MP/H Rules/Multiple primaries--Prostate: Is duct carcinoma of the prostate the same as an adeno/acinar carcinoma of the prostate? Specifically, does rule M3 apply when there is an adenocarcinoma of the prostate followed by a duct carcinoma of the prostate or a duct carcinoma followed by adenocarcinoma?
Rule M3 does not apply to adenocarcinoma followed by duct carcinoma of the prostate or vice versa. Rule M3 pertains to cases of adenocarcinoma and acinar carcinoma. These two terms, adenocarcinoma and acinar carcinoma, are equivalent for the purpose of applying the MP/H rules to prostate cases. See page 77 of the Other Sites Terms and Definitions, http://www.seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf
Reportability--Head & Neck: Would this be reportable and if so what histology would be coded? Soft tissue mass left cheek excision reveals Carcinoma Ex Pleomorphic Adenoma Non-Invasive with focal vascular invasion. Margins clear.
Carcinoma ex pleomorphic adenoma (Ca-ex-PA) is reportable. Assign 8941/3. The WHO classification of head and neck tumors defines Ca-ex-PA as an epithelial malignancy arising in a benign pleomorphic adenoma. Most of these originate in the parotid gland but can also arise in other salivary glands.
Multiple primaries--Heme & Lymphoid Neoplasms: Should the 2014 diagnosis be abstracted as a new primary since it is not mantle cell lymphoma and all of the types listed in the differential diagnosis would be a new primary? See discussion.
Mantle cell lymphoma diagnosed in 1997 which was treated with chemotherapy. Now in 2014 a 'relapse' of non-Hodgkin lymphoma. They do a biopsy of the pericardium, which is called low grade B cell non Hodgkin lymphoma. See comment. The comment says histochemical stains are reviewed and findings are consistent with involvement by a CD5 positive low grade B cell lymphoma. Lack of cyclin D1 and SOX-11 positivity as well as negative IGH-CCND1 FISH analysis essentially rule out mantle cell lymphoma. The morphologic and immunophenotypic features of this disorder are not specific for any lymphoma subtype. The differential includes CLL, marginal zone lymphoma, and lymphoplasmacytic lymphoma. If this is coded NHL, NOS (9591) it is the same primary as seq. 1 and would not be abstracted.
This is the same primary, the mantle cell lymphoma.
Differential diagnoses cannot be used to assign histology. For the 2014 diagnosis, the only histology that can be assigned is 9591/3 for non-Hodgkin lymphoma, NOS. (CLL, mantle cell lymphoma and lymphoplasmacytic lymphoma are all NHL's.)
Compare the 1997 diganosis of mantle cell lymphoma with the 2014 diagnosis of non-Hodgkin lymphoma. Start with Rule M1. The first rule that applies is Rule M15, which instructs you to use the multiple primaries calculator. Enter 9673/3 and then 9591/3 and then calculate. The result is same primary.
If at a later time one of the differential diagnoses is confirmed, apply the rules again.
MP/H Rules/Histology/Multiple primaries--GE junction: How is histology coded for a goblet cell carcinoma in the GE junction? See discussion.
The patient was diagnosed with GE junction signet ring adenocarcinoma (8490/3) in 5/2012, treated with radiation. GE junction biopsy on 9/20/2012 showed residual signet ring carcinoma. Subsequent biopsies on 7/8/2013 showed GE junction biopsy of invasive adenocarcinoma, signet ring cell type along with “Esophagus, distal and GE junction biopsies” (site not further clarified in available documentation) with Goblet cell carcinoma. The histology code for the goblet cell carcinoma is needed to determine the number of primaries.
According to our expert pathologist consultant, goblet cell is a descriptive term and not a specific histology in this context. There is no ICD-O-3 code for it. The "goblet cell carcinoma" in this case is not a new primary.
Goblet cell is used to describe some cells containing mucin. In addition to individual tumor cells containing mucin which compresses the nucleus to give the appearance of signet rings, the mucin is present in columnar cells with the nuclei at one end -- this latter is a pattern often seen when glandular structures are formed by the tumor cells. It is also often intermixed with the signet ring cells in the surrounding stroma.
MP/H Rules/Multiple primaries--Ampulla of vater: Is this a new primary? Patient has intramucosal adenocarcinoma in a tubulovillous adenoma of the ampula of vater in Sept. of 2011. In May of 2012, patient has another ampullary adenoma with intraepithelial carcinoma (pTis) and an area suspicious for invasion. This is coded 8263/3.
Rule M14, Multiple in situ and/or malignant polyps are a single primary, precedes rule M15, An invasive tumor following an in situ tumor more than 60 days after diagnosis is a multiple primary, per the MP rules for 'Other sites',
Rule M14 applies. Abstract this case as a single primary.
MP/H Rules/Multiple primaries--Colon: Does rule M7 apply here (A frank malignant or in situ adenocarcinoma and an in situ or malignant tumor in a polyp are a single primary)? Can the frank malignant adenocarcinoma be any specific type of adenocarcinoma for this rule to apply?
A patient has 2 synchronous tumors in the ascending colon. The first is grade 3 adenocarcinoma with signet ring differentiation and focal mucinous features (8255/3). The second is grade 2-3 adenocarcinoma in a tubulovillous adenoma (8263/3).
M7 applies to this case. The frank adenocarcinoma can be a specific type of adenocarcinoma.
Histology--Heme & Lymphoid Neoplasms: Should the 1995 diagnosis be changed to plasmacytoma? A 1995 case on the central registry database indicates that MRI and bone surveys revealed a pubic ramus lesion that was biopsied. There are no other bone lesions. A bone marrow biopsy was negative. The pathologist's diagnosis at that time was "Plasma Cell Myeloma". In 2013 there was a positive bone marrow biopsy and a diagnosis of Plasma Cell Myeloma. In 2013, a history of "sequential plasmacytomas since 1995" was mentioned. Since the 1995 diagnosis was only a solitary bone lesion with no marrow involvement, it certainly seems to fit a diagnosis of plasmacytoma better than myeloma.
Do not change the 1995 diagnosis in this case. It is best to code the histology according to information from the time of the diagnosis. Using information obtained many years later is less reliable.
Laterality: Why is a code 5 for laterality midline only allowed for certain sites of brain and skin? I have a nasal cavity tumor and the path report specifically says "Tumor laterality: midline". What is the correct laterality code here?
Assign laterality code 9 for midline nasal cavity tumor. We will investigate this issue further.
Reportability--Lung: One of our facilities has a case they are not really sure how to report.
This patient came in for a double lung transplant due to COPD which occurred on 1/27/14. At time of transplant, the team found out the donor hospital had identified a small nodule in the right lower lobe donor lung, which they biopsied and deemed negative. However, the slides were reviewed and felt to represent adenocarcinoma. The team performed a right lower lobe lobectomy of the donor lung before transplanting into the patient.
So, we are not really sure how to handle this case. The adenocarcinoma actually belongs to the donor patient from another hospital, however, they actually didn’t identify it at that facility as their pathology was negative for a malignancy.
This very interesting case is not reportable to either facility. Since the right lower lobe nodule was resected prior to transplantation, the case does not belong to your patient. Ideally, the cancer should be assigned to the donor; however, donor information is confidential.