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| Report | Question ID | Question | Discussion | Answer | Year |
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20000529 | EOD-Extension--Lung: If LUL mass "crosses the pleural surface" into the LLL, do we assume this represents extension to the pleura? See discussion. | 9/22/93 Left upper lobe lobectomy: 3 x 3 cm mass in the periphery of the LUL near the LLL. Multiple enlarged nodes around the aortic arch and within the pulmonary fissure.
9/22/93 Pathology: Moderately differentiated Adenoca. The neoplasm does cross the pleural surface into the segment of the lower lobe. Lower margin of resection is free of neoplasm. Six lymph nodes negative for metastatic carcinoma. Tumor staged as T2N0M0 Stage Ib by physician.
Is tumor extension coded 10 [confined to one lung] or 40 [extension to pleura]? |
For cases diagnosed 1998-2003:
Code the EOD-Extension field to 40 [extension to pleura]. The tumor has penetrated (extended to) the pleura. |
2000 |
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20031189 | Multiple Primaries (Pre-2007)--Thyroid: Would a papillary carcinoma of the right lobe of the thyroid diagnosed approximately 2 1/2 years after a papillary carcinoma of the left lobe be coded as a second primary? See Description. | 8/31/1999: papillary carcinoma, left lobe thyroid, treated with lobectomy. 1/17/2002: papillary carcinoma, right lobe, treated with lobectomy, completion thyroidectomy. |
For tumors diagnosed prior to 2007:
Yes, this is a second primary. The second papillary carcinoma was more than 2 months after the first and not specified as recurrent or metastatic.
For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules. |
2003 |
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20170027 | MP/H Rules/Multiple primaries--Melanoma: Is a melanoma with an unknown laterality a different laterality for the purposes of applying Multiple Primaries/Histology Rule M4? See Discussion. |
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? |
Abstract multiple primaries following Multiple Primary Rule M4. Unknown laterality is a different laterality for the purposes of applying the MP/H rules for melanoma. NOTE: This answer applies to cases diagnosed prior to 2018. As of 1/1/2018, early melanoma is not reportable. |
2017 |
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20160045 | Neoadjuvant treatment/Grade--Prostate: How should the grade/differentiation field be coded when hormone therapy is given prior to radiation for metastatic prostate cancer? Is hormone treatment "neoadjuvant treatment" in this situation? Per NCCN guidelines, neoadjuvant hormone therapy is strongly discouraged outside of a clinical trial for localized disease. However for metastatic disease, hormone is recommended (gold standard). See discussion. |
8/1/15 CT Exam showed enlarged prostate and left seminal vesicle with multiple enlarged pelvic LNs. Findings: suspicious for prostate cancer with invasion of seminal vesicle. Bone scan findings: positive bone mets in multiple sites. PSA 169.0 (elevated). Patient was started on casodex 8/12/15. A prostate biopsy was performed on 9/16/15 to confirm diagnosis, adenocarcinoma Gleason 4+5. Patient's treatment continued with radiation to bone. |
For cases diagnosed prior to 2018 Code the grade/differentiation field from the biopsy for this situation. According to experts consulted, hormone therapy does not alter the grade in this case and grade should be coded based on information after hormone therapy when that is the only grade information available. |
2016 |
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20140027 | MP/H Rules/Histology--Bladder: What is the correct histology for the following bladder case and how do you determine? See discussion. |
8/1/10 CYSTOSCOPY -- MULTIPLE BLADDER TUMORS INVOLVING POSTERIOR WALL, DOME & BLADDER NECK AREA. LARGEST WOULD BE MORE THAN 5 CM IN SIZE. 8/17/10 path -- BLADDER TUMORS:PAPILLARY TRANSITIONAL CELL CARCINOMA OF urinary bladder, GRADE III. ONE FRAGMENT OF TISSUE SHOWS NECROTIC CHANGE WITH APPARENT TRANSFORMATION TO A HIGH GRADE SARCOMATOID VARIANT W ITH EXTENSIVE SUBMUCOSAL INVASION & FOCAL AREA SUGGESTIVE OF ANGIOLYMPHATIC INVASION NOTED. MAJORITY OF TUMOR APPEARS CONFINED TO MUCOSAL SURFACE W ITH NO OTHER AREAS OF DEFINITIVE SUBMUCOSAL INVASION FOUND. |
Code 8122/3 (UC/TCC, Sarcomatoid). Rule H5 and Table 1 apply.
This is based on the information provided: Transitional Cell Carcinoma with sarcomatoid variant, and Table 1 in Terms and Definitions for "Ureter/Renal Pelvis/Bladder". |
2014 |
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20200053 | Solid Tumor Rules (2018)/Multiple primaries--Bladder. Would the metastatic diagnosis indicate a new primary? If the metastatic diagnosis indicates a new primary, would the primary site be C688 and date of diagnosis 11/14/18? See Discussion. |
7/8/16 Urinary bladder, biopsy: Non-invasive low grade papillary urothelial carcinoma. Muscularis propria (detrusor muscle) is not identified. 9/2/16 Urinary bladder, bladder tumor, transurethral resection: High grade papillary urothelial carcinoma. No definite invasion identified. Muscularis propria (detrusor muscle) is identified and not involved by tumor. 1/7/17 A\S\Bladder: Noninvasive low grade papillary urothelial carcinoma. Granulomatous cystitis, consistent with BCG (Bacillus Calmette-Guerin) treatment. Lamina propria is not involved with tumor. Detrusor muscle is not identified. 4/4/17 Dome: Papillary urothelial carcinoma, low grade. No evidence of invasion. Muscularis propria is not present. Patient is clearly followed for at least a year but no further information until 19 months later, 11/14/18, when biopsy of lung indicates metastatic disease. 11/14/18 Lung, right lower lobe, mass, biopsy: Metastatic urothelial carcinoma. Immunohistochemical analysis results (CK7 positive, CK20 focally positive, P63 positive, GATA3 positive, TTF1 negative and NAPSIN-A negative) support the diagnosis |
Do not use the solid tumor rules to assess the 2018 diagnosis. See Note 1 on page 20 of the Urinary Sites Solid Tumor Rules, https://seer.cancer.gov/tools/solidtumor/Urinary_STM.pdf The 2018 diagnosis proves that this patient had invasive bladder cancer. Change the behavior on the abstract to /3 and use text fields to record the details. |
2020 |
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20120021 | Multiple primaries--Heme & Lymphoid Neoplasms: How are the terms "chronic" and "acute" used to help determine the number of primaries to be abstracted and what rule applies when a diagnosis of diffuse large B-cell lymphoma is followed two years later by a diagnosis of follicular lymphoma, grade 3A of 3? See Discussion. |
7/31/08 Biopsy of the left supraclavicular lymph node diagnosed Stage IIIB DLBCL [9680/3] 10/14/10 Biopsy of a right supraclavicular lymph node diagnosed follicular lymphoma, grade 3A or 3 [9698/3]. Which multiple primary rule applies to determine the number of primaries to report? Is Rule M4 ignored? Does Rule M13 apply because follicular lymphoma normally transforms to DLBCL? Is this still a transformation because the follicular lymphoma came AFTER the DLBCL (the "acute" reverted to "chronic")? Or does Rule M15 apply, and the Multiple Primaries Calculator should be used to determine the number of primaries to report? Are "transformations" the acute phases of the more chronic disease? The Heme Manual and previous training sessions do not make this apparent. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. This case should be accessioned as two primaries per Rule M13. Code the histology for the 7/31/08 diagnosis to 9680/3 [diffuse large B-cell lymphoma] and the code the histology for the 10/14/2010 diagnosis to 9698/3 [follicular lymphoma, grade 3A of 3]. Rule M13 applies to this case because the neoplasm was originally diagnosed in the blast or acute phase (DLBCL) and reverted to a less aggressive or chronic phase (follicular lymphoma) after treatment. Per the "Transformations to" section in the Heme DB for follicular lymphoma, grade 3 transforms to diffuse large B-cell lymphoma [9680/3]. This means that the follicular lymphoma is the chronic neoplasm and that DLBCL is the acute neoplasm. In this case, the chronic neoplasm was diagnosed after the acute neoplasm was diagnosed and treated (with chemotherapy). Do not Stop at Rule M4 because diffuse large B-cell lymphoma and follicular lymphoma (both NHL's) were not present in the same node(s) AT THE SAME TIME. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2012 |
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20190006 | MP/H Rules/Multiple primaries--Breast: Please confirm Multiple Primaries/Histology Breast Rule M8 applies in this 2017 case. The surgical resection is >60 days past the biopsy date but is it possible treatment plans for breast could span >60 days and this is one primary? See Discussion. |
7/25/17 Part A: Left breast at 8:00, 5 CFN: Specimen type: Stereotactic biopsy. Tumor type: Ductal carcinoma in situ (DCIS), cribriform type. Tumor size: The largest focus of DCIS measures 1 mm in greatest dimension as measured on the slide. Nuclear grade: 2 (Intermediate grade). Microcalcifications: Present. Other findings: Stromal fibrosis, microcalcification and fat necrosis. 11/1/17 A. Sentinel lymph node, left: One lymph node, negative for metastatic tumor on three levels of routine H\T\E and pan cytokeratin immunohistochemical stains. B. Left breast: Procedure: Total mastectomy with skin and nipple. Specimen Laterality: Left. Lymph Node Sampling: Yes, portion A. Specimen Integrity: Intact. Histologic Type: Extensive ductal carcinoma in situ and one focus of Invasive ductal carcinoma with mucinous features. Histologic Grade (Nottingham Histologic Score): Glandular Differentiation: Score 3 Nuclear Grade: Score 2. Mitotic Count: Score 1. Total Nottingham score 6 (grade 2, moderately differentiated). Tumor Size: 3.3 x 2 mm (0.33 x 0.2 cm) measured on slide (B3). Tumor Site: Lower inner quadrant of left breast. Tumor Focality: Unifocal. Ductal Carcinoma In Situ (DCIS): Present, cribriform, solid and micropapillary types with focal necrosis and calcifications. Size of DCIS: Number of blocks examined: Thirty (30). Number of blocks with DCIS: Thirteen (13). Lobular Carcinoma In Situ (LCIS): Not identified, Lymphovascular Invasion: Present. Perineural Invasion: Not identified. Other Findings: Changes consistent with previous biopsy site. Cysts, foci of atypical ductal hyperplasia, focal ductal hyperplasia, adenosis, stromal fibrosis and microcalcifications. Skin (epidermis): Uninvolved. Nipple: Uninvolved. Margins: 1 mm from DCIS to the closest deep margin (slide B12). At least 10 mm (1 cm) from invasive carcinoma to deep margin. Estrogen receptor (ER, clone 1D5) by immunohistochemistry performed on this material: Positive (invasive and in situ carcinoma), high intensity, in greater than 95% of carcinoma cells. Progesterone receptor (PR, clone 16) by immunohistochemistry performed on this material: Positive (invasive and in situ carcinoma), moderate intensity in about 80% of the carcinoma cells. Her 2 by FISH performed on this material: Pending, an addendum to follow. Pathologic staging: pT1aN0(sn)MX (AJCC 7th edition). Dictated by: (Pathologist), MD Intradepartmental review. |
Abstract a single breast primary. Apply MP/H Rule M3 as this is a single tumor identified in the biopsy at 8 o'clock and at the same location in the mastectomy specimen. Code the behavior as invasive according to rule H9. The first course of therapy ends when the documented treatment plan is completed, no matter how long, unless there is progression, recurrence, or treatment failure. |
2019 |
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20120092 | MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence? See Discussion. | 7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.
3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and "there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence."
Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a "recurrence" of the 7/12/2007 diagnosis after reviewing the slides? |
For cases diagnosed 2007 or later, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007.
The steps used to arrive at this decision are:
Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.
General Information Rule 7 states "Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary."
Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary. |
2012 |
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20130166 | Reportability--Heme & Lymphoid Neoplasms: Is "indolent multiple myeloma" reportable and synonymous with "indolent/smoldering myeloma"? See Discussion. |
7/10/12 Diagnosed with monoclonal gammopathy of undetermined significance (MGUS) 7/27/12 Diagnosed with MGUS/smoldering myeloma. There was no intervention at this time. In about October/November 2012 the diagnosis was reported as smoldering myeloma,. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Indolent myeloma [9732/3] and smoldering myeloma [9732/2] are reportable terms synonymous with plasma cell myeloma. Monoclonal gammopathy of undetermined significance (MGUS) [9765/1] is not reportable. SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx. |
2013 |
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