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Core biopsy of left breast at 2:00: Invasive ductal carcinoma, Nottingham score 6/9.

Core biopsy of left breast at 4:00: Invasive mucinous carcinoma (variant of ductal carcinoma), Nottingham score 5/9.

Post neo-adjuvant mastectomy: Main (largest tumor): Invasive ductal carcinoma, upper outer quadrant grade 2. Secondary tumor: mucinous carcinoma, grade 1 at 4:00.

The Extent of Disease (EOD) Manual states: Neoadjuvant (preoperative) therapy: If the patient receives neoadjuvant (preoperative) systemic therapy (chemotherapy, immunotherapy) or radiation therapy, code the clinical information if that is the farthest extension documented. If the post-neoadjuvant surgery shows more extensive disease, code the extension based on the post-neoadjuvant information.

Example: Patient has a secretory carcinoma of minor salivary gland tissue (mammary analogue secretory carcinoma [MASC]) of the mucosal lower lip; it is unclear which table to use and how to arrive at the correct histology using the H Rules.

Rule H1 (code the histology when only one histology is present) states, Note 1: Use Tables 1-9 to code histology. There is no table that includes the lip. The correct histology should be 8502 which is listed in Table 6 (Tumors of Salivary Glands) however this does not correspond to minor salivary glands of the mucosal lip (site C003 per ICD-O-3 coding instruction).

The 2018 ICD-O-3 Update table does not include this histology, however Table 6 indicates code 8502 (secretory carcinoma) is a new code that was approved by IARC/WHO.

The ICD-O-3 only includes this histology as secretory carcinoma of breast. Therefore, in order to arrive at the correct histology, one must be aware of previous SINQ entries 20160036 and 20130003 that indicate secretory carcinoma (or MASC) is histology 8502. However, these are related to MP/H Rules, so registrars may be hesitant to apply this guideline to cases coded using Solid Tumor Rules.

Example: FoundationAct assay of circulating tumor DNA in blood sample results: Tumor type = non-small cell lung carcinoma, NOS, with 3 genomic alterations identified: NRAS Q61H, IDH2 R140Q and TP53 V172F. The tumor was identified on imaging and the imaging findings were not clearly what one would expect to see with a SCLC.

ICD-O-3 Rule H states to use the topography code provided when a topographic site is not stated in the diagnosis. This topography code should be ignored if the tumor arose in another site. For the following brain and central nervous system (CNS) examples, should the suggested sub-site codes be assigned based on the histology, or should the primary sites be coded as C719 (posterior fossa or suprasellar brain) since the only information available was a tumor in these non-specific sites?

Example 1: Resection of a posterior fossa tumor proved medulloblastoma, WNT-activated. Although medulloblastoma has a site-associated code in the ICD-O-3 (C716, cerebellum), the only information available is that this was a posterior fossa tumor (C719).

Example 2: Resection of a suprasellar brain tumor proved pineoblastoma. The pathologist labeled this as a brain tumor, suprasellar. Although pineoblastoma has a site-associated code in the ICD-O-3 (C753, pineal gland), the only information available is that this was a suprasellar brain tumor (C719).

Example: Bladder primary with transurethral resection of the bladder tumor (TURBT) on 2/17/2017 (Date of First Surgical Proc) followed by a second TURBT on 3/24/2017 (Date Most Definitive Surgery) with mitomycin C instilled on the second, most definitive TURB procedure.

There is an edit failure (IFX166) when Systemic/Surgery Sequence is coded 5 (intra-operative systemic) and Systemic Date does not match Date of First Surgical Procedure. How should we capture the intra-operative systemic treatment during the second, most definitive TURB? Is the correct Surgery/Systemic Sequence code 3 (systemic after surgery) for this case because (intra-operative) chemo was technically given after the first surgery?

Chest x-ray: Multifocal pneumonia in left lung; possibility of masses in left lung not excluded.

Chest CT: 4 large ground-glass masses in LUL (largest 46mm); beginning of Tree-In-Bud appearance in LUL; 2 small ground-glass nodules in right lung.

Lung LUL biopsy: Adenocarcinoma, Solid Predominant.

No further information as patient did not want to discuss treatment options.

Per the AJCC book and CAnswer Forum, multifocal classification should be applied equally whether the lesions are in the same lobe OR in different ipsilateral lobes OR contralateral lobes, cT2b(m), cN0, cM0.

The patient was never treated for the 2016 diagnosis, so the 2019 diagnosis is the same tumor that has progressed. Prior SINQ 20091096 for a similar case type cited multiple primaries per the 2007 Multiple Primaries/Histology Rules, Rule M8, the same rule as the current Solid Tumor rule M17, because this is to be reported as an incidence case.

However, it seems like Solid Tumor Rule M3 would apply because a single tumor is a single primary, and behavior of the 2016 primary would then be updated from /2 to /3. It is unclear how one would advance to the Multiple Tumors module and apply M17 because there is really only a single tumor in this case.