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Report Produced: 09/16/2025 15:29 PM

Report Question ID Question Discussion Answer Year
20100006

MP/H Rules/Multiple primaries--Kidney: In a patient with a history of renal cell carcinoma, would a new primary be accessioned per Rule M10 for a soft tissue mass in the renal fossa not stated to be a metastasis but that was referred to as recurrent renal cell carcinoma, clear cell per the excision pathology report? See Discussion.

This patient was diagnosed with clear cell carcinoma of the right kidney in 2003, treated with nephrectomy. The tumor was limited to the kidney. An FNA of the pancreas in 11/07 was consistent with metastatic renal cell carcinoma. In 2009 the patient was diagnosed with a right renal fossa mass by CT. The mass was excised on 8/26/09 and showed, "recurrent renal cell ca, clear cell." The path specimen was labeled as, "soft tissue, rt renal fossa." The original 2003 slides were not reviewed and the renal fossa mass was not described as being metastatic.

If the renal fossa soft tissue mass is a new tumor, the MP/H rules for Other Sites directs you to code it as a new primary per rule M10 [Tumors diagnosed more than one (1) year apart are multiple primaries]. Would this be a new soft tissue tumor per rule M10? Or would this be a recurrence of the original kidney primary?

For cases diagnosed 2007 or later:

This is not a new primary. The patient has metastatic disease from the 2003 kidney primary. Clear cell carcinoma metastasized to the pancreas in 2007 and to the right renal fossa in 2009.

 2010
20100095

MP/H Rules/Multiple primaries--Kidney, renal pelvis: In a patient who was never disease free because of multiple recurrences of invasive transitional cell carcinoma of the bladder originally diagnosed in 2004, is an invasive high grade urothelial carcinoma of the renal pelvis diagnosed in 2010 a new primary? See Discussion.

Patient has invasive TCC of the bladder diagnosed in 2004, and has never been disease free.

In 2/18/10 a left renal pelvis wash showed urothelial carcinoma, high grade.

On 4/7/10 a nephroureterectomy revealed high grade urothelial carcinoma with sarcomatous and squamous differentiation invading through pelvic wall and perihilar soft tissue.

Is this a new renal pelvis primary?

For cases diagnosed 2007 or later, the renal pelvis is a new primary per rule M7. M7 will be better explained in the revised MP/H rules, but the rationale is that no field effect was present for more than 3 years. Although the bladder CA continued to recur, there were no other organs involved until 2010. M7 is intended to make the renal pelvis a new primary because there was no field effect (no organs other than bladder involved) for more than 3 years.

 2010
20100053 Primary site--Heme & Lymphoid Neoplasms: How is primary site coded for a myeloid sarcoma (granulocytic sarcoma) arising in the chest wall in a patient that has a negative bone marrow biopsy? See Discussion.

Patient was diagnosed with Myeloid Sarcoma (granulocytic sarcoma) by chest wall biopsy. This is an extramedullary manifestation of acute leukemia and is not in the bone marrow (bone marrow is negative).

How should primary site be coded? The Heme DB states that almost any part of the body can be involved. It also states to not code primary site to C421. In this case the only involvement is the chest wall [C493]. However, use of the primary site code C493 triggers an edit error questioning this site/histology combination. If the primary site is coded to C421 [bone marrow], there is no edit error. Please explain the site code and rationale.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Unless there are scans showing involvement of a lymph node or tissue other than the chest wall, the histology should be coded myeloid sarcoma [9930/3] and the primary site to C493 [soft tissue of chest wall]. Per Rule PH 30, use the Heme DB to determine primary site and histology when rules PH1-PH29 to not apply. Override the edit.

Per the Abstractor Notes section in Heme DB, for myeloid sarcoma [9930/3] the most frequently affected sites are skin, lymph nodes, gastrointestinal tract, soft tissue, and testis.

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.

2010
20100046

Heme & Lymphoid Neoplasms: Is a clinical remission sufficient to change the tumor status to "disease free" for a patient on long-term chemotherapy for a diagnosis of either a chronic hematologic disease, such as CML, or a myeloproliferative disorder, such as essential thrombocythemia? See Discussion.

For some patients with chronic hematologic diseases, the disease/recurrence status could change frequently as chemotherapy is started and stopped over an extended period of time. Should the tumor status for these cases always be "not disease free"? When the physician documents the patient is in clinical remission, does their status change to "NED or disease free?" There seems to be a lot of variation across the US in how registrars are coding this field. Clarification would be appreciated.

The term "disease free" is not used in a standard fashion for hematopoietic and lymphoid neoplasms.

Code the cancer status to free of disease when the physician indicates NED. For hematopoietic and lymphoid neoplasms, a physician's statement of NED, disease-free, clinical remission or no evidence of disease at this time, should be recorded with cancer status to disease free. The term "disease free" or NED means that there is no clinical evidence of disease.

2010
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
20100009 MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion.

A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.

Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma?

 For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. 2010
20100026 Multiplicity Counter--Kidney, Renal Pelvis: How many times is this field updated after an invasive primary is originally diagnosed? Should subsequently diagnosed in situ tumors to be included in this field? See Discussion. How should the Multiplicity Counter be coded when a patient has a renal pelvis primary [C659] diagnosed 1/23/08. The patient had one tumor, invasive grade 3 of 3 papillary urothelial carcinoma arising in the depth of a calyx in mid portion of kidney. In 6/1/09, a TURBT showed three separate high grade urothelial carcinoma in-situ lesions on the right side of the bladder, the largest tumor being 7mm. In 2/8/10, another TURBT showed one lesion on the left side of bladder, high grade urothelial carcinoma in-situ, tumor was 4mm. These are all a single primary per rule M8.

Code multiplicity counter 04. Count both invasive and in situ tumors.

Multiplicity counter would have been coded 01 in 2008. Add the three in situ tumors diagnosed in 2009 to the first tumor and update multiplicity counter to 04. Make only one update to multiplicity counter. Because the multiplicity counter was updated once, the fifth tumor diagnosed in 2010 does not need to be added.

2010
20100014 Reportability: Are there criteria other than a pathologist or clinician's statement that a registrar can use to determine reportability of gastrointestinal stromal tumors (GIST)? See Discussion.

Per SINQ 20091021 and 20021151, GIST cases are not reportable unless they are stated to be malignant. A pathologist or clinician must confirm the diagnosis of cancer. There are cases that are not stated to be malignant in the pathology report or confirmed as such by a clinician; however, these cases do have information that for other primary sites would typically be taken into consideration when determining reportability. The final diagnosis on the pathology report for all 16 cases is "GIST." The additional comment(s) for each of the 16 different cases is reported below. Are any of the following cases reportable?

1) Pathology report indicates that the bulk of the tumor is submucosal. It extends through the muscularis propria and abuts the serosa.

2) Pathology report states tumor extends to serosal surface of transverse colon, but not into muscularis propria. CD 117 and CD 34 are positive.

3) Pathology report indicates that tumor invades through the gastric wall to the serosal surface.

4) Pathology report indicates that tumor invades pericolic fat tissue.

5) No further information in pathology report, however, scans indicate omental caking.

6) No further information in pathology report, however, scans indicate hepatic metastases. Hepatic metastases are not biopsied.

7) Tumor stated to be unresectable and extends into pancreas. Chemotherapy given.

8) Pathology report states tumor is low to intermediate grade and involves serosal (visceral peritoneum).

9) Tumor size is 17.5 cm. Pathology report states "malignant risk".

10) Pathology report states tumor "into muscularis propria" or tumor "involves muscularis propria" or "infiltrates into muscularis propria".

11) Pathology report states, "high malignant potential; omentum inv by tumor." It is not stated in path report or final diagnosis to be malignant GIST.

12) Pathology report states that tumor arises from wall of small bowel and extends into thin serosal surface.

13) Pathology report states minimal invasion of lamina propria; does not penetrate muscularis propria.

14) Pathology report states, "high mitotic activity >10/50 HPF; high risk for aggressive behavior; moderate malignant potential."

15) Pathology report states tumor size is >5 cm. Intermediate risk for aggressive behavior; CD117+ KIT exon 11+.

16) Pathology report states "high risk of malignancy."

 For GIST to be reportable, the final diagnosis on the pathology report must definitively state that the GIST is malignant, or invasive, or in situ. Case 6 is the only exception. It would be reportable assuming the scan actually states "hepatic metastases." Based only on the information provided, none of the other examples are reportable. The type of extension and/or invasion mentioned in the other examples are not sufficient to confirm malignancy. Borderline neoplasms can extend and invade, but do not metastasize. Only malignant neoplasms metastasize. 2010
20100029 MP/H Rules/Histology--Corpus uteri: How should histology be coded and how many primaries should be accessioned for an endometrial primary in which curettings showed malignant mixed mullerian tumor (carcinosarcoma) but hysterectomy specimen showed endometrioid adencarcinoma? See Discussion. The pathology report COMMENT for the hysterectomy specimen stated that the previous curettage was reviewed. The findings are compatible with malignant mixed mullerian tumor. No residual features of malignant mixed mullerian tumor are found in the current resection, which shows FIGO grade I adenocarcinoma in the wall of the uterus. The malignant mixed Mullerian tumor appears to have been removed with the curettage. There is no information available regarding the number of tumors in these specimens.

For cases diagnosed 2007 or later, abstract a single primary. Rule M1 applies because there is no information on the number of tumors and there is no way to know whether the curettage sample was from a separate tumor or from the tumor in the hysterectomy specimen.

Apply rule H17 and code histology to 8980/3 for malignant mixed Mullerian tumor [Carcinosarcoma, NOS].

2010
20100019 Histology--Ovary: How is histology coded for an ovarian mucinous neoplasm of low malignant potential (borderline mucinous cystadenoma) that shows extensive intraepithelial carcinoma and focal microinvasion? See Discussion. At surgery a 25 cm left ovarian mass is found adherent to the anterior abdominal wall. The final diagnosis per the pathology report is, "Mucinous neoplasm (26 cm) of low malignant potential (borderline mucinous cystadenoma) with extensive intraepithelial ca and focal microinvasion. Right ovary, fallopian tubes, uterus, omentum, biopsies of diaphragm, 28 para-aortic and pelvic LNS and peritoneal fluid are all negative for malignancy." Histology code 8470/3 [mucinous cystadenocarcinoma] is the best choice in this case. There is a mucinous cystadenoma [8470/0] with intraepithelial carcinoma and focal microinvasion. 8470/3 comes as close as possible to the description of the tumor. 2010