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Report Produced: 12/31/2025 08:12 AM

Report Question ID Question Discussion Answer Year
20091119

MP/H Rules/Multiple primaries--Lung: How many primaries are to be reported for an adenocarcinoma of the lung in the right middle lobe of the lung and bronchioalveolar carcinoma, non-mucinous type in the right upper lobe? See Discussion.

Bilobectomy revealed two tumors, adenocarcinoma in the right middle lobe and bronchioalveoar carcinoma non-mucinous type in the right upper lobe. MP/H rule M10 states that tumors with non-small cell carcinoma (8046) and a more specific non-small cell type (chart 1) are a single primary. Does rule M10 apply to only those cases for which one tumor is stated to be non-small cell, NOS? Or do we use chart 1 to identify specific subtypes? For this case, using chart 1, would we note that bronchioalveolar is a subtype of adenocarcinoma and count this case as a single primary? Most of the MP/H rules schemas have a rule making an adenocarcinoma and a more specific type of adenocarcinoma a single primary. Would we apply rule M10 to this case and count it as a single primary? Or would we move on to rule M11 and count the case as two primaries?

For cases diagnosed 2007 or later, Rule M11 applies. Accession two primaries.

Rule M10 applies only to cases for which one tumor is stated to be "non-small cell carcinoma."

 2009
20091014

MP/H Rules/Histology--Melanoma: Please clarify what we should code when we see the term 'spitz or spitzoid' in association with melanomas. See Discussion.

Path reports often diagnose "melanoma with spitzoid features." There is no code for this in ICD-O-3. Would it be melanoma NOS with a specific type for MP/H rule H9 (with features of...), or would we stop at H3? Could the matrix principle apply, changing 8770/0 (one of the synonyms is Spitz nevus) to 8770/3 (although no Spitz synonyms are specifically listed under this code)? What if the path report says "melanoma arising in a Spitz nevus"?

For cases diagnosed 2007 - 2020

Assign code 8720/3 [Malignant melanoma] for melanoma with Spitzoid features, Spitzoid variant of nevoid melanoma, melanoma arising in Spitz nevus, or Spitzoid melanoma. The WHO Classification of Tumors groups these with Nevoid melanomas and codes them to 8720/3.

According to WHO, "Nevoid melanoma is a subtype of malignant melanoma of the skin that is distinctive in that the primary lesion mimics many of the architectural features of a common compound or intradermal nevus ... or a Spitz nevus... These lesions are defined not as atypical nevi, but as melanomas because they involve the dermis and have the potential for metastasis."

 2009
20091043

Multiple primaries--Lymphoma: Should a second primary lymphoma be accessioned if the reporting hospital disagrees with the final diagnosis stated on a review of slides? See Discussion.

Example: Patient had an original diagnosis of small lymphocytic lymphoma (9670/3) of lung in 1986 and later presents with small B-cell non-Hodgkin lymphoma (9670/3) of small bowel in 2008 at Hospital A. Slides sent for review at Hospital B where patient was also seen. Slides there read as low grade B-cell lymphoma most consistent with extranodal marginal B-cell lymphoma of mucosal associated tissue (MALT Lymphoma). Hospital A's pathology report stated that immunostains would exclude mantle cell lymphoma and MALT lymphoma and the original pathology report has not been amended to match the outside path diagnosis. Is this a second primary of MALT lymphoma (9699)?

For cases diagnosed prior to 1/1/2010:The 2008 diagnosis is not a new primary according to the Definitions of Single and Subsequent Primaries for Hematologic Malignancies (the tri-fold heme table) using the pathology report diagnosis from the facility where the procedure was performed (Hospital A). Since Hospital A disagreed with the slide review and did not amend their diagnosis based on the slide review, do not use the slide review diagnosis in this case.

For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2009
20091117 MP/H Rules/Histology--Breast: How is histology to be coded for a breast primary described as "tubular carcinoma (well differentiated invasive ductal carcinoma)"? See Discussion.

How are terms that are modified by parentheses to be interpreted? Do terms in parentheses modify the stated diagnosis and thus have priority over the stated diagnosis? Or would rule H17 apply and histology would be coded as duct and other carcinoma? For this case, the wording of the diagnosis and use of parentheses seem to indicate that tubular is a type of ductal carcinoma. Tubular is not listed as a specific duct carcinoma in the MP/H rules histology tables for breast.

For cases diagnosed 2007 or later, code the histology as tubular carcinoma [8211/3]. This is not a case of tubular AND infiltrating duct. The histology is stated to be tubular. Tubular is not a specific type of duct carcinoma. 2009
20091047 MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"? For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored. 2009
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
20091116 MP/H Rules/Multiple primaries - - Colon: Is a colon tumor reported as "recurrent at the anastomotic junction" just over one year after the diagnosis of a T4 colon tumor to be counted as a new primary? See Discussion.

MP/H rules do not apply to metastasis. However, it has been our experience that pathologists and clinicians tend to use the terms metastatic and recurrence interchangeably. The term "recurrence" is not limited to a tumor recurrence in the same site as a previous malignancy. Sometimes it is obvious that the clinician is using the term recurrence to describe a metastatic lesion. When a "recurrence" is located in tissue that is very different from the original primary site, it is easy to recognize that the intended meaning of the term is metastasis.

Example: Patient with squamous cell carcinoma of the tongue with recurrence in the lung.

However, when the metastatic deposit occurs in similar tissue, it is more difficult to determine the number of primaries.

Example when the term "recurrence" is ambiguous: In April 2008 patient was diagnosed with adenocarcinoma of the ascending colon. At the time of hemicolectomy the tumor was noted to be plastered into the paraduodenal and peripancreatic area. Patient received one dose of adjuvant chemo and then discontinued treatment. In May 2009 the patient was found to have adenocarcinoma in the transverse colon. Per the pathology report the diagnosis for segmental resection at that time showed colonic adenocarcinoma. Tumor location: tumor appears recurrent at anastomotic junction. Abdominal wall mass showed metastatic adenocarcinoma.

One has to wonder if the pathologist found a metastatic nodule at the anastomotic site and called it "recurrent." It is unlikely that the pathologist will compare this specimen to the previous tumor, having already diagnosed it as "recurrent."

For cases diagnosed 2007 or later, Rule M4 applies to the example of adenocarcinoma of ascending colon diagnosed in 2008 followed by adenocarcinoma of transverse colon diagnosed in 2009. When a colon resection has taken place, the original primary site is no longer present. A colon resection usually includes a portion of uninvolved colon on either side of the tumor. A tumor diagnosed at the anastomotic junction cannot be located in the same site as the previous tumor. Use of the term "recurrent" in this case is not synonymous with "metastatic." Apply the MP/H rules. 2009
20091083 Grade/Cell indicator--Lymphoma: How is Grade/Cell indicator coded for anaplastic large cell lymphoma? See Discussion. The SPCM states cell indicator codes take precedence over grade/differentiation codes for lymphoma and leukemia cases.

For cases diagnosed prior to 1/1/2010:Because there is no cell indicator information, code 9 [cell type not determined] in the grade/cell indicator field. Do not code grade for lymphoma. For lymphoma and leukemia this field is the cell indicator.

For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2009
20091105

Multiple Primaries--Hematopoietic: How many primaries and which histologies should be reported for a case presenting with a 2005 diagnosis of CLL/SLL, 2006 clinical diagnosis of MDS and a 2008 diagnosis of AML? See Discussion.

2005 diagnosis of CLL/SLL (9670) with lymph node involvement, treated with FCR. 2006 clinical diagnosis of MDS secondary to chemo (9987) with CLL/SLL in remission. 2008 biopsy reveals AML (9861). Per Seer Hematopoietic Table, 9987 & 9861 are a single primary. In 6/2008 patient receives bone marrow transplant. 2009 status post BMT, BM biopsy reveals RAEB-1 (9983). Is this still the same disease process or a new primary (since status post BMT)?

For cases diagnosed prior to 1/1/2010:Two primaries should be abstracted. Using the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, compare 9670 (SLL) in 2005 and 9987 (MDS secondary to chemo) in 2006. This is two primaries.

MDS can transform to AML. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9861 (AML) are a single primary. The AML would be documented in follow-up. (While 9670/SLL and 9861/AML are two different primaries, the SLL has already been reported.)

RAEB is a form of MDS. On the Definitions of Single and Subsequent Primaries for Hematologic Malignancies table, 9987 (MDS) and 9983 (RAEB) are a single primary. The RAEB would be documented in follow-up. (While 9670/SLL and 9983/RAEB are two different primaries, the SLL has already been reported.)

For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2009
20091091 Primary Site/CS Extension--Lymphoma: How should these fields be coded for a malignant lymphoma with spleen involvement, inguinal and iliac adenopathy, T12 lesion with bony destruction, and a paraspinal mass in lower lumbar region with extension into iliac fossa involving left psoas muscle and causing bony destruction?

For cases diagnosed prior to 1/1/2010, 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.

Code the primary site C496 [Connective, subcutaneous and other soft tissue of trunk]. When lymphoma is present in an extranodal organ/site and in that organ/site's regional lymph nodes, code the extranodal organ/site as the primary site. In this case, there is a soft tissue paraspinal mass at T12 extending into iliac fossa, left psoas muscle and bone. Lymph nodes are also involved. Assign CS extension code 21 [Direct extension to adjacent organs or tissues].

For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

 2009