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Partial nephrectomy showed carcinoma, histologic type: succinate dehydrogenase-deficient renal cell carcinoma. This is not a term in the ICD-O, and is not a histology covered in the Kidney MPH rules. However, a recent web search indicates this is a specific type of RCC that was added to the 2016 WHO classification of RCC (per abstract: https://www.ncbi.nlm.nih.gov/pubmed/27179267) and makes up 0.05-0.2% of RCC cases (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4229399/).

Pathology report microscopic description: The tumor is a meningothelial neoplasm (EMA+; BCL-2 and CD34 negative) with prominent collagen deposition. Necrosis and prominent nucleoli are present; no other atypical features are seen. Mitoses are present, up to 2 per 10 high-powered fields. Final Diagnosis: Dura, bicoronal craniotomy (specimen A): Meningioma with atypical features.

There is no rule in benign brain and CNS section of Multiple Primary/Histology (MP/H) Rules stating to code the most specific histologic term when the diagnosis is (something less specific, i.e., adenocarcinoma). This rule is in other site chapters of MP/H but appears missing in the benign brain and CNS section.

The MP/H Rules (Other Sites Terms and Definitions, Table 2) currently lists a separate mixed germ cell tumor code (9101) for germ cell tumors with choriocarcinoma plus teratoma, seminoma or embryonal carcinoma. Is this separate mixed germ cell tumor code still to be used now that all mixed germ cell tumors (9065 and 9085) have been collapsed into code 9085 for analysis per SINQs 20160056 and 20110013? The current WHO Classification for testis tumors does not list code 9101, but also collapses all seminomatous and nonseminomatous mixed germ cell tumors of more than one histologic type under code 9085.

The partial nephrectomy final diagnosis is renal cell neoplasm. The College of American Pathologists (CAP) Summary lists histology as: multilocular clear cell neoplasm of low malignant potential. The diagnosis comment adds: This neoplasm currently termed multilocular clear cell renal cell neoplasm of low malignant potential (WHO 2016), was previously termed cystic renal cell carcinoma.

The FORDS Manual (pg. 22) states: The first course of treatment includes all methods of treatment recorded in the treatment plan and administered to the patient before disease progression or recurrence. The instructions in the FORDS Manual and clarification from multiple CAnswer Forum posts indicates the planned first course treatment stops following disease progression, even when the first course treatment plan is not altered or changed.

SEER, on the other hand, instructs registrars to do the opposite. The SEER Manual instructs registrars to code all completed treatment given as part of the initial first course treatment plan, even after disease progression, provided the treatment plan is not changed or altered. (See 2016 SEER Manual, Section VII First Course of Therapy, Treatment Timing, Rule 1 and Example 1.)

For consistency in data collection, shouldnt the standard setters use the same guidelines to define first course treatment? Given that the majority of cases are reported to SEER by registrars in CoC facilities, who may not be abstracting treatment modalities that occur after progression, the SEER expectation is likely not able to be performed consistently. Wont this difference in standard setter data collection expectations negatively impact the treatment data reflected on our files?

Patient has an April 2009 biopsy proven diagnosis of cholangiocarcinoma with a single liver mass in segment 4 that was treated with TACE and systemic chemotherapy. The treated lesion was stated to be stable in subsequent scans performed between 2010 and late 2015.

December 2015 imaging identified a new mass in the left hepatic lobe consistent with cholangiocarcinoma. Is the 2015 tumor a new primary?

In auditing files for expected (but not received) abstracts due from facilities, we've observed these types of cases not being consistently reported as multiple primaries.

We are seeing more use of PI-RAD categories on scans. The final impression on the scan will be PI-RADS Category 5, with no specific statement of malignancy. The scans include a blanket statement with the definitions of the PI-RADS categories as below.

PI-RADS (v2) categories:

PI-RADS 1 - Very low (clinically significant cancer is highly unlikely to be present)

PI-RADS 2 - Low (clinically significant cancer is unlikely to be present)

PI-RADS 3 - Intermediate (the presence of clinically significant cancer is equivocal)

PI-RADS 4 - High (clinically significant cancer is likely to be present)

PI-RADS 5 - Very high (clinically significant cancer is highly likely to be present)

A previous SINQ 20010094 indicates that we cannot use BI-RADS categories for breast cancer diagnosis, and SINQ 20160008 indicates we can use LI-RADS for HCC diagnosis, but those definitions are slightly different. Most often there will be a subsequent biopsy diagnosis of carcinoma, so the question is also in reference to Diagnosis Date. Can we use the date of the scans impression, which states PI-RADS category 5, as the Diagnosis Date?

8/1/2016 Left Abdomen biopsy: Early melanoma in situ (C445-2, 8720/2).

9/2/2016 Upper back: Superficially invasive malignant melanoma (C445-9, 8720/3).

Does rule M4 apply and multiple primaries should be reported or does rule M8 apply and a single primary should be reported?