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Report Produced: 10/04/2024 13:09 PM

Report Question ID Question Discussion Answer Year
20071073 MP/H Rules/Histology--Breast: How is histology coded for a single tumor with ductal and tubular features in only the invasive component and not in the in situ component? See Discussion.

A breast tumor diagnosed in Feb. 2007 is a single tumor with in situ and invasive components. The invasive component is diagnosed as ductal with tubular features.

The only rule that applies is H9 which says 'code the invasive histology.' Is it ductal (8500) or tubular (8211)? If you continue through the H rules, then H12 does not apply, because tubular is not a type of ductal. So then you end up at H17, which would make this 8523. Which code is correct?

For cases diagnosed 2007 or later, code the histology 8523 [duct mixed with other types of carcinoma].

After determining that the invasive histology is to be coded using rule H9, there is another decision to make in this case -- which invasive histology should be coded? Make a second pass through the histology rules, begining with rule H10. Stop at H17 and code 8523.

This advanced concept of a "second pass" through the rules is discussed in an online web training session called "Beyond the basics." Go to the SEER website to view this session http://www.seer.cancer.gov/tools/mphrules/training_advanced.html

 2007
20071107

MP/H Rules/Recurrence--Breast: If the pathologist and oncologist call a 2007 lobular carcinoma that appears in a skin nodule of a mastectomy scar a recurrence of a patient's 1975 primary breast duct carcinoma, should we abstract this as a new primary? See Discussion.

According to the pathologist and oncologist, the change in histology is attributed to the present availability of E-cadherin, which was not available in 1975.

For cases diagnosed 2007 or later, abstract the 2007 diagnosis as a separate primary using rule M5.

Rule M5 applies to this case because it comes before rule M12. Furthermore, based on your statement, the answer presumes that the original tumor was duct carcinoma only, there was no lobular carcinoma present. This must be a new primary because there are two different histologies.

The 2007 MP/H rules were developed with input from clinicians. They advised that a subsequent breast tumor more than five years later is a new primary. It is important to apply the rules so that these cases are handled in a consistant manner across all registries.

 2007
20071124 Multiplicity Counter-Breast: The general instructions say to ignore separate microscopic foci when determining when to use the single tumor or multiple tumor modules. Do these instructions apply if sizes are given for the foci? See Discussion. For instance, would a 1.2 cm breast tumor with 3 scattered microscopic foci ranging from 2-4 mm be treated as multiple tumors (4), or as a single tumor? If the microscopic foci are measured and listed as part of the diagnosis, they should be counted as multiple tumors. 2007
20071096 Multiplicity Counter--Prostate: How is multiplicity counter to be coded for a clinically inapparent prostate cancer for which sextant needle biopsy cores on left and right sides are positive for adenocarcinoma? See Discussion.

Prostate cancer typically presents as multifocal diffuse disease. The coding exercise in the MPH rules presentations coded prostate cancer as one tumor.

Reference: SEER Training Web Casts - Other Sites Rules Practicum

 Code the number of tumors present if known. This information can be taken from any part of the record, including imaging and prostatectomy. If the only information available is "diffuse," or "multifocal," assign code 99. Do not assume there are multiple tumors just beacause there are multiple biopsies. When there is no information about the number of tumors, code Multiplicity Counter to 99 and Type of Multiple Tumors to 99. 2007
20071036 MP/H Rules/Histology--Thyroid: Is a "papillary carcinoma of the thyroid" coded to 8260/3 [Papillary adenocarcinoma] per the ICD-O-3 because it lists "papillary carcinoma of the thyroid" as a synonym for that code or should it be coded to 8050 [Papillary carcinoma, NOS]? For cases diagnosed 2007 or later, assign code 8260 [papilary carcinoma of the thyroid]. 2007
20071017 CS Extension--Prostate: Can the phrase "hard, fixed prostate" be interpreted as clinical extracapsular extension and coded to 50 [extension or fixation to other structures]? See Discussion.

Patient had a "hard, fixed prostate" with needle core bx positive for Gleason grade 4+5=9 adenocarcinoma extensively involving gland. PSA was 87.5. Lymphadenectomy showed 3 positive pelvic/obturator lymph nodes. No prostatectomy was done and no physician TNM staging documented.

Do we need a specific clinical description of other organs to which the prostate is fixed in order to code CS Clinical Extension 50, or does the statement "hard, fixed prostate" qualify? If not, how would we code extension for this seemingly advanced cancer?

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 extension code 50 [extension or fixation to adjacent structures] based on the term "fixed." Fixation to a particular structure(s) does not have to be specified in order to use code 50.

Do not use the statement "hard" to determine CS extension.

 2007
20071010 MP/H Rules/Histology--Prostate: While cases of "acinar adenocarcinoma" of the prostate are required to be abstracted with the histology code 8140/3 [adenocarcinoma, NOS] for cases diagnosed 1/1/07 or later, can 8550/3 [acinar adenocarcinoma] be used for cases diagnosed prior to 1/1/07? See Discussion. The SEER Multiple Primary and Histology manual, effective with 2007 forward diagnosis dates, indicates that this histology should be coded to 8140/3 [adenocarcinoma, NOS]. Does this contradict ICD-O-3? Can acinar adenocarcinoma be coded for other primary sites?

For cases diagnosed 2007 or later, code acinar adenocarcinoma of the prostate as 8140/3.

Prior to diagnosis year 2007, code 8550/3 [acinar adenocarcinoma] may be used for prostate cases and for acinar adenocarcinoma of other sites, such as pancreas.

 2007
20071097 Multiplicity Counter--Thyroid: How is multiplicity counter to be coded for a thyroid cancer presenting as multiple foci? See Discussion. Thyroidectomy showed papillary thyroid carcinoma. Path diagnosis: tumor focality: multifocal. Path described 3 foci of tumor on each side. The main tumor mass in right thyroid was 1.5 cm. Smaller foci of tumor ranged in size from .1 cm to 1.0 cm. Per guidelines, "we still don't count foci as tumors for the purpose of these rules, even if there is more than one." The 1 cm tumor was probably macroscopic in size. Do we count it in the multiplicity counter? Do we count only the 1.5 cm main tumor mass?

If the number of tumors is known, code the number in Multiplicity Counter. If foci are measured, include them in the multiplicity counter. If the only information available is "multiple foci" assign code 99.

For the case above, code 06 in the multiplicity counter (3 tumors on each side).

 2007
20071026 MP/H Rules/Histology--Colon: When the microscopic description indicates a colon tumor is "tubulovillous," but the final diagnosis only states "adenocarcinoma," is the histology coded to 8263/3 [adenocarcinoma in a tubulovillous adenoma]?

For cases diagnosed 2007 or later:

Yes. This is an example of a site-specific exception to the general rule to code only from the final diagnosis. The Colon Histology Rules specifically state that "other parts of the pathology report" may be used to identify a tumor arising from a polyp, adenomatous polyp, villous adenoma, or tubulovillous adenoma.

 2007
20071074 MP/H Rules/Multiple Primaries--Lung: How many primaries should be reported when an "adenocarcinoma" is discovered in one of several new nodules at the scar in a lung and it is less than a year after a wedge resection for a diagnosis of "bronchioalveolar adenocarcinoma" in the same lung? See Discussion.

In March 2006 patient diagnosed with bronchioalveolar adenocarcinoma [8250/3] and had wedge resection. In November 2006 a CT chest shows nodules at the scar suspicious for recurrence. In January, 2007, there was a biopsy of one of the nodules showing adenocarcinoma [8140/3].

Is this part of the original disease process diagnosed in March 2006 or should it be abstracted as a new primary based on 2007 MP/H rules (histology is different at the first 3 digits)?

For cases diagnosed 2007 or later:

Try to obtain more information/clarification on the 2007 diagnosis -- for example, is it metastasis?

Based only on the information provided for this case, the 2007 diagnosis is a separate primary.

Use the 2007 MP/H rules to assess the 2007 diagnosis. Begin with rule M3 in the multiple tumors section. Stop at rule M11, multiple primaries.

 2007