2008 | |
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20081132 | MP/H Rules--Breast: What is the histology code for a breast tumor that is ductal ca with focal squamous differentiation? See Discussion. | SINQ 20021062 states for cases Dx'd prior to 2007, use 8570. Is 8570 also used when the squamous differentiation is focal? | For cases diagnosed 2007 or later, use rule H14 and code the histology 8500 [duct carcinoma]. Ignore histologies described as "focal," "focus," or "foci." This instruction will be added to the histology rules in the upcoming revision of the MP/H manual. | 2008 |
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20081133 | MP/H Rules--Breast: What histology code is used for lobular carcinoma, pleomorphic type? | For cases diagnosed 2007 or later, use rule H14 and code the histology 8520 [lobular carcinoma]. 8520 is the only ICD-O-3 code for lobular carcinoma. There are no codes for specific lobular types. | 2008 | |
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20100035 | MP/H Rules/Multiple primaries--Colon: How many primaries are accessioned for a patient with two colon carcinomas in different segments of colon when there is no documentation that either tumor arose in a polyp, there is no statement indicating the presence of adenomatous polyposis coli and the resected pathology specimen indicates the presence of over 200 polyps? See Discussion. | The first MP/H rule that applies for this case is M4 [tumors in different segments of the colon]. Following rule M4, the case would be counted as two primaries and the histology would be coded per Rule H11. As these are multiple primaries, Rule H17 [Code 8220 (adenocarcinoma in adenomatous polyposis coli) when there are > 100 polyps identified in the specimen] would never apply, because H17 applies to multiple tumors abstracted as a single primary. However, Rule H17 seems to fit this case. Should Rule M3 be expanded to include a statement about > 100 polyps so these cases are not accessioned as multiple primaries?
Example: Total colectomy: 1) Distal tumor: - ulcerating moderately differentiated colonic adenocarcinoma, 3.2 cm in greatest dimension. Tumor invades through the muscularis propria into the subserosa (pt3). 2) Proximal tumor: exophytic moderately differentiated colonic adenocarcinoma, 2.9 cm in greatest dimension. Tumor invades submucosa (pt1). Multiple tubular adenomas present throughout the colon, approximate count greater than 200. |
For cases diagnosed 2007 or later, use rule M3 for this case and abstract as a single primary. The case information makes it clear that this is adenomatous polyposis coli. Clarification will be added to rule M3 in the next revision of the rules. | 2010 |
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20100034 | MP/H Rules/Multiple primaries--Esophagus: Should two separate nodules of adenocarcinoma with one at the GE junction [C160] and one arising in Barretts esophagus of the distal esophagus [C155] be accessioned as a single primary because these sites are now grouped together in the same stage grouping per the AJCC 7th Edition? See Discussion. | Per notes included in CSv2, the cardia/EGJ, and the proximal 5cm of the fundus and body of the stomach [C16.0-C16.2] have been moved from the Stomach chapter and added to the Esophagus chapter effective with AJCC TNM 7th Edition. A new schema, EG Junction, was created in CSv2 to accommodate this change. Tumors arising at the EGJ, or arising in the stomach within 5 cm of the EGJ and crossing the EGJ are staged using the schema for EG Junction. MP/H Rule M11 states that tumors with ICD-O-3 topography codes that are different at the second (Cxxx) and/or third characters (Cxxx) are multiple primaries.
In light of the fact that tumors of the GE junction are now included with tumors of the esophagus in AJCC 7th Edition, will the MP/H rules also be adjusted to reflect that change? |
For cases diagnosed 2007 or later, use the multiple primary rules to determine the number of primaries. Use staging resources for staging. Abstract two primaries for the case example using Rule M11. | 2010 |
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20021185 | Surgery of Primary Site--Major salivary gland: How do you code Surgery of Primary Site for a submandibular gland primary when the operative report refers only to an excision of the submandibular "tumor" while the pathology report states the submandibular "gland" was removed? See discussion. | The gross description on the pathology report indicates that the specimen consists of a "submandibular gland." A further description on the pathology report included, "the specimen was sectioned exposing a focally cystic mass that nearly replaces the entire specimen." | For cases diagnosed on 1/1/2003 or after: Code the Surgery of Primary Site field to 40 [Total parotidectomy, NOS; total removal of major salivary gland, NOS], per the pathology report's gross description of the specimen unless the operative report description of procedure indicates that the removal was less than total. | 2002 |
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20041017 | EOD-Lymph Nodes--Breast: When isolated tumor cells are found in an axillary lymph node, should lymph node involvement be coded to 0 [no lymph node involvement] or 1 [micrometastasis (less than or equal to 0.2 cm)]? | For cases diagnosed prior to 2004: Code the EOD-Lymph Node field to 0 [No lymph node involvement] when regional lymph nodes are negative, even if there are positive isolated tumor cells (ITC). | 2004 |
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