Report | Question ID | Question | Discussion | Answer | Year |
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20130054 | MP/H Rules/Multiple primaries--Lung: How many primaries are accessioned if a lobectomy has two tumors that are both stated to be adenocarcinoma but the pathologist states they are synchronous primaries? See Discussion. | Left upper lung lobectomy: Adenocarcinoma, poorly-differentiated (grade 3), tumor size 1.2 cm, confined to lung. Second primary lung tumor: adenocarcinoma, well-differentiated (grade 1), tumor size 0.9 cm, confined to lung. Diagnosis COMMENT: The two tumors, although both adenocarcinoma, show markedly different histologies and thus are classified as synchronous primaries. Multiple synchronous primaries are staged separately according to the 7th edition of AJCC.
The AJCC Staging Manual 7th ed states, "Multiple tumors may be considered to be synchronous primaries if they are of different histological cell types. When multiple tumors are of the same cell type, they should only be considered to be synchronous primary tumors if, in the opinion of the pathologist, based on features such as ..., they represent different subtypes of the same histologic cell type..."
In this case, the pathologist insists these are two synchronous primaries, although different subtypes are not given, because the tumors have different grades and look completely different under the microscope. The MP/H rules indicate this is a single primary. How many primaries are accessioned? |
For cases diagnosed 2007 or later, accession a single primary, adenocarcinoma [8140/3] of the left upper lobe lung [C341]. The steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules Manual. Choose one of the three formats (i.e., flowchart, matrix or text). Go to the Lung MP rules because site specific rules exist for this primary.
Start at the MULTIPLE TUMORS module, rule M3. The rules are intended to be reviewed in consecutive order within a module. The patient has two tumors in the same lung with the same histology.
Do not use the AJCC Manual to make multiple primary decisions. Use the MP/H Rules to determine the number of primaries to accession. |
2013 |
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20130067 | Histology--Heme & Lymphoid Neoplasms: How is histology coded for a pathology report final diagnosis of diffuse large B-cell lymphoma (50%) and follicular lymphoma, 3A (50%)? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to diffuse large B-cell lymphoma [9680/3] per Rule PH11.
Code the histology to 9680/3 [diffuse large B-cell lymphoma] when DLBCL and any other non-Hodgkin lymphoma (follicular lymphoma, grade 3 in this case) are present in the same anatomic location. DLBCL is coded because it is the more aggressive histology.
NOTE: This answer assumes these two histologies are present simultaneously in the same anatomic location. Per Rule M4, this is a single primary.
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. |
2013 | |
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20130113 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient diagnosed and treated for multiple myeloma is subsequently diagnosed with multiple large plasmacytomas involving the scalp and thorax? See Discussion |
The patient was diagnosed with multiple myeloma, underwent treatment and subsequently was in remission. The patient later presented with lesions on the scalp and thorax lesions. The final diagnosis on the pathology report for the scalp lesion was multiple myeloma with plasmablastic transformation (high grade). The physician states this is an aggressive, recurrent multiple myeloma with multiple large plasmacytomas involving the scalp and thorax. |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph. Accession a single primary, multiple myeloma [9732/3] per Rule M2. The multiple myeloma is in an advanced stage when plasma cells are being deposited on the scalp and thorax. Clinically, those plasma cells are rightly called plasmacytomas by the physician. However, the patient has a late-stage multiple myeloma causing the plasma cells/plasmacytomas. Note that under the myeloma Recurrence and Metastases section of the Heme DB it indicates that extramedullary involvement (e.g., the scalp and thorax involvement) usually indicates advanced disease. Therefore, this scenario represents a case of a single histology that is accessioned as a single primary per Rule M2. 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. |
2013 |
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20130202 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are reported when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013? See Discussion. | In the Heme Manual it indicates one is to abstract a second primary when a solitary plasmacytoma (chronic) is followed by a plasma cell myeloma (acute) greater than 21 days after the chronic diagnosis.
The Heme Manual does not indicate what to do when a solitary plasmacytoma diagnosed in 2010 (T spine) is followed by another solitary plasmacytoma (L spine, different primary site) in 2013. The physician specifically stated the patient does not have multiple myeloma. Is this case one or two primaries? |
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule M2, this is a single primary. According to Rule M2, the single histology is always the single primary.
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. |
2013 |
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20130165 | MP/H Rules/Multiple primaries--Thyroid: How many primaries are reported and what is histology for the papillary carcinomas if a Classical cytomorphology with a follicular architecture is on the right and a Columnar cell cytomorphology with a follicular and papillary architecture is on the left? See Discussion. |
The answer seems to hinge on whether or not the two tumors differ at the third digit of histology. Can we code the histology based on the terms listed for variant or architecture? |
This is a single thyroid primary. The tumors are both papillary carcinoma with follicular architecture for the most part. Apply Rule M6 and abstract a single primary. | 2013 |
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20130090 | MP/H Rules/Primary site/Histology--Colon/Rectum: How are the primary site and histology to be coded for a diagnosis of familial polyposis with malignant tumors in the sigmoid and rectum? See Discussion. | Preoperative diagnosis was familial polyposis with rectal and rectosigmoid cancer.
The pathology report from the colon resection showed:
Gross description: The mucosa of the colon is tan pink with polyposis throughout; more than 1000 tan sessile polyps.
Should this be a single primary per MP/H Rule M3, histology coded to 8220/3 [familial polyposis] per MP/H Rule H17, and primary site coded to C199? |
This case should be accessioned as a single primary. Code the primary site to the colon and rectum [C199] and the histology to adenocarcinoma in familial polyposis coli [8220/3] per MP/H Rule H17.
For cases of familial polyposis, when the rectosigmoid or rectum are involved, assign code C199 [colon and rectum]. When the rectosigmoid or rectum are not involved, assign code C189 [colon, NOS]. |
2013 |
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20120020 | MP/H Rules/Multiple primaries--Breast: How many primaries are to be accessioned when a lumpectomy shows a single 6 mm "infiltrating mammary adenocarcinoma, histologic type: ductal (tubular)" tumor, and "peritumoral microscopic foci of solid type ductal carcinoma in situ"? See Discussion. |
Per SINQ 20091117, tubular (ductal) carcinoma would be coded to 8211/3 [tubular]. However, in that case the tubular/ductal carcinoma is composed of a single tumor. In this case, the foci of DCIS were specifically stated to be peritumoral, and not a part of the infiltrating tubular carcinoma. Are these microscopic foci of DCIS a separate primary per Rule M12 and SINQ 20110092 [two primaries are accessioned when one tumor is invasive and another is in situ, and histology codes differ at 1st, 2nd or 3rd numbers]? Does the size of the DCIS matter when there are two distinct histologies? Abstracting a second primary for these microscopic foci seems like over-reporting. |
The following answers depend on what this pathologist means by "ductal (tubular)." According to the WHO classification, tubular is not a duct subtype. Check with the pathologist if possible to determine if the intended meaning is "tubular carcinoma" or "duct carcinoma". If the pathologist uses the expression "ductal (tubular)" as an equivalent of "tubular carcinoma": Accession two primaries, a tubular carcinoma [8211/3] and a ductal carcinoma in situ, solid type [8230/2]. For cases diagnosed 2007 and later, the steps used to arrive at this decision are: Determine the provisional histologies of these tumors in order to apply the Multiple Primary rules. Open the Multiple Primary and Histology Coding Rules manual. For a breast primary, use the Breast Histology rules to determine the histology codes because there are site specific rules for breast primaries. Determine the histology of in situ carcinoma, solid type ductal carcinoma in situ. Start at Rule H1. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the more specific histologic term when the diagnosis is intraductal carcinoma and a type of intraductal carcinoma. Solid is a specific type of DCIS. The histology is 8230/2. Determine the histology of the invasive carcinoma, tubular carcinoma. Start at Rule H10. Code the histology when only one histologic type is identified, Tubular carcinoma was the only type identified. The histology is 8211/3. Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual after determining the histology of each tumor. Start at the MULTIPLE TUMORS Module, Rule M4, because the patient has a single invasive tumor and separate foci of DCIS. These tumors have ICD-O-3 histology codes that are different at the third (xxx) number and are, therefore, multiple primaries. If the pathologist uses the expression "ductal (tubular)" as an equivalent of "duct carcinoma": Accession a single primary, a duct carcinoma [8500/3]. For cases diagnosed 2007 and later, the steps used to arrive at this decision are: Go to the Breast MP rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS Module, Rule M4 because the patient has a single invasive duct carcinoma and separate foci of solid type ductal carcinoma in situ. Multiple intraductal and/or duct carcinomas are a single primary. Table 1 identifies solid type as a specific type of intraductal carcinoma. Go to the Breast Histology rules found in the Multiple Primary and Histology Coding Rules Manual. Start at the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY Module, Rule H20. Code the invasive histology when both invasive and in situ tumors are present. Code the histology as 8500/3 [duct carcinoma]. |
2012 |
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20120090 | First course treatment/Chemotherapy: Can a drug be coded as treatment for primary sites or histologies not listed for that drug in the SEER*Rx Database? See Discussion. | The patient was diagnosed with chronic myelogenous leukemia in 2008 followed by a diagnosis of chronic lymphocytic leukemia in 2011. Per the physician statement, the patient started nilotinib in 10/2011 for CML.
The SEER*Rx Database lists CML and GIST as the only primary site/histology combinations treated using nilotinib. Can nilotinib also be coded as treatment for the CLL primary? |
SEER*Rx lists the approved sites/histologies for each drug. However, if you have a physician statement that indicates the drug was given for another site/histology, code the agent as treatment for that site/histology. | 2012 |
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20120009 | Histology--Heme & Lymphoid Neoplasms: How is the histology coded when the pathology report states the morphologic features and immunophenotype of a low grade B-cell lymphoma are most compatible with lymphoplasmacytic lymphoma or marginal zone lymphoma? | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9591/3 [B-cell lymphoma, NOS] per Rule PH28 which states that one is to code the histology when the diagnosis is
There is only one non-specific histology code mentioned, low grade B-cell lymphoma. This term is synonymous with B-cell lymphoma, NOS.
Per the Multiple Primaries Calculator, when comparing the histology 9591/3 [B-cell lymphoma, NOS] and 9671/3 [lymphoplasmacytic lymphoma], it is the same primary. When comparing the histology 9591/3 [B-cell lymphoma, NOS] and 9699/3 [marginal zone lymphoma], it is the same primary.
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. |
2012 | |
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20120074 | Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient is diagnosed in 2004 with extranodal diffuse large B-cell lymphoma (DLBCL) of the stomach followed by a 2011 diagnosis of DLBCL involving abdominal lymph nodes? See Discussion. | In 2004 a patient's extranodal DLBCL was treated with a partial gastrectomy at another facility. A recurrence of DLBCL was diagnosed in 2011 by a fine needle aspiration of abdominal lymph nodes. The patient presented to this facility for chemotherapy. | For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case is accessioned as a single primary. Code the histology to 9680/3 [diffuse large B-cell lymphoma] and diagnosis date to 2004. Per Rule M2, abstract as a single primary when there is a single histology.
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. |
2012 |