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Report Produced: 02/11/2026 10:16 AM

Report Question ID Question Discussion Answer Year
20071068 MP/H Rules/Multiple Primaries/Histology--Prostate: How many primaries should be abstracted and how should the histology field(s) be coded for a case in which the pathology specimen showed adenocarcinoma in 20% of the tissue and sarcoma in 50% of the tissue? See Discussion.

Patient has TURP. The final path diagnosis is adenocarcinoma in 20% of tissue and sarcoma in 50% of tissue.

Because it is unknown whether there is a single or multiple tumors, rule M1 (Other Sites) is used which states the case is to be abstracted as a single primary.

Single invasive histology rules are followed to rule H16, but table 2 does not contain a mixed code for this situation, even though ICD-O-3 has a code 8933/3 for "adenosarcoma". Therefore, rule H17 is applied that states to use the highest code, which in this case would be 8800/3 [Sarcoma, NOS]. Is this correct?

For cases diagnosed 2007-2014, code as two primaries, one adenocarcinoma and the other sarcoma.

This is two tumors (adenocarcinoma and separate sarcoma) until proven otherwise. Do not code as adenosarcoma, as this is a gyn-specific diagnosis. Adenosarcoma of the prostate is not a recognized entity in the WHO classification of prostate tumors.

 2007
20110027 MP/H Rules/Multiple primaries/Histology--Thyroid: How many primaries and what histology(ies) are coded when a patient is diagnosed with a single papillary carcinoma in the left thyroid lobe and multiple foci of papillary microcarcinoma in the right thyroid lobe? See Discussion.

Is the term papillary microcarcinoma being used to describe the size of the foci only, or are the right thyroid lobe lesions a different histologic type? Does rule M6 apply (single primary)? Or does rule M11 apply (multiple primaries)?

Case summary: Left thyroid with 2.2 cm papillary carcinoma and right thyroid with "multiple microscopic foci of papillary carcinoma (papillary microcarcinoma) ranging from less than 1 mm to 2 mm in greatest dimension."

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.

For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult. The histology is the same in both lobes of the thyroid.

The steps used to arrive at this decision are:

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

Start with the MULTIPLE TUMORS module, Rule M3. The rules are intended to be reviewed in consecutive order within the module from Rule M3 to Rule M18. You stop at the first rule that applies to the case you are processing.

. This patient has multiple papillary carcinomas of the thyroid diagnosed simultaneously; no other rule applies, so this is a single primary. Abstract a single primary for this patient.

Determine the histology code. For a thyroid, use one of the three formats (i.e., flowchart, matrix or text) under the Other Sites Histo rules to determine histology because thyroid primaries do not have site specific rules.

Start with the MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY module, Rule H18. The rules are intended to be reviewed in consecutive order within the module from Rule H18 to Rule H31. You stop at the first rule that applies to the case you are processing.

. Code papillary carcinoma of the thyroid to papillary adenocarcinoma, NOS [8260].

 2011
20120084 MP/H Rules/Multiple primaries/Histology: How many primaries are accessioned and how is the histology coded if a patient has a 1.2 cm hepatocellular carcinoma and a 7 cm hepatocellular carcinoma, solid, acinar and trabecular type? See Discussion. FINAL Diagnosis: 2 separate lesions of the liver 1)1.2 cm hepatocellular carcinoma and 2) 7 cm hepatocellular carcinoma, solid, acinar, and trabecular type.

For cases diagnosed 2007 or later, accession a single primary, hepatocellular carcinoma [8170/3].

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 liver does not 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. There is one tumor with HCC and another tumor with a specific type of HCC.

Hepatocellular carcinomas vary and often display different architectural patterns such as solid, acinar and trabecular.

 2012
20071009 MP/H Rules/Multiple Primaries/Laterality--Brain and CNS: How many primaries are to be abstracted and how is laterality to be coded for two meningiomas, one occurring at the midline and the other in the right termporal region? See Discussion. MRI of the brain shows two meningiomas: One is stated to be 'midline' (laterality code 9) and one is stated to be in the 'right' temporal region. The rules state if same site (C700), same histology & laterality is same side or one side unknown, then abstract as single primary. Based on this, the MRI findings would be one primary, but how should laterality be coded? For cases diagnosed 2007 or later, abstract two primaries. The lateralities of both meningiomas are known. Right (code 1) and midline (code 9) are different lateralities. 2007
20120092 MP/H Rules/Multiple primaries/Recurrence -- Lung: How many primaries are accessioned if a diagnosis of squamous cell carcinoma of the lung is followed three years later by a diagnosis of adenocarcinoma of the lung if the pathologist reviews all the slides and states the subsequent diagnosis is a recurrence? See Discussion.

7/12/2007 Left upper lobe lung lobectomy: Squamous cell carcinoma.

3/09/2010 Left lung completion pneumonectomy: Adenocarcinoma, predominantly acinar. The diagnosis comment on the pathology report indicates the previous lobectomy specimen from 2007 was reviewed and "there are areas that appear histologically similar to the current neoplasm. Thus, the findings are most compatible with recurrence."

Despite the difference in histology, is this a single primary per the MP/H Coding Rules, General Information instruction 7 because the pathologist did refer to the 3/9/2010 diagnosis as a "recurrence" of the 7/12/2007 diagnosis after reviewing the slides?

For cases diagnosed 2007 or later, accession a single primary, left upper lobe squamous cell carcinoma diagnosed 7/27/2007.

The steps used to arrive at this decision are:

Go to the General Information notes for Determining Multiple Primaries for Solid Malignant Tumors in the Multiple Primary and Histology Coding Rules Manual.

General Information Rule 7 states "Use the multiple primary rules as written unless a pathologist compares the present tumor to the "original" tumor and states that this tumor is a recurrence of cancer from the previous primary."

Accession a single primary. Do not apply the Multiple Primary rules because the pathologist compared the 2007 and 2010 slides and determined this was a recurrence and not a new primary.

2012
20081026 MP/H rules/Multiple primaries: Is a 2007 cytology diagnosis of adenocarcinoma in bile duct a new primary for a patient with a 2005 diagnosis of adenocarcinoma of gallbladder? See Discussion.

A case abstracted for an adenocarcinoma of gallbladder (C23.9) in 2005. In 2007, cytology diagnosis of adenocarcinoma in bile duct(C24.0). Oncologist calls this recurrence. There is no pathologist statement of recurrence.

Using Other Sites multiple primary rules, rule M10 indicates this is multiple primaries. Sequence 01 dx in 2005 and sequence 02 dx in 2007. Is this correct? There is no statement of a primary tumor; the MP/H rules talk in terms of mass, lesion, tumor in a primary site.

 For cases diagnosed 2007 or later, abstract the 2007 bile duct diagnosis as a new primary unless it is described as metastatic. 2008
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
20071065 MP/H Rules/Multiplicity Counter--Lung: If metastatic tumors are not counted in this field, should the multiplicity counter be coded to 01 for a case with a primary left lower lobe of lung tumor with a satellite tumor in the left upper lobe?

For cases diagnosed 2007-2013:

No, code multiplicity counter to 02 [two tumors present]. According to the multiple primary rules, these two lung tumors are reported as a single primary. Record the number of tumors reported as a single primary in Multiplicity Counter.

Multiplicity Counter no longer required by SEER as of 1/1/2013.

 2007
20110119 MP/H Rules/Primary Site--Bladder: How is the primary site coded when a patient is diagnosed with synchronous, non-invasive papillary urothelial carcinomas of the bladder and renal pelvis? See Discussion.

This patient was diagnosed with at least three non-invasive papillary urothelial carcinomas of the bladder in 11/09. The patient subsequently underwent a complete nephroureterectomy in 12/09 showing a single non-invasive papillary urothelial carcinoma of the renal pelvis.

Per the MPH Rule M8, this is a single primary. Is the primary site to be coded C659 [renal pelvis] or C689 [urinary system, NOS]?

Assign code C68.9 when multiple tumors are found in multiple urinary sites at the same time. 2011
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:

  1. 5 mm tumor in the sigmoid. Histologic type: adenocarcinoma.

  • 1.9 cm tumor in the distal rectum. Histologic type: adenocarcinoma with signet ring cell differentiation.

  • 4 cm tumor in the proximal rectum. Histologic type: adenocarcinoma.

    • 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