MP/H Rules/Multiple Primaries--Breast: How many primaries are abstracted when bilateral breasts contain DCIS? Is a physician statement referring to this situation as one primary ignored? See Discussion.
Patient has microcalcifications both breasts. Has bilateral mastectomy. Path report states Left breast multifocal DCIS predominantly micropapillary. Right breast two foci of DCIS micropapillary.
For cases diagnosed 2007 or later:
There are two primaries in this case.
Using the 2007 MP/H rules for breast, go to the multiple tumors module and start with Rule M4. Stop at rule M7. Tumors on both sides (right and left) are multple primaries.
Always use the 2007 Multiple Primary rules to determine the number of primaries. Do not use the physician statement.
Multiplicity Counter--Prostate: How is multiplicity counter to be coded for a clinically inapparent prostate cancer for which sextant needle biopsy cores on left and right sides are positive for adenocarcinoma? See Discussion.
Prostate cancer typically presents as multifocal diffuse disease. The coding exercise in the MPH rules presentations coded prostate cancer as one tumor.
Reference: SEER Training Web Casts - Other Sites Rules Practicum
Code the number of tumors present if known. This information can be taken from any part of the record, including imaging and prostatectomy. If the only information available is "diffuse," or "multifocal," assign code 99. Do not assume there are multiple tumors just beacause there are multiple biopsies. When there is no information about the number of tumors, code Multiplicity Counter to 99 and Type of Multiple Tumors to 99.
Grade, Differentiation--Bladder: Can grade be coded from the pathology report for a recurrent bladder cancer specimen? See Discussion.
In 2006 a TURB was done for bladder carcinoma diagnosed 10 years ago. Is grade always coded 9 on class 3 cases unless the original slides were reviewed?
Code grade from the original tumor; do not code grade from recurrence.
If the grade of the original primary tumor is specified, code it, regardless of class of case.
MP/H Rules/Histology--Brain: How many primaries are reported and what is the histology for a single brain tumor described as a low grade astrocytoma at the time of the initial partial resection and a low grade glioneuronal neoplasm at the time of the subsequent total resection? See Discussion.
On 4/20/07 a partial resection of a brain tumor is interpreted as low grade astrocytoma. Patient has a gross total resection on 8/13/07 with this diagnosis: low grade glioneuronal neoplasm (see comment). Comment: This case has been reviewed at ---. Dr. agrees with our interpretation (low grade glioneuronal neoplasm, possibly a dysembryoplastic neuroepithelial tumor).
For cases diagnosed 2007 or later, this is a single primary. A single tumor is always a single primary.
Assign histology code 9400/3 [Astrocytoma, low grade]. This diagnosis was not revised or amended based on the later surgery. It is possible that the malignant component was entirely removed during the first surgery.
MP/H Rules/Histology--Thyroid: Is a "papillary carcinoma of the thyroid" coded to 8260/3 [Papillary adenocarcinoma] per the ICD-O-3 because it lists "papillary carcinoma of the thyroid" as a synonym for that code or should it be coded to 8050 [Papillary carcinoma, NOS]?
For cases diagnosed 2007 or later, assign code 8260 [papilary carcinoma of the thyroid].
Multiplicity Counter--Thyroid: How is multiplicity counter to be coded for a thyroid cancer presenting as multiple foci? See Discussion.
Thyroidectomy showed papillary thyroid carcinoma. Path diagnosis: tumor focality: multifocal. Path described 3 foci of tumor on each side. The main tumor mass in right thyroid was 1.5 cm. Smaller foci of tumor ranged in size from .1 cm to 1.0 cm. Per guidelines, "we still don't count foci as tumors for the purpose of these rules, even if there is more than one." The 1 cm tumor was probably macroscopic in size. Do we count it in the multiplicity counter? Do we count only the 1.5 cm main tumor mass?
If the number of tumors is known, code the number in Multiplicity Counter. If foci are measured, include them in the multiplicity counter. If the only information available is "multiple foci" assign code 99.
For the case above, code 06 in the multiplicity counter (3 tumors on each side).
Surgery of Primary Site--Breast: Should code 51 (Modified radical mastectomy without removal of uninvolved contralateral breast) be used when a patient has excisional biopsy (22) and axillary dissection followed by a simple mastectomy without removal of uninvolved contralateral breast (41) as part of the first course of treatment?
Assign code 51 or 52 if a patient has an excisional biopsy and axillary dissection followed by a simple mastectomy during the first course of therapy. Code the cumulative result of the surgeries, which is a modified radical mastectomy in this case.
SEER collects only one surgery code per case. Code the most invasive, extensive or definitive surgery in Surgery of Primary Site.
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.
MP/H Rules/Multiple Primaries--Breast: How many primaries are to be abstracted when two tumors occur in one breast and both are ductal with the smaller tumor representing tubular carcinoma [variant]? See Discussion.
Right breast partial excision: Two invasive foci, one measuring 0.2cm and the second measuring 0.5cm. Both lesions are ductal carcinoma with the smaller representing tubular carcinoma (variant).
The breast histology table does not list tubular as a type of ductal, however, the pathologist states ductal carcinoma, tubular variant.
For cases diagnosed 2007 or later, this is two primaries of the right breast, using the 2007 MP/H rules. For the purposes of the 2007 rules, tubular is not a specific type of duct. Duct carcinoma (8500) and tubular carcinoma (8211) are different at the second digit of the histology code. Rule M12 applies, making these separate primaries.
CS Lymph Nodes--Kidney, renal pelvis: Under what circumstances would code 80 [Lymph nodes, NOS] be used to document the presence of positive lymph nodes? See Discussion.
The CS Schema for Kidney (Renal Parenchyma) states to use code 70 for Regional Lymph Nodes, NOS. The schema for for Renal Pelvis states to use code 50 for Regional Lymph Nodes, NOS. Both schemas have a Code 80, for Lymph Nodes, NOS that maps to N1 in both schemas.
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.Code 80 can be used for positive lymph nodes when you are unable to determine if they are regional or distant. CS Lymph Nodes code 80 is provided for this situation in accordance with the downstaging rule.
Code 80 should be used very infrequently and only when there is no indication whether the involved lymph nodes are regional or distant.
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