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Report Produced: 05/27/2026 10:54 AM

Report Question ID Question Discussion Answer Year
20091127

MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are to be accessioned for a patient with Neurofibromatosis 2 (NF2) who presents with meningiomas on the left and right side of the brain and multiple meningiomas of the spinal cord? See Discussion.

We have a patient with NF2 who also has meningiomas diagnosed on the left and right side of the brain as well as multiple meningiomas of the spinal cord. Are the meningiomas all one primary (separate from the NF2): C70.9 and 9530/1?

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

Report NF2 because it occurs with reportable neoplasms. Note: Report NF only once per patient.

Per MP/H Benign CNS Rule M4, the meningiomas of the meninges/brain (C70.0) and meninges/CNS (C70.1) are multiple primaries. Code the meningiomas of the spine to the histology to 9530/1 [Multiple meningiomas] (Rule H6) because there are multiple tumors in the spine.

Per Rule M5, the meningiomas of the right and left side of the brain are multiple primaries. Code of each to the histology 9530/0 [Meningioma, NOS] per Rule H2 because they are separate primaries (assuming there is one tumor on each side of the brain).

 2009
20091037 MP/H Rules/Histology--Brain: How is histology coded for a "low grade neuroglial tumor" of the fourth ventricle?

For cases diagnosed 2007 or later, assign histology code 9505/1 [Ganglioglioma, NOS].

According to our pathologist consultant, low grade neuroglial tumor of the fourth ventricle correlates best to the "rosette-forming glioneuronal tumor of the 4th ventricle" which is a new WHO entity. There is no current ICD-O-3 code for this. The best code available at this time is 9505/1.

 2009
20091128

MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a patient was diagnosed with breast carcinoma in 2001 and was subsequently diagnosed with a mammary carcinoma in a chest wall mass in 2008? See Discussion.

Patient was diagnosed with invasive lobular carcinoma of the right breast in April 2001. Following modified radical mastectomy in May 2001, the patient was disease free. In December 2008 the patient was diagnosed with a right chest wall mass, invasive poorly differentiated mammary carcinoma with lobular origin. If this is a new primary in 2008, would we code the primary site to breast or chest wall? Please see I&R answers 25924, 22163 and 26155 with similar case scenarios that give two different answers. One response indicates coding this type of scenario as new primary to chest wall and the other two responses indicate this should not be a new primary because the chest wall is a metastatic site. The pathology report does not state that this is metastatic and it is unknown if there is breast tissue left behind at the chest wall.

For cases diagnosed 2007 or later, this case is a single primary. The chest wall (NOS) is a metastatic site for breast cancer. There is no mention of residual breast tissue, so the 2008 diagnosis cannot be a new primary.

"Chest wall" is an ambiguous term. It can mean the internal chest wall or the external chest wall. When the path report states that the "recurrence" is in residual breast tissue, this is most likely the external chest wall and the residual breast tissue is part of the breast not removed by the MRM. In contrast, skin or the chest wall, NOS, are regional metastases.

 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
20091049 P/H Rules/Multiple Primaries--Lung/Breast: Can we assume that a current tissue specimen is a recurrence of previous primary if a pathologist states that he has compared the current specimen with the slides from the prior tumor and concludes that the current tumor is "similar" to a previous tumor? See Discussion.

The MP/H rule general information section states that we do not accession a second primary unless a pathologist compares the current tumor to the original tumor and states that the current tumor is a recurrence of cancer from the previous primary. In our experience it is rare that a pathologist speaks so bluntly. They frequently hedge somewhat.

Are the following statements worded strongly enough for us to make the assumption that the current tumor is a recurrence of patient's previous cancer?

Example 1: Pathologist states: Patient's prior lung tumor reviewed. The tumor in the current case (left lower lobe) shows similarities to some areas of the patient's prior left lower lobe tumor.

Example 2: Pathologist states: The focus of ductal carcinoma in the mastectomy specimen does resemble the carcinoma in the previous partial mastectomy specimen. (Slides reviewed).

All pathologists do not use words in the same way. Therefore, we will not provide a list of specific words to accept or not to accept in order to determine recurrence. For cases diagnosed 2007 or later, do not base your decision about recurrence on words such as "similar" or "resembles." If the pathologist believes two or more tumors are the same or believes one is a recurrence of another after comparison, accept it. When pathologists believe that two or more tumors are not the same or believe that one is not a recurrence of another, there is usually a strong statement indicating that opinion. 2009
20091011 MP/H Rules/Histology--Breast: What histology is coded for a tumor diagnosed as "intraductal papillary carcinoma (neuroendocrine differentiation)"? See Discussion. Final diagnosis states: Right breast, excisional bx with findings most consistent with intraductal papillary carcinoma (neuroendocrine DCIS). The path micro states: the morphologic features are those of a neuroendrocrine-type tumor & IHC stains confirm neuroendocrine differentiation.

For cases diagnosed 2007 or later, assign code 8503/2 [Intraductal papillary carcinoma] using Breast rule H2. Code the histology from the final diagnosis.

There is no code for neuroendocrine DCIS in ICD-O-3.

 2009
20091090 First course treatment--Leukemia: How should an allogeneic stem cell transplant for acute myeloid leukemia be coded in the Hematologic Transplant and Endocrine Procedures field? See Discussion. There is debate as to whether this procedure should be coded as a 12 in order to capture the allogeneic part of the procedure. Assign code 20 [Stem cell harvest (stem cell transplant) and infusion as first course therapy] for stem cell procedures, even allogeneic procedures. 2009
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
20091109 Surgery of Primary Site - - Esophagus/Stomach/Colon: Is an endoscopic mucosal resection (EMR) for an esophagus, stomach or colon malignancy coded to 20 [local tumor excision, NOS] or to a more specific code such as 22 [local tumor excision combined with electrocautery]? Assign code 20 [local tumor excision, NOS] for a procedure described as an esophagus stomach or colon endoscopic mucosal resection (EMR), NOS. If there is additional information specifying electrocautery, laser or PDT (for example), assign a more specific code. 2009
20091029 MP/H Rules/Histology--Melanoma: How should histology be coded for a melanoma arising in a compound nevus, NOS or a nevus, NOS?

For cases diagnosed 2007 or later, assign code 8720 [Melanoma, NOS] to melanoma arising in a nevus that does not have a specific code or to melanoma arising in a nevus, NOS.

Currently, ICD-O-3 does not have a specific classification for a melanoma arising in a compound nevus.

 2009