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At the central registry, we have accessioned this scenario as three primaries per Multiple Primaries/Histology (MP/H) Rule M10 (diagnosed more than 1 year apart), as the patient was stated to be disease free between each occurrence. However, the diagnosing/treating facility is not reporting these cases due to clinical statements of recurrent disease.

This is an example of a case type identified on casefinding audits conducted by our central registry in which we have learned SEER's expectation of MP/H rule application does not match hospital reporting. Can the 2018 version of the MP/H rules more clearly address how this type of clinically recurrent (multiple times) case should be handled?

The patient is diagnosed by bilateral mammograms suspicious for malignancy in both breasts. A biopsy is done on one breast and is positive. The physician states that he will not biopsy the contralateral breast, as the patient has consented to bilateral mastectomy. The patient receives neoadjuvant chemo, follow by bilateral mastectomies. Both breasts are negative for residual cancer, stated as a complete response. Based on "suspicious for malignancy" can we accession two primaries and assume bilateral complete response?

SINQs 20190083, 20180088, and 20130221 all indicate diagnoses of prostate adenocarcinoma, followed by a diagnosis of metastatic small cell carcinoma of the prostate are separate primaries because these are distinctly different histologies. Does this logic still apply for 2023 and later since Rule M4 was added to the Other Sites M Rules? Rule M4 states, “Abstract multiple primaries when the patient has a subsequent small cell carcinoma of the prostate more than 1 year following a diagnosis of acinar adenocarcinoma and/or subtype/variant of acinar adenocarcinoma of prostate.”

This patient has a 2018 diagnosis of prostate adenocarcinoma treated with radical prostatectomy, followed by a 2023 diagnosis of metastatic small cell carcinoma of the prostate diagnosed on a liver metastasis core biopsy. Rule M4 does not indicate whether it applies to subsequent biopsy confirmed metastatic tumor only. When a diagnosis of small cell carcinoma follows a diagnosis of prostatic adenocarcinoma, it is almost always confirmed in metastatic sites rather than in the primary site. Does the logic in the referenced SINQs above still apply for Rule M4?

We think this should be a single primary because the Solid Tumor rules do not apply to metastases. However, we are not sure whether or not the instructions outlined for prostate (SINQ 20180088, 20130221), that indicate we are to accession a new metastatic tumor only with a small cell neuroendocrine histology after an adenocarcinoma, also applies to lung primaries.

We are aware of a phenomenon in which lung adenocarcinoma cases treated with Erlotinib can transform to small cell, but do not know whether it impacts the number of reportable primaries.

Patient has biopsy of prostate 12/28/2018 showing Gleason 5+5 adenocarcinoma. Liver biopsy on same date is metastatic small cell carcinoma consistent with prostate primary. Oncology consult states that liver biopsy is likely neuroendocrine conversion from prostate carcinoma. Patient also has bone metastasis and receives radiation, Lupron, Casodex, and chemotherapy of carboplatin and etopiside.

Per Solid Tumor Rules, we code histology from primary site over a metastatic site. Thus, the small cell carcinoma, which appears to be the focus of the chemotherapy is lost. Is it correct to code this as a single primary with an adenocarcinoma histology?

Both SINQ 20130221 and 20180088 instruct us to abstract multiple primaries when patient develops a metastatic small cell carcinoma of the prostate after being previously diagnosed with adenocarcinoma of the prostate.

Would a second prostate primary with histology coded to 8041/3 [small cell carcinoma] be accessioned for the following examples? Or are these metastases despite the different histologies?

Example 1: Prostate adenocarcinoma diagnosed in 2001, no treatment given. Metastatic small cell neuroendocrine carcinoma diagnosed 03/2012 on liver biopsy with a physician's statement in 4/2012 that the prostate is likely the cause of the metastasis to the liver.

Example 2: Prostate adenocarcinoma diagnosed in 2006, treated with TURP. Bone marrow biopsy in 5/2012 shows involvement by metastatic small cell carcinoma with morphologic and immunophenotypic features that argue against prostatic adenocarcinoma. The oncologist assessment states, "The patient has Stage 4 small cell carcinoma of the prostate and the bone marrow biopsy path shows metastatic small cell carcinoma (likely prostate in origin)."

As of 2013, radiofrequency ablation is coded to "radiation therapy," chemoembolization is coded to "chemotherapy," and microwave ablation code to "other."  Or, is coding microwave ablation (using heat not alcohol) coded to surgical code "16"? The latest documentation year that I could find in the SEER website regarding the above was 2013. I would appreciate clarification/confirmation of correct coding especially for microwave ablation.

In the WHO Classification of Female Genital Tumors, 5th edition, for the uterine cervix squamous intraepithelial lesions, there is related terminology for high grade squamous intraepithelial lesion HSIL (CIN3) 8077/2 and it is severe squamous dysplasia; squamous cell in situ. However, in the online WHO Classification of Digestive System Tumors, 5th edition, there is no related terminology for esophageal high-grade squamous dysplasia, 8077/2. Can you collect cases of severe dysplasia the same as cases of high grade dysplasia?