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Report Produced: 11/27/2024 20:22 PM

Report Question ID Question Discussion Answer Year
20071023 MP/H Rules/Multiple Primaries: When the pathology report from a FNA or other biopsy states an "in situ" carcinoma and the patient waits more than 60 days for a more definitive procedure which documents an "invasive" carcinoma, is this reported as two primaries?

For cases diagnosed 2007 or later:

No. When the invasive component is discovered as part of the work-up phase leading to treatment decisions, the case should not be abstracted as a multiple primary. In the rare instance when a patient has not been treated and is still having diagnostic work-up greater than 60 days after the malignancy is diagnosed, do not count the invasive diagnosis as a new primary.

 2007
20091116 MP/H Rules/Multiple primaries - - Colon: Is a colon tumor reported as "recurrent at the anastomotic junction" just over one year after the diagnosis of a T4 colon tumor to be counted as a new primary? See Discussion.

MP/H rules do not apply to metastasis. However, it has been our experience that pathologists and clinicians tend to use the terms metastatic and recurrence interchangeably. The term "recurrence" is not limited to a tumor recurrence in the same site as a previous malignancy. Sometimes it is obvious that the clinician is using the term recurrence to describe a metastatic lesion. When a "recurrence" is located in tissue that is very different from the original primary site, it is easy to recognize that the intended meaning of the term is metastasis.

Example: Patient with squamous cell carcinoma of the tongue with recurrence in the lung.

However, when the metastatic deposit occurs in similar tissue, it is more difficult to determine the number of primaries.

Example when the term "recurrence" is ambiguous: In April 2008 patient was diagnosed with adenocarcinoma of the ascending colon. At the time of hemicolectomy the tumor was noted to be plastered into the paraduodenal and peripancreatic area. Patient received one dose of adjuvant chemo and then discontinued treatment. In May 2009 the patient was found to have adenocarcinoma in the transverse colon. Per the pathology report the diagnosis for segmental resection at that time showed colonic adenocarcinoma. Tumor location: tumor appears recurrent at anastomotic junction. Abdominal wall mass showed metastatic adenocarcinoma.

One has to wonder if the pathologist found a metastatic nodule at the anastomotic site and called it "recurrent." It is unlikely that the pathologist will compare this specimen to the previous tumor, having already diagnosed it as "recurrent."

For cases diagnosed 2007 or later, Rule M4 applies to the example of adenocarcinoma of ascending colon diagnosed in 2008 followed by adenocarcinoma of transverse colon diagnosed in 2009. When a colon resection has taken place, the original primary site is no longer present. A colon resection usually includes a portion of uninvolved colon on either side of the tumor. A tumor diagnosed at the anastomotic junction cannot be located in the same site as the previous tumor. Use of the term "recurrent" in this case is not synonymous with "metastatic." Apply the MP/H rules. 2009
20091115 MP/H Rules/Multiple primaries - - Melanoma: How many primaries are reported when a patient presents with a malignant melanoma (NOS) and a separate lentigo maligna, both on right chest? See Discussion.

MP/H rule M5 states that melanomas with ICD-O-3 histology codes that are different at the third number are multiple primaries. However, the 2007 MP/H fundamentals Webcast session on melanoma rules states that this is not two histologic types. Lentigo maligna is a growth pattern, not a histologic type. Will clarification be included in the next MP/H rules revision?

For cases diagnosed 2007 or later, two primaries are to be reported for this case. Rule M5 applies because there is a difference in the histology codes at the third digit.

Clarifications regarding histologic types of melanoma will be added to the rules when they are revised.

2009
20120093 MP/H Rules/Multiple primaries -- Ovary: How many primaries are to be accessioned and what rule applies when a patient has a serous carcinoma of the right ovary treated with neoadjuvant chemotherapy followed by a debulking surgery that revealed a serous tubal intraepithelial carcinoma of the left fallopian tube?

For cases diagnosed 2007 or later, accession two primaries, serous carcinoma of the right ovary and serous tubal intraepithelial carcinoma of the left fallopian tube based on the information provided.

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) and go to the Other Sites MP rules because neither the ovary nor fallopian tube have site specific rules developed.

Start at the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within a module. The patient has multiple tumors with ICD-O-3 topography codes that are different at the third character (Cxx) and therefore this case should be accessioned as a multiple primary.

It could be helpful to know the extent of involvement noted prior to neoadjuvant therapy and debulking surgery. For example, if the patient had widely metastatic disease throughout the entire pelvis prior to the initiation of treatment, the answer may have been different.

2012
20110007 MP/H Rules/Multiple primaries--Bladder: How many primaries are to be abstracted and how are the histologies coded when a bladder resection demonstrates tumor with invasive small cell neuroendocrine carcinoma [8041/3], high grade papillary urothelial carcinoma in situ [8130/2], adenocarcinoma in situ [8140/2], and multifocal flat urothelial carcinoma in situ? See Discussion.

Are the areas of in situ tumor to be ignored or would MP/H Rule M9 apply?

Ignore the in situ histologies. This is a single primary. Code the histology to invasive small cell neuroendocrine carcinoma [8041/3]. 2011
20100009 MP/H Rules/Multiple primaries--Bladder: Is a new primary accessioned for a 2009 diagnosis of transitional cell carcinoma of the bladder when the patient has a history of invasive bladder cancer NOS diagnosed? See Discussion.

A patient has a history of invasive bladder cancer diagnosed several years ago in another state. In 2009, the patient was admitted and found to have a positive biopsy for transitional cell carcinoma of the bladder.

Is this a new primary because the histology of the previous bladder cancer is unknown? When the histology of a previously diagnosed bladder cancer is unknown, should we assume the previous tumor was urothelial carcinoma?

 For cases diagnosed 2007 or later, apply rule M6. The 2009 diagnosis is not a new primary. Transitional cell carcinomas account for more than 90% of bladder cancers. If the patient actually had a rare small cell, squamous cell, or adenocarcinoma of the bladder in the past, it is highly likely it would be mentioned in the medical record. 2010
20110068 MP/H Rules/Multiple primaries--Bladder: Which multiple primary rule is used to determine the number of primaries to accession when a patient has a papillary transitional cell carcinoma of the bladder diagnosed in 2009 followed by a high grade invasive urothelial carcinoma with neuroendocrine features per immunohistochemistry diagnosed in 2010? See Discussion.

A patient has papillary transitional cell carcinoma of the bladder in March of 2009. In June of 2010 the patient has another TURBT that demonstrates a flat in situ and invasive high grade urothelial carcinoma. The path addendum indicates, "Genzyme IHC show results consistent with high grade invasive urothelial carcinoma with neuroendocrine features." Two months later a liver biopsy shows poorly differentiated malignant tumor. The path addendum indicates, "Genzyme IHC results show metastatic poorly differentiated carcinoma with neuroendocrine features, favor bladder primary."

Is the latter a second bladder primary with histology code 8246/3 [neuroendocrine carcinoma]?

NOTE: Neuroendocrine is not listed as an urothelial tumor in Table 1 of MP/H Rules.

Use the Multiple Primary and Histology Coding Rules Manual for cases diagnosed 2007 or later to determine the number of primaries. This is a single primary. The 2010 diagnosis is urothelial carcinoma. The presence of "neuroendocrine features" does not change the histologic category.

The steps used to arrive at this decision are:

Open the Multiple Primary and Histology Coding Rules manual. Once in the manual, locate the Urinary MP rules under one of the three formats (i.e., flowchart, matrix or text). The rules are intended to be reviewed in consecutive order within the module. You stop at the first rule that applies to the case you are processing.

Start at the MULTIPLE TUMORS module start at rule M3.

. Bladder tumors with any combination of transitional cell carcinoma and papillary transitional carcinoma are a single primary.

2011
20130203 MP/H Rules/Multiple primaries--Brain and CNS: How many primaries are accessioned for a diagnosis of cerebral cavernous malformation disorder (CCM1) and MRI evidence of dozens of cavernous angiomas/malformations throughout the supra and infratentorium? See Discussion.

9/9/11 IMP: Presymptomatic cerebral cavernous malformation disorder (CCM1).

9/9/11 Brain MRI: FINDINGS: Total of 14 foci. 2 largest in rt frontal lobe. In rt frontal lobe, total of 4 foci. Of remaining 10 small foci, 4 are in cerebellum, 1 in rightward pons, 1 in lt temporal lobe, 1 in lt occipital lobe, 1 in rt occipital lobe, 1 in posterior rt temporal lobe, & 1 in lt frontal lobe. Lesions in bilateral occipital lobes & lt temporal lobe are associated w/weighted signal suggestive of hemosiderin & are most c/w additional cavernous malformations. IMPRESSION: Just over a dozen scattered foci of gradient susceptibility throughout supra & infratentorium.

9/13/13 Brain MRI. Clinical diagnosis: Cerebral cavernous angiomas. FINDINGS: Approximately a dozen scattered foci. 2 largest in rt frontal lobe. Remaining small foci identified w/in cerebellum, rightward pons, rt occipital lobe, rt temporal lobe, & lt frontal lobe. Many are less conspicuous than in 2011 & a few that were present on prior study are not evident on current exam. This is likely due to differences in technique. IMPRESSION: Redemonstration of numerous scattered foci c/w cavernous malformations.

This case is not reportable as is. The clinical diagnosis on the 9/13/13 MRI was "cerebral cavernous angiomas," but the final impression on the MRI was a re-demonstration of the numerous scattered foci consistent with cavernous malformations seen on the previous 9/9/11 MRI. There was no reportable statement of cavernous angioma. Cavernous malformation is not a reportable neoplasm; it has no valid ICD-O-3 code.

Vascular tumors of the CNS are reportable when they arise in the dura or parenchyma of the CNS. When they arise in blood vessels or bone, they are not reportable. Do not report vascular tumors when there is not enough information to determine whether they arise in the dura or parenchyma or elsewhere.

2013
20091121 MP/H Rules/Multiple primaries--Brain: Does a patient diagnosed with anaplastic astrocytoma of the left temporal lobe in 2000 followed by a diagnosis of oligoastrocytoma of the right frontal lobe in 2007 have a single primary per rule M7 or multiple primaries per rule M8? See Discussion. MP/H rule M7 states that tumors with ICD-O-3 histologies on the same branch in chart 1 are a single primary. Chart 1 shows that both of the histologies for our sample case are located on the glial branch. However, the glial tumor branch has three secondary branches. Does rule M7 apply to secondary branches? Anaplastic astrocytoma [9402] is classified under the secondary branch for astrocytic tumors. Oligoastrocytoma [9382] is classified under the secondary branch for mixed glioma. Does rule M7 or does rule M8 apply for this case? Does this case represent one or two primaries?

For cases diagnosed 2007 or later, Rule M8 applies. There are two primaries.

Anaplastic astrocytoma and oligoastrocytoma (mixed glioma) are on separate branches in Chart 1. They are both gliomas, but one is a mixed glioma and the other is an astrocytic tumor.

2009
20100054 MP/H Rules/Multiple primaries--Breast: How many primaries are accessioned if a pathology specimen reveals an infiltrating mammary carcinoma with mixed tubular and lobular features, 2.3 cm, low grade cribriform in situ ductal carcinoma, and Paget disease of the overlying skin with ulceration? See Discussion. According to SINQ 20081134 the histology would be 8524 if this is one primary.

For cases diagnosed 2007 or later, this is a single primary.

In order to determine whether this case represents a single or multiple primary, you must first determine the correct histology code for the underlying tumor. Using rule H9, ignore the DCIS.

See Table 3 in the equivalent terms and definitions. Infiltrating lobular, tubular, and Paget are coded to a single histology code (8524/3). Our current multiple primary rules do not say infiltrating lobular and tubular and Paget are a single primary. This was an omission and will be corrected in a future revision. Thank you for bringing this omission to our attention.

 2010