Report | Question ID | Question | Discussion | Answer | Year |
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20081127 | MP/H Rules/Histology--Thyroid: How would the histology "micropapillary carcinoma" of the thyroid be coded for cases dx'd 2007 and after? | For cases diagnosed 2007 or later, assign code 8260/3 [Papillary adenocarcinoma] according to rule H14. 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, usually less than 1 cm. in diameter. |
2008 | |
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20091098 | MP/H Rules/Histology: How is histology coded for a partial vulvectomy showing "vulvar intraepithelial neoplasia III, basaloid type"? See Discussion. | Is this VIN III (8077/2) or basaloid squamous cell carcinoma (8083 and change the behavior code from 3 to 2)? It seems that H4 and H6 both lead to 8083. | For cases diagnosed 2007 or later, assign 8077/2 [Squamous intraepithelial neoplasia, grade III] for VIN III diagnoses, regardless of the type. According to the WHO Classification of Tumours (page 319), "VIN is predominately of the warty or basaloid types...." Use the multiple tumors module to determine the histology code for VIN. Rule H21 applies. |
2009 |
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20071079 | MP/H Rules/Recurrence--Breast: Do we use a pathologists comment of "recurrent ductal carcinoma" found in the pathology report for a new specimen to determine whether the new specimen actually represents a new primary or recurrent disease? See Discussion. | The patient had a left breast cancer LIQ, ductal with DCIS. Nodes (-) diagnosed in 1998 Treatment: Lumpectomy-clear margins Refused radiation Hormone therapy: Tamoxifen
Present: June 2007 Left breast-invasive ductal ca, UOQ Pathology report comments: Recurrent ductal ca. Left axillary nodes (+) |
For cases diagnosed 2007 or later, apply the 2007 MP/H breast rules. Go to the multiple tumors module and begin with rule M4. Stop at rule M5: tumors diagnosed more than 5 years apart are multiple primaries. The only time you can accept a pathologist's statement of recurrence is when the statement is made based on a review of the slides from the previous diagnosis compared to the slides from the current diagnosis. |
2007 |
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20100010 | MP/H Rules/Multiple primaries--Ovary: How many primaries are to be abstracted when a patient is diagnosed with serous cystadenocarcinoma [8441] of the right ovary and clear cell adenocarcinoma [8310] of the left ovary? See Discussion. |
Patient had bilateral ovarian tumors. The right ovary had serous cystadenocarcinoma and left ovary had clear cell adenocarcinoma. The pathology COMMENT section stated, "Based on the histologic differences of the tumors within each ovary, feel these represent two distinct separate primaries. Lymph node metastases are clearly serous ca." The physician staged the right ovary as T2a N1 M0 and left ovary as T1c N0 M0. Do we accession one primary per rule M7 [Bilateral epithelial tumors (8000-8799) of the ovary within 60 days are a single primary]? What is intention of Rule M7? If the histology in each ovary is different but within the range (8000-8799), is that supposed to be accessioned as one primary? Or is the intention of Rule M7 that tumors in both ovaries must have the SAME histology within that histology range to be a single primary? |
For cases diagnosed 2007 or later, apply rule M8 and abstract this case as multiple primaries. Rule M7 does not apply when each ovary has a distinctly different histology, even when both histologies are with the specified code range. This clarification will be added to the next version of the rules. |
2010 |
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20071049 | MP/H Rules/Histology--Colon: If a tubulovillous (TV) adenoma is in situ and other polyp(s) have an invasive component, does the in situ TV adenoma still have priority and should rule H18 be applied? | For cases diagnosed 2007 or later, always give precedence to coding the invasive. Rule H18 applies UNLESS the adenocarcinoma in the TV is in situ and the others are invasive. In this case, code the histology of the invasive adenocarcinoma. This clarification will be added when the MP/H manual is revised. |
2007 | |
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20120093 | MP/H Rules/Multiple primaries -- Ovary: How many primaries are to be accessioned and what rule applies when a patient has a serous carcinoma of the right ovary treated with neoadjuvant chemotherapy followed by a debulking surgery that revealed a serous tubal intraepithelial carcinoma of the left fallopian tube? | For cases diagnosed 2007 or later, accession two primaries, serous carcinoma of the right ovary and serous tubal intraepithelial carcinoma of the left fallopian tube based on the information provided.
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 neither the ovary nor fallopian tube 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. The patient has multiple tumors with ICD-O-3 topography codes that are different at the third character (Cxx) and therefore this case should be accessioned as a multiple primary.
It could be helpful to know the extent of involvement noted prior to neoadjuvant therapy and debulking surgery. For example, if the patient had widely metastatic disease throughout the entire pelvis prior to the initiation of treatment, the answer may have been different. |
2012 | |
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20120062 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a patient has a history of breast cancer in 2006 treated with bilateral mastectomies and in 2011 is found to have invasive carcinoma in "breast tissue, right lumpectomy"? See Discussion. |
Patient was originally diagnosed in June 2006, with right breast cancer and underwent lumpectomy and chemotherapy. This was followed by a bilateral mastectomy with reconstruction in January of 2007 that showed no residual tumor in the breast but 1 positive right axillary lymph node. The patient started Arimidex in May 2007 and had ongoing follow-up. In November 2011, the patient noted a "lump to her right upper reconstructed breast at approximately 2:00." Needle biopsy in December 2011 showed invasive carcinoma and the patient underwent a lumpectomy. The lumpectomy pathology report stated, "Breast tissue, right, lumpectomy: poorly differentiated infiltrating ductal cancer." There is no comparison of the current pathology to the previous pathology, as the previous lumpectomy/mastectomy was done at another facility. The patient is being treated at this facility with radiation as if this is a "recurrent/persistent right sided breast cancer." Should this case be classified as a new primary because the pathology report indicates the malignancy was in breast tissue? Or is this actually a chest wall recurrence given the fact that the patient was previously treated with bilateral mastectomies? Should this case be treated as indicated in SINQ 20110111? |
For cases diagnosed 2007 or later, accession two primaries, right breast cancer diagnosed in June 2006 and a subsequent right breast primary diagnosed in December 2011. 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). Go to the Breast MP rules because site specific rules exist for this primary. Start at the MULTIPLE TUMORS module, rule M4. The rules are intended to be reviewed in consecutive order within a module. Accession two primaries, tumors diagnosed more than five (5) years apart are multiple primaries. If the pathology report stated the tumor originated in residual breast tissue, then this is a new tumor and, therefore, a new primary per rule M5. If the pathology report stated the tumor arose in the chest wall and/or there is no designation of residual breast tissue, then this is a regional metastasis and not a new primary. |
2012 |
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20110092 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned when a pathology specimen reveals one tumor with invasive mucinous carcinoma [8480/3] and a second tumor with in situ ductal carcinoma, solid and cribriform types [8523/2]? |
For cases diagnosed 2007 or later, accession two primaries, invasive mucinous carcinoma [8480/3] and in situ ductal carcinoma, solid and cribriform types [8523/2]. The steps used to arrive at this decision are: Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor (8480/3 and 8523/2). Start at the MULTIPLE TUMORS module, rule M4. These tumors have ICD-O-3 histology codes that are different at the second (xxx) and third (xxx) number and are, therefore, multiple primaries. |
2011 | |
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20120095 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a patient is diagnosed with inflammatory carcinoma of the left breast, (ductal with apocrine features type on biopsy), and an incidental lobular carcinoma in the right breast? See Discussion. | A 1.2 cm lobular carcinoma was incidentally discovered during the work-up of the patient's left breast that was inflammatory carcinoma. The lobular carcinoma on the right was localized without any skin involvement. Rule M6 indicates inflammatory breast carcinoma in either breast is a single primary. Does rule M6 apply when the patient has inflammatory carcinoma in one breast and a separate lobular carcinoma in the other? | For cases diagnosed 2007 or later, accession two primaries, ductal with apocrine features in the left breast and lobular carcinoma in the right breast.
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). Go to the Breast MP rules because site specific rules exist for this primary.
Start at the MULTIPLE TUMORS module, rule M4. The rules are intended to be reviewed in consecutive order within a module. The patient has tumors in both the right and left breasts.
Rule M6 does not apply because inflammatory carcinoma involves only the left breast and the patient has a different histology in the right breast and there is no mention of inflammatory carcinoma in that breast. In this situation continue to the next applicable rule. |
2012 |
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20120082 | MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if the patient has two tumors in the left breast, one that is ductal carcinoma with mucinous differentiation and the other is ductal carcinoma, NOS? See Discussion. |
The final diagnosis from the left mastectomy was multifocal invasive ductal carcinoma (mpT1cN0) with associated intermediate grade ductal carcinoma in situ located between the invasive foci. Larger 2:00 focus: moderately differentiated ductal carcinoma with mucinous differentiation (1.4 cm). Smaller 3:00 focus: moderately to poorly differentiated ductal carcinoma (1.2 cm). The histologies of the invasive foci should be coded 8523/3 and 8500/3 respectively. To determine the number of primaries, does rule M11 apply which indicates this should be a single primary even though ductal with mucinous differentiation is not in Tables 1 or 2? Or does rule M12 apply because there is a difference in the third digit of histology and thus means this should be reported as a multiple primary case? |
For cases diagnosed 2007 or later, accession two primaries, ductal carcinoma with mucinous differentiation [8523/3] and ductal carcinoma, NOS [8500/3]. 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). Go to the Breast MP rules because site specific rules have been developed for this primary. Start at the MULTIPLE TUMORS module, rule M4. The rules are intended to be reviewed in consecutive order within a module. These tumors have ICD-O-3 histology codes that are different that the third (xxx) digit and are, therefore, multiple primaries. Ductal carcinoma with mucinous differentiation is not a specific type of ductal carcinoma identified in either Table 1 or 2. (To locate Tables 1 and 2, go to Breast under the Terms & Definitions section of the manual.) It is ductal carcinoma mixed with another type of carcinoma (mucinous carcinoma in this case) see Table 3. Rule M11 does not apply. |
2012 |