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Report Produced: 03/01/2026 15:11 PM

Report Question ID Question Discussion Answer Year
20091108 MP/H Rules/Multiple Primaries--Lung: How do we apply the MP/H rules if a pathologist states a patient has multiple reportable primaries after he compares an October 2006 RLL lung specimen with a March 2009 RML lung specimen? See Discussion. Patient had a right lung lobectomy (RLL) in Oct. 2006 diagnosed as adenocarcinoma. In March of 2009, two nodules in the right upper lobe were identified. Following a RUL wedge resection, the pathology report indicated: Two foci of M.D. adenocarcinoma with mixed mucinous and micropapillary and solid patterns. COMMENT: The present tumor is compared to the previous adenocarcinoma reviewed in 2006. Although there is some overlap in their appearance, the present tumor shows a much greater component of mucinous adenocarcinoma. Because there is some difference in the appearance, and the nodule is located in a separate lobe, this will be dictated as a separate lung primary.

For cases diagnosed 2007 or later, this is two primaries.

MPH General Instructions tell us a pathologist may decide when there is recurrence when comparing the current tumor to a previous specimen. In this case, the pathologist did the comparison and documented that the second tumor is NOT a recurrence but a new primary.

Histologies described by the terms "pattern" and "component" do not indicate a more specific type when applying the histology rules. The histology for the 2009 diagnosis is adenocarcinoma [8140/3]. Rule H3 applies.

2009
20091104 MP/H Rules/Histology--Esophagus: How is histology coded for a biopsy of the esophagus with a pathologic diagnosis of "adenocarcinoma, intestinal type" when there is no evidence of a gastric tumor in scans or EDG? See Discussion. There is a rule for colon to disregard "intestinal type" and code to adenocarcinoma (8140) but no rule for esophagus. How should histology for this esophageal case be coded?

For cases diagnosed 2007 or later:

Follow MP/H Other Sites Rule H11 and code 8144/3 [Adenocarcinoma, intestinal type]. Adenocarcinoma, intestinal type, is called that because it resembles the normal pattern of adenocarcinoma seen in the large intestines. It is not an indication of the location of the adenocarcinoma. We find that it is not uncommon in the sinuses, stomach, lungs, cervix, and many other organs.

 2009
20091093

Race--How and when is Appendix D, Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics, to be used? See Discussion.

For example, if race is recorded as unknown on the facesheet of a hardcopy medical record or in the race field of an electronic medical record, how should race be coded for the following descriptions found in the history and physical or consultation reports submitted by clinicians?

1) Patient is Czechoslovakian

2) Patient is born in Czechoslovakia

3) Patient is Ethiopian

4) Patient is born in Ethiopia

5) Patient is Japanese

6) Patient is born in Japan

7) Patient is Brazilian

8) Patient is born in Brazil

Would you code these cases any differently if these descriptions were actually used in the race fields in the medical record or on a death certificate?

Code the patient's stated race when possible. Refer to Appendix D, Race and Nationality Descriptions from the 2000 Census and Bureau of Vital Statistics, for guidance.

Use the lists in Appendix D when race is not stated but other information is provided in the medical record. The cases you provide are good examples of the use of Appendix D. They would be coded the same if the descriptions were used in the medical record or death certificate race fields.

 2009
20091062 CS Site Specific Factor--Head & Neck: How is Site Specific Factor 2 coded when the pathologist describes regional lymph nodes as "matted"? See Discussion. The primary tumor is located in the tonsil. The patient underwent neck dissection. Pathology report stated there were matted regional lymph nodes. Does the term matted describe extracapsular extension? The definition for site specific factor 2 uses the term "fixed" to describe extracapsular extension (but not matted). For breast, fixed/matted appear to be interchangeable. Would they also be interchangeable for head and neck cases?

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."Matted" is not a synonym for "Fixed" in the CS schema for Head and Neck. "Matted" is not indicative of extracapsular extension for the Head and Neck schema.

 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
20091041

CS Lymph Nodes--Ovary: Are positive lymph nodes removed from "colon tissue" during a modified posterior pelvic debulking regional or distant? If regional, what is the appropriate CS LN code?

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.Pericolonic lymph nodes are "regional" lymph nodes for an ovarian primary. If you do not have enough information to assign codes 12-30, assign code 50 [Regional lymph nodes, NOS].

 2009
20091040 MP/H Rules/Histology--Breast: How is histology coded for an "infiltrating papillary carcinoma" of the breast when there is no mention of ductal or adenocarcinoma in the pathology report?

For cases diagnosed 2007 or later, assign histology code 8503 [Papillary adenocarcinoma]. Rule H14 applies.

ICD-O-3 code 8050 does not apply in this case. Refer to the numeric listing in ICD-O-3. 8050 is a squamous cell neoplasm. Papillary carcinoma of the breast is NOT a squamous cell neoplasm. It is a neoplasm of the breast parenchyma - ducts, lobules or connective tissue. 8503 is the correct code in this case.

 2009
20091088 MP/H Rules/Histology--Breast: How is histology coded for a diagnosis of "metaplastic carcinoma with the sarcomatous component of high grade sarcoma with focal areas of osteoid formation"? See Discussion. Right breast simple mastectomy, path: 2.5 x 1.5 x 1.5 cm metaplastic carcinoma with; the sarcomatous component is high grade sarcoma with focal areas of osteoid formation. The epithelial component is predominantly grade 2 DCIS. For cases diagnosed 2007 or later, assign code 8575 [Metaplastic carcinoma, NOS]. Metaplastic carcinomas often include mixtures of epithelial carcinoma with sarcoma, for example. 2009
20091057 CS Site Specific Factor--Lymphoma: Can the term "intermediate risk" be used to code IPI score? See Discussion. Patient has Hodgkin disease. The physician states that the patient has bulky stage IIA intermediate risk disease. Is the term "risk" another way of stating IPI score? If so, how would intermediate risk be coded?

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 SSF 3 for lymphoma based on the IPI score stated in the record. Do not attempt to interpret statements or terms in order to assign a code to SSF 3. If no further information is available for this case, code SSF 3 999 [Unknown].

 2009
20091078 MP/H Rules/Multiple Primaries--Head & Neck: How many primaries should be reported when an invasive squamous cell carcinoma of the right mandibular body (C06.9) was diagnosed in 2004 (treated with surgery and radical neck dissection), and an invasive squamous cell carcinoma of the left buccal mucosa (C06.0) was diagnosed in 2007? See Discussion. According to the MP/H Rules, it appears Rule M12 would apply since none of the others fit and these would be a single primary.

For cases diagnosed 2007-2014:

Based on the information provided, the primary site code for the 2004 primary should be C031 [mandibular gingiva, lower alveolar mucosa, etc.].

The 2007 diagnosis would be a separate primary according to rule M7 because the patient was disease free following treatment for the 2004 diagnosis. C031 and C060 are different at the third character.

 2009