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For tumors diagnosed prior to 2007:

This is one primary. Mucosal spread of in situ cancer from a hollow organ (bladder) into another hollow organ (prostatic urethra) is coded as a single primary.

This type of mucosal spread of tumor is sometimes referred to as "intramucosal extension" or " in situ component extending to." Mucosal spread can also be expressed as a statement of an invasive component in one organ with adjacent or associated in situ carcinoma in a contiguous organ with the same type of epithelium.

This case represents an invasive bladder tumor with in situ extension to the prostatic urethra. A tumor that is breaking down can be invasive in the center with in situ cancer at its margins. Occasionally, the in situ margin can move into a contiguous organ with the same type of epithelium.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

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.

For cases diagnosed in 2004 and later code CS extension:

1) no smooth muscle invasion -- 15

2) no muscle invasion -- 15

3) without muscle invasion -- 15

4) no invasion of muscularis propria -- 03

For tumors diagnosed prior to 2007:

If the histology of the bladder primary is "transitional cell carcinoma" or "papillary transitional cell carcinoma," do not code the prostatic urethra as a new primary. This is probably a case of intraluminal (mucosal) spread of the original tumor, rather than separate primaries. The clinical diagnosis supports this view.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

The carcinosarcoma is a separate tumor, abstract a new primary per M13. Code this primary to 8980/3.

Based on the information provided, the patient was first diagnosed with papillary urothelial carcinoma and received neo-adjuvant treatment for that specific histologic type. Subsequent resection identified carcinosarcoma arising within the papillary neoplasm. Carcinosarcoma is rare in bladder primaries and is not included in Table 2; however, it is a subtype/variant of sarcoma.

The example used in Rule M15 of the Urinary Solid Tumor Rules should refer to Table 2. We will update this in the next revision of the Rules.

This case is not reportable. The pathology proved the cytology to be incorrect. The pathologic diagnosis is the "gold standard." When cytology and pathology disagree, use pathology.

For tumors diagnosed prior to 2007:

Code combined small cell carcinoma [8045]. This mixed carcinoma is both urothelial and small cell. It is important to capture the small cell information in the code because the prognosis for small cell is different from pure urothelial carcinoma.

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

Based on the information provided, code the primary site to urachus (C677). Primary adenocarcinoma of the bladder accounts for less than 1% of all bladder malignancies. Of these, 20–39% are urachal in origin.

Code the instillation of Mitomycin-C into the bladder for a bladder primary in both the Chemotherapy and Surgery to Primary Site fields. Code the Chemotherapy field to 02 [Single-agent chemotherapy administered as first course therapy]. Mitomycin-C is listed in SEER book 8 as a chemotherapeutic drug, specifically an alkylating agent.

Also, code the Surgery of Primary Site field to 15 [intravesical therapy]. Code the surgical procedure as well as the type of drug (chemotherapy in this case).

Code the histology to 8082/3 [urothelial carcinoma, plasmacytoid].

The Multiple Primary and Histology Coding Rules Manual is the correct source for coding histology for cases diagnosed 2007 or later. Unfortunately, in this case there is no current rule that directs you appropriately to Table 1 from Rule H7 to find this histology combination. We need to add an example under Rule H7 that instructs you to "See Table 1" for an urothelial carcinoma diagnosis that mentions a more specific cell type (e.g., plasmacytoid). We will add a reference to Table 1 in Rule H7 in the updates to MP/H Rules.