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Report Produced: 06/15/2025 19:50 PM

Report Question ID Question Discussion Answer Year
20091047 MP/H Rules/Histology--Ovary: How is histology coded for "serous carcinoma, papillary invasive pattern"? For cases diagnosed 2007 or later, code the histology 8441/3 [Serous carcinoma, NOS]. Use the Other Sites rules. Start with rule H8 and stop at rule H11. "Pattern" is not one of the terms used to identify a specific type (See H16), so papillary is ignored. 2009
20091120

MP/H Rules/Histology--Esophagus: Should the modifying expression "with areas of" be used to code histology? See Discussion.

Patient was found to have two tumors in the esophagus. The large tumor was diagnosed as adenocarcinoma with areas of neuroendocrine differentiation (small cell carcinoma). The smaller tumor was diagnosed as small cell carcinoma. If we accept the "areas of" to be part of the diagnosis, rule H16 indicates that histology for the large tumor would be coded 8045 (combined small cell and adenocarcinoma). If we ignore the "areas of," then histology for the large tumor would be coded to 8140 (adenocarcinoma). Either way, when counting primaries, rule M17 would be applied and the two tumors would be classified as separate primaries. However, it seems that the two tumors are probably the same disease process since they both show small cell carcinoma.

For cases diagnosed 2007 or later, do not use the modifying expression "with areas of" to determine a more specific histology per rule H13 in the MP/H rules.

 2009
20091113 MP/H Rules/Histology--Breast: How is histology coded when a nipple biopsy shows Paget disease but the mastectomy specimen shows only infiltrating ductal carcinoma in the breast tissue and the nipple is negative for Paget disease? See Discussion. Biopsy of nipple showed Paget disease. Subsequent mastectomy showed two tumors proven to be infiltrating ductal carcinoma. Nipple is negative. Per MP/H rule M9, this is all counted as a single primary. Do we code histology from the most representative specimen and lose the information about the Paget disease? For cases diagnosed 2007 or later, code the histology 8541/3 [Paget disease and infiltrating duct carcinoma]. Paget disease of the nipple and infiltrating duct are separate tumors. For each tumor, take the histology from the most representative specimen. The biopsy is the most representative specimen for the Paget disease. The mastectomy is the most representative specimen for the infiltrating duct. According to the multiple primary rules, tumors that are Paget disease and duct are a single primary (M9). According to the histology rules, assign code 8541/3 (H26). 2009
20091030 MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10?

For cases diagnosed 2007 or later:

The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.

Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.

For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites.

 2009
20091060 MP/H Rules/Multiple Primaries--Head and Neck: How many primaries are to be accessioned for a case in which a second tumor occurs in an area previously involved by direct extension from a prior primary located in an adjacent site? See Discussion. Patient diagnosed in August 2007 with squamous cell carcinoma in the right tonsil. This tumor extended to the base of tongue. Treatment consisted of radiation and chemotherapy. In May 2008, the patient was found to have squamous cell carcinoma of the base of tongue. How many primaries are to be accessioned for this case? Rule M7 states that tumors in sites with ICD-O topography codes that are different at the second or third character are multiple primaries. The topography code for base of tongue differs from that of tonsil. Would rule M7 apply? On the other hand, the base of tongue was involved by the tonsil primary which was diagnosed less than one year before.

For cases diagnosed 2007 or later:

The May 2008 diagnosis is not a new primary. Base of tongue involvement was originally present in August 2007. The May 2008 diagnosis does not represent new tumor. The 2007 rules apply to new tumors only; therefore, the 2007 rules do not apply to this case.

 2009
20091054

First course treatment--Liver: Is planned therapy second course therapy if it is administered after documented progression of disease? See Discussion.

A patient with hepatocellular carcinoma of the liver is waiting for a planned liver transplant. During the waiting period, a CT showed an increase in the liver nodule. The physician performed a bridging chemoembolization. Later on, the patient received a liver transplant. Is the liver transplant still first course treatment? Is the chemoembolization part of first course therapy? Per the SEER manual, first course therapy ends when the treatment plan is completed.

In this case, neither the chemoembolization nor the liver transplant is part of the first course of therapy. The documented treatment plan was changed after disease progression. Chemoembolization was not part of the original treatment plan. First course therapy ends at this point.

 2009
20091114 MP/H Rules/Multiple primaries--Breast: Would a left chest wall mass excision stated to be ductal carcinoma consistent with a breast primary and, "compatible with either local recurrence or potentially a metastasis" be a new primary per the MP/H rules? See Discussion. Patient underwent mastectomy in 1986 for infiltrating ductal carcinoma of left breast. Excision of left chest wall mass in March 2009 showed ductal carcinoma consistent with breast primary. The pathology report COMMENT stated it would be compatible with either local recurrence or a metastasis. The patient's primary breast carcinoma material is not available for direct comparison and the MP/H rules instruct us to ignore metastasis. For cases diagnosed 2007 or later, the MP/H rules do not apply to metastasis. If there is no further information available for this case, the MP/H rules do not apply to the 2009 diagnosis. 2009
20091059 CS Tumor Size--Breast: How is this field coded for DCIS that is present in scattered small foci over five of eight slides, and the greatest aggregate dimension measures 0.5 cm? See Discussion. Breast biopsy was prompted by abnormality seen on mammography. Would this be an example of when to code 996 (mammographic/xerographic diagnosis only, no size given; clinically not palpable) applies for the CS Tumor Size field?

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.Assign code 005 [0.5 cm] in this case. According to the General Instructions for CS tumor size, it is acceptable to code an aggregate size stated by the pathologist (see instruction 4.i).

 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
20091056 MP/H Rules/Histology--Ovary: How is histology coded for an ovarian tumor diagnosed as an "ovarian clear cell cystadenocarcinoma"? See Discussion. Final diagnosis for a resected ovary is ovarian clear cell cystadenocarcinoma. In applying the MP/H rules, rule H16 does not apply because cystadenocarcinoma is not included in Table 2. As a result rule H17 applies. Thus it appears the histology should be coded 8440. Cystadenocarcinoma is a specific histologic type and it is assigned the numerically higher histology code. This result differs from pre-2007 SINQ entry 20041045 that states: Code histology to 8310/3 [Clear cell adenocarcinoma, NOS]. This is consistent with the WHO Classification of Tumours and reflects the current practice of placing less emphasis on "cyst-" prefix for ovarian malignancies.

For cases diagnosed 2007 or later:

Assign code 8310 [Clear cell adenocarcinoma] according to rule H13. Ignore "cyst" when determining the histologic type for ovarian malignancies. For this case, the only histology is clear cell.

The histologies for the common ovarian epithelial malignancies are serous, mucinous, endometrioid, clear cell, and transitional cell/Brenner. This clarification will be added to the rules in the next revision.

2009