MP/H Rules--Ovary: Rule M7 states bilateral epithelial tumors (8000-8799) are reportable as a single primary. Are bilateral germ cell tumors of the ovary (e.g., dysgerminoma (9060/3)) that occur simultaneously now reported as two primaries?
For cases diagnosed 2007 or later, rule M7 applies to ovarian epithelial tumors with ICD-O-3 histology codes between 8000 and 8799. Rule M7 does not apply to dysgerminoma which is coded to 9060. Go on to the next rule, M8 and abstract as multiple primaries, left and right.
MP/H Rules/Recurrence--Breast: If the pathologist and oncologist call a 2007 lobular carcinoma that appears in a skin nodule of a mastectomy scar a recurrence of a patient's 1975 primary breast duct carcinoma, should we abstract this as a new primary? See Discussion.
According to the pathologist and oncologist, the change in histology is attributed to the present availability of E-cadherin, which was not available in 1975.
For cases diagnosed 2007 or later, abstract the 2007 diagnosis as a separate primary using rule M5.
Rule M5 applies to this case because it comes before rule M12. Furthermore, based on your statement, the answer presumes that the original tumor was duct carcinoma only, there was no lobular carcinoma present. This must be a new primary because there are two different histologies.
The 2007 MP/H rules were developed with input from clinicians. They advised that a subsequent breast tumor more than five years later is a new primary. It is important to apply the rules so that these cases are handled in a consistant manner across all registries.
MP/H Rules--Bladder: Does rule M6 mean that any combination of tumors with the histologies 8050, 8120-8124, or 8130-8131 are the same primary regardless of the amount of time between tumor occurrences? See Discussion.
Many interpret Rule M7 to mean when separate occurrences of TCC of the bladder are diagnosed more than 3 years apart, it is reportable as a second primary. However, doesn't Rule M6 mean that if the histology is any combination of 8050, 8120-8124 or 8130-8131 for tumors diagnosed more than 3 years apart, they are reported as a single primary?
For cases diagnosed 2007 or later:
Papillary, transitional cell and/or papillary transitional cell carcinomas of the bladder are a single primary using Rule M6. Rule M6 includes diagnoses within 3 years of each other AND diagnoses more than three years apart for the histologies listed. If rule M6 applies to your case, stop. Do not continue on to Rule M7.
Multiple Primaries/Histology--Lymphoma/Leukemia: How many primaries and what histologies are coded when a path diagnosis for a cervical/neck mass demonstrates classical Hodgkin's lymphoma on a background of chronic lymphocytic leukemia?
For cases diagnosed prior to 1/1/2010:Hodgkin disease and chronic lymphocytic leukemia are separate primaries according to our current instructions. Abstract and code them separately.
For cases diagnosed 1/1/10 and later, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.
MP/H rules/Histology--Breast: How many primaries and what histologies are coded for a left breast when a bi-lumpectomy path reveals one tumor with a microscopic focus of mucinous adenocarcinoma and extensive DCIS and a second .9 cm mucinous adenocarcinoma with extensive DCIS, and the subsequent mastectomy reveals foci of residual DCIS and Paget's disease of the nipple?
For cases diagnosed 2007 or later:
There are two primaries. Primary 1: The two tumors described on the pathology report from the lumpectomy are a single primary using rule M13. Primary 2: Disregard the foci of residual DCIS. Paget disease of the nipple is a separate primary using rule M12.
Primary 1: invasive mucinous adenocarcinoma and extensive ductal carcinoma in situ: Code the histology as 8480/3 [mucinous adenocarcinoma] using rule H27.
Primary 2: Paget disease of nipple: Code the histology as 8540/3 [Paget disease] using rule H14.
Systemic/Surgery Sequence--Breast: How is this field coded for a breast cancer patient treated with a lumpectomy followed by chemotherapy and then a mastectomy?
Assign code 2 [Systemic therapy before surgery]. The code in Systemic Treatment/Surgery Sequence is related to the surgery coded in Surgery of Primary Site. For SEER, the mastectomy will be coded in the surgery field. The chemotherapy occurred before the mastectomy.
Multiplicity Counter/CS Tumor Size: The Multiplicity Counter rule 6c states "Use code 99 when the tumor is described as diffuse". Is code 99 used in all circumstances when tumor size is coded to 998? See Discussion.
The CS manual lists esophagus, stomach, familila/familial polyposis (colon), lung, and breast as the only circumstances when code 998 is valid. If this is correct, then if TS is coded to 998, then Multiplicity Counter must be 99.
If the number of tumors is known, code the number in Multiplicity Counter. If the number of tumors is not known, assign code 99. If "diffuse" is the only information available to describe the tumor, assign code 99.
Type of Multiple Tumors--Colon: How is this field coded for a case in which the patient is found to have two in situ polyps and an adenocarcinoma arising in a polyp all in the same segment of the colon? See Discussion.
Code 30 would not count the fact that these are polyps. Code 31 states "AND a frank adenocarcinoma." What would be the correct code?
Assign code 30 [In situ and invasive] in this case. Code 31 does not apply here because frank adenocarcinoma is not present.
MP/H rules/Histology--Lung: How is histology coded for a path diagnosis of "pleomorphic carcinoma with adenocarcinoma, squamous, clear cell and spindle components"? Please see discussion.
Path diagnosis of lung tumor is pleomorphic carcinoma, with adenocarcinoma, squamous, clear cell, and spindle cell components. Path comment states: "While the majority of tumor displays usual adenocarcinoma-type features, elsewhere the tumor shows varying differentiation, including squamous, clear cell and spindle cell differentiation. Therefore the tumor is best categorized as pleomorphic carcinoma."
This tumor is best described by a non-specific histology. However, the MP/H rules guide the abstractor to identify a more specific histology. If we work through the lung rules, would we end up using rule H7 and code the histology with the numerically highest ICD-O-3 code?
For cases diagnosed 2007 or later, assign histology code 8022 [pleomorphic carcinoma] based on the pathologist's assessment and rule H3. He/she reviewed all of the histologic components and rendered a final diagnosis of pleomorphic carcinoma.
"Components" is not a term indicative of a more specific histology. See note under rule H5.
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