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Report Produced: 02/10/2026 23:53 PM

Report Question ID Question Discussion Answer Year
20130221 MP/H Rules/Multiple primaries--Prostate: How many primaries are accessioned for a diagnosis of metastatic small cell neuroendocrine carcinoma of the prostate following a previous diagnosis of adenocarcinoma of the prostate? See Discussion.

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)."

Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619], followed by small cell (neuroendocrine) carcinoma [8041/3] of the prostate [C619] for each of the examples given per Rule M10.

In each case, the second histology (because it is not adenocarcinoma) is a new prostate primary. Small cell carcinoma and small cell neuroendocrine carcinoma are not adenocarcinomas. As a result they are not covered by Rule M3.

2013
20130198 MP/H Rules/Multiple primaries--Rectosigmoid: How many primaries are accessioned for a synchronous diagnosis of neuroendocrine carcinoma and a separate adenocarcinoma arising in a villous adenoma when both arise in the rectosigmoid junction? See Discussion. Total colectomy showed neuroendocrine carcinoma of the rectosigmoid junction, as well as a separate adenocarcinoma arising in a villous adenoma of the rectosigmoid junction. Is this a single primary per Rule M13 (a frank adenocarcinoma and an adenocarcinoma in a polyp) or Rule M16 (adenocarcinoma and a more specific adenocarcinoma)? Or are these two primaries?

Accession two primaries per Rule M17, neuroendocrine carcinoma [8246/3] of the rectosigmoid junction [C199], and adenocarcinoma in a villous adenoma [8261/3] of the rectosigmoid junction [C199]. There are two tumors with ICD-O-3 histology codes that differ at the third number.

Rule M13 does not apply to neuroendocrine carcinoma. Rule M16 does not apply to this case because there are two specific histologies.

2013
20110073 MP/H Rules/Multiple primaries--Sarcoma: Does a prior clinical diagnosis of a metastatic deposit for a previously diagnosed sarcoma have priority if the diagnosis on a subsequent resection (18 months later) indicates it is also a sarcoma but does not state it represents metastasis from the original sarcoma primary? See Discussion.

1/28/08 Patient was diagnosed with spindle cell sarcoma in the right gluteus muscle. Metastatic tumors were found in a vertebral body and in the lung. Chemotherapy was started.

4/22/08 PET scan done to evaluate response to chemo. The primary tumor had increased in size. New mass in the left thigh that was highly suspicious for metastasis found. (The left thigh tumor was not accessioned at that time as it was described as a metastatic tumor.)

7/3/09 Left thigh tumor was resected and path revealed spindle cell sarcoma. There was no mention that it represented metastasis.

Does the left thigh tumor represent a new primary per rule M12? Or does the previous clinical description of the left thigh tumor representing metastasis have priority?

this is a single primary per Rule M1. According to our expert pathologist, "if multiple solid tissue tumors are present (sarcomas), then almost always there is one primary and the rest are metastases. There are infrequent occasions of multifocal liposarcoma or osteosarcoma occurring, but the patient would be treated as a patient with metastatic disease."

The steps used to arrive at this answer are:

Open the Multiple Primary and Histology Coding Rules manual. For a soft tissue primary, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites MP rules to determine the number of primaries because soft tissue primaries do not have site specific rules.

Go to the UNKNOWN IF SINGLE OR MULTIPLE TUMORS module, Rule M1.

Rule M1 states, "It is not possible to determine if there is a single tumor or multiple tumors, opt for a single tumor and abstract a single primary." Given the information from the expert pathologist, this case should be reported as a single primary applying this rule.

2011
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.

  • Dominant Tumor: Tumor

  • Laterality: Right lobe

  • Tumor Size: Greatest dimension: 9 cm

  • Histologic Type: Papillary carcinoma

  • Variant, specify: Classical

  • Architecture: Follicular

  • Cytomorphology: Classical

  • Tumor Size: Greatest dimension: 6 cm

  • Histologic Type: Papillary carcinoma

  • Variant, specify: Columnar cell

  • Architecture: Solid, follicular, and papillary

  • Cytomorphology: Columnar cell

    • 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
    		20091030 MP/H Rules/Multiple Primaries--Thyroid: How many primaries should be coded if there is a clinical diagnosis of recurrent thyroid carcinoma in 3/08 in a patient with a history of thyroid carcinoma diagnosed in 1995 with a 2002 clinical recurrence? See Discussion. Thyroid carcinoma diagnosed in 11/95 and treated with total thyroidectomy (although path report only mentions the left lobe) and ablation. Elevated thyroglobulin level in 11/02, stated to have recurrent carcinoma and again treated with ablation. History on this case states patient had a near total thyroidectomy at diagnosis. Patient is seen again at a third hospital 3/08. Diagnosis again is recurrent carcinoma apparently because of a thyroid mass that is palpable. No treatment was performed and patient expired 4/08. Is this a new primary because of MP/H rule M10?

    For cases diagnosed 2007 or later:

    The pathology report takes precedence over the other information when there is a discrepancy. Based on the information available, only the left thyroid lobe was removed 11/95.

    Use the 2007 MP/H rules to evaluate new tumors. If the 3/08 diagnosis represents a new tumor, use the MP/H rules. If the diagnosis in 3/08 is not new tumor, the MP/H rules do not apply.

    For this case, a new tumor in 3/08 would be a new primary using rule M10 for Other Sites.

    		 2009
    		20091027 MP/H Rules/Multiple primaries--Thyroid: How many primaries should be coded in a patient with a 4/5/08 left thyroid lobectomy diagnosis of follicular carcinoma followed by a 7/25/08 right thyroid lobectomy diagnosis of papillary carcinoma, follicular variant?

    For cases diagnosed 2007 or later:

    Rule M17 under Other Sites applies. These are separate primaries based on their ICD-O-3 histology codes. Follicular carcinoma is coded 8330. Papillary carcinoma, follicular variant is coded 8340. The histology codes are different at the third number. Rule M6 does not apply because these diagnoses are more than 60 days apart.

    		 2009
    		20091126 MP/H Rules/Multiple primaries--Vagina: How many primaries should be abstracted for a patient with a complex history of multiple occurrences of vaginal intraepithelial neoplasia (VAIN III) between 2001 and 2008 and invasive squamous cell carcinoma (SCCA) of the vagina diagnosed in 2006 and again in 2008? See Discussion. Patient had VAIN III in March of 2001. She had a partial vaginectomy and then continues to have laser surgery in 2002, 2003, 2005 and 2006 for recurrences. In 12/2006 she is diagnosed with SCCA of the vagina with microinvasion (new primary). Then in 2/2008 she has VAIN III again -- new primary according to rule M10 (more than 1 year later). An invasive SCCA of the vagina is again diagnosed in 9/2008. Is this another new primary per rule M15 (invasive after in situ)? Every instance in 2008 is called a recurrence, but we disregard that statement.

    There are two primaries according to the information provided.

    1. VAIN III March 2001.

    2. SCCA of vagina Dec. 2006 (invasive tumor following an in situ

    For cases diagnosed 2007 or later, the MP/H rules apply to new tumors, which means that there has been a disease-free interval at some point. In this case, the patient has never been declared disease-free (NED) using the information provided in the question. The consistent recurrence of VAIN is typical of this disease.

    		 2009
    		20091122 MP/H Rules/Multiple primaries-Brain: Does a glioblastoma multiforme following a low grade glioma (oligodendroglioma) represent a new primary? See Discussion.

    In 2/08 patient underwent resection of tumor of right frontal lobe. Path diagnosis showed a low grade glioma, favor low grade oligodendroglioma (WHO grade II). In 02/09 biopsy of a left thalamic mass showed glioblastoma mutiforme. Per rule M6 glioblastoma multiforme following a glial tumor is a single primary. Per path diagnosis, the first tumor represented a low grade glioma. However, oligodendroglioma is not on the glial branch of chart 1 in the MP/H rules.

    		For cases diagnosed 2007 or later, glioblastoma multiforme following oligodendroglioma are multiple primaries according to rule M8. Rule M6 does not apply. M6 applies only to glial tumors as listed in chart 1. Chart 1 is based on the WHO classification. The WHO classification separates oligodendroglial tumors from glial tumors. 2009
    		20091018 MP/H Rules/Multiple Primaries/CS Extension: How many primaries are to be accessioned when tumors are present bilaterally in the pleura and fallopian tubes? See Discussion.

    For both pleura and fallopian tube, the MP/H rules indicate that bilateral involvement of these sites should be coded as multiple primaries. However, both of these sites have CS extension codes that classify the contralateral disease as regional extension.

    Is a case described as a left sided pleural mesothelioma that has right sided pleural disease coded as one or two primaries? How is CS coded?

    For cases diagnosed 2007 or later:

    For a pleural or fallopian tube primary, if there is tumor(s) on the left and separate tumor(s) on the right and neither is stated to be metastatic from the other, abstract as multiple primaries according to rule M8 for other sites. If both sides are involved, but there is only one tumor, rule M2 for other sites applies and this is a single primary. Code each primary separately in CS.

    		 2009
    		20071077 MP/H Rules/Multiple Primaries/Histology--Colon: How many primaries should be reported and how is the histology field(s) coded if the left colon contains two adenocarcinomas and one mucinous adenocarcinoma arising in a villous adenoma and each has a different level of invasion? See Discussion. A patient had three tumors in the left colon including an 1) invasive well differentiated mucinous adenocarcinoma arising in tubulovillous adenoma with pericolonic subserosal fat invasion 8.5cm, 2) An infiltrative moderately differentiated colonic adenocarcinoma with invasion of muscularis propria 4cm and 3) an invasive moderately differentiated adenocarcinoma with invasion of muscularis propria, 1/69 nodes positive. The case was coded using rule M8 for one primary, but M10 contradicts; and H13 coding rule for histology 8263/3.

    For cases diagnosed 2007 or later:

    Assuming that all tumors are in the left colon, there are three tumors:

  • Mucinous adenocarcinoma arising in a villous adenoma

  • Colonic adenocarcinoma

  • Colonic adenocarcinoma

    • Multiple Primary Determination

    In the colon MP rules go to the multiple tumors module. Start with M3. Stop at M7 and abstract as a single primary.

    Histology Code

    Go to the histology coding rules, multiple tumors module, and start with H15. Stop at H20 which tells you to code the most invasive tumor. Tumor 1 is the most invasive according to the definition of most invasive in the 2007 SEER Manual, page C-271. Code 8263/3 [Adenocarcinoma in tubulovillous adenoma].

    		 2007