MP/H Rules--Breast: Is inflammatory breast cancer always one primary per lifetime? Or is a subsequent inflammatory breast cancer a second primary if diagnosed more than five years later?
For cases diagnosed 2007 or later, a diagnosis of inflammatory breast cancer more than five years after a previous diagnosis of inflammatory breast cancer is a separate (new) primary. See rule M5 in the Breast Multiple Primary Rules.
Date Multiple Tumors--Prostate: For a prostate biopsy done 10/20/08, both lobes involved with tumor, unknown how many tumors, what would be coded in date of multiple tumors?
In this case, code the date of the biopsy in Date of Multiple Tumors [10202008]. When the number of tumors is unknown, code the date of diagnosis as the Date of Multiple Tumors. This is the date on which it was determined that there were an unknown number of tumors. This instruction will be added to next edition of the MP/H manual.
CS Extension--Brain and CNS: How is this field coded for a malignant tumor presenting as a confluent lesion over right parietal, posterior frontal and thalamic regions?
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.
Assign CS extension code 40 [Tumor crosses the midline; Tumor involves contralateral hemisphere; Tumor involves corpus callosum (including splenium)]
The thalamus is located between the corpus callosum and the cerebellum and brain stem. A supratentorial tumor extending to the thalamus involves the corpus callosum (extension code 40) but has not yet reached the cerebellum or brain stem. Code 40 applies, but code 50 or any higher code is not applicable in this case.
Laterality--Brain and CNS: When a meningioma extends to both right and left sides, is laterality coded 4 for bilateral or 9 for midline? See Discussion.
Operative Findings: Bilateral frontal craniotomies for excision of giant meningioma which extended onto optic chiasm.
Path: Bifrontal tumor, 6.5 cm meningotheliomatous meningioma.
If it is not possible to determine whether the meningioma originated on the left or the right, assign code 4 [Bilateral involvement, lateral origin unknown; stated to be single primary].
Reportability--Brain and CNS: Is hygroma reportable? See Discussion.
Benign brain guidelines indicate that named tumors that have been assigned an ICD-O-3 code are reportable. However, per I&R: "Most cystic hygromas (9173/0) are fetal malformations and occur in patients less than two years old. If this patient was an adult, they are primarily treated with surgery. Hygroma (used in a general sense) is a response to trauma (i.e., subdural hematoma) and as such, is not a "new growth" and would not be reportable either as a cyst or as a neoplasm. Unless the patient had some sort of operation, I'd hesitate to include the case as a reportable benign tumor."
How is the cancer registrar to distinguish between reportable and non-reportable hygromas? Example: Brain MRI showed diffuse cerebral volume loss and incidental bilateral frontal subdural hygromas (histology code 9173/0).
Reference: I&R 14825
Hygromas are not reportable. This instruction will be added to the next revision of the benign brain rules.
According to an expert in the field, hygromas are not neoplastic. Hygromas are cystic dilations of a localized subarachnoid or subdural accumulation of clear fluid related to an excess accumulation of CSF, typically related to an old hemorrhage that somehow prevents reabsorption of CSF.
#2: Invasive ductal carcinoma, well-differentiated, 1.0cm (12:30 o'clock). -Minor component of DCIS, low-grade? See Discussion.
In the MP/H Rules, Table 1 lists apocrine as a type of intraductal carcinoma. Apocrine does not appear in Table 2, the list of specific duct carcinomas. If Apocrine is a type of ductal carcinoma, then Rule M11 would make this a single primary. If it is a single primary, what is the histology?
For cases diagnosed 2007 or later:
Using rule M11, there is one primary in the left breast. Apocrine is a specific duct carcinoma. To make this more clear, apocrine will be added to Table 2 in a future revision.
To code the histology, go to the multiple tumors module and start with rule H20. Stop at rule H29 and code the histology with the numerically higher ICD-O-3 code, 8500/3.
Reportability/Diagnostic Confirmation: If a physician signs a case out as "precancerous melanosis of the face" (8741/2) and there is no microscopic confirmation of the disease, is thisĀ a reportable clinical diagnosis?
This case is reportable because the diagnosis of precancerous melanosis was stated by a recognized medical practitioner. Precancerous melanosis meets the reportable diagnosis criteria (See 2007 SEER Manual page 1).
MP/H Rules--Breast: How many primaries for the following?
Breast lumpectomy: Three foci of invasive ductal carcinoma.
Tumor nodule #1 - Invasive ductal carcinoma.
Tumor nodule #2 - Invasive ductal carcinoma with tubular features.
Tumor nodule #3 - Invasive tubular carcinoma.
See Discussion.
According to the MP/H rules, this case is reportable as three primaries with histologies coded 8500, 8523 and 8211. However, our QC staff is having a problem accepting this. When the pathologist specifies that a ductal carcinoma has tubular features or is tubular type, isn't s/he saying that tubular is a type of duct? In addition, the first line of the FDx states, "Three foci of ductal carcinoma," which indicates that the pathologists interprets the three nodules to be ductal carcinoma.
For cases diagnosed 2007 or later:
These three tumors are three separate primaries. Rule M12 applies.
According to the 2007 MP/H rules, tubular carcinoma is not a type of duct carcinoma.
Among the paramount reasons for writing the MP/H rules are the non-standard usage of nomenclature by physicians and the inconsistency in interpretation of these non-standard phrases. The MP/H rules must be applied consistently by each cancer registrar in order for data to be comparable across registries.
Histology--Pancreas: What is the correct code for "non-secretory pancreatic endocrine tumor" with positive lymph nodes on excision indicating a malignant tumor? Pathologist indicated it was not an exocrine tumor.
Code as islet cell carcinoma [8150/3].
There are several cell types in the islets, and each produces a different hormone. The custom has been to name the tumors by their hormone production e.g. insulinoma, glucagonoma, etc. Occasional tumors do not produce any hormone (at least one that can be determined or measured). These tumors are called non-functioning endocrine tumors. Most of the endocrine tumors in the pancreas are islet cell tumors.