MP/H Rules/Histology--Colon: How do you use Rule H5 or H6 to code "moderately diff adenoca with mucinous component"?
For cases diagnosed 2007 or later, code the histology 8140 [Adenocarcinoma]. Rule H6 applies because the final diagnosis is not "mucinous adenocarcinoma" and the percentage of mucinous adenocarcinoma is not stated.
Rule H13 does not apply because "component" is not a term that indicates a specific histology.
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.
Reportability/Histology--Head and Neck: Is a right cerebellopontine (CP) angle endolymphatic sac papillary tumor (ELST) reportable? If so, what is the histology code?
Revised December 2015
ELST is reportable. Code histology to adenocarcinoma (8140/3). Code primary site to inner ear (C301).
Endolymphatic sac tumors are rare non-metastasizing adenocarcinomas that originate in the endolymphatic sac of the inner ear (C301). They are slow growing and widely invade, and in later stages often destroy, the petrous bone. The WHO Classification assigns ICD-O-3 code 8140/3.
CS Tumor Size: Is a 5.5 mm tumor coded as 005 or 006? See Discussion.
We interpret the CS Manual general instructions to indicate to ONLY round up to 001 when the tumor size is stated to be 0.1 to 0.9mm.
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 CS tumor size 006. Because only whole numbers in mm can be collected, basic mathematical principles are used for rounding; 1-4 round down, 5-9 round up.
CS Extension--Brain and CNS: How is CS Extension coded for a malignant meningioma that demonstrates extension into adjacent brain tissue?
For malignant brain tumors, code 60 represents extension into the meninges. Would code 60 be the correct code for extension from a malignant meningioma into brain tissue?
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 60 for malignant meningioma with extension to adjacent brain tissue.
According to the I&R, this section of CS was taken directly from SEER Summary Staging, since AJCC does not have a staging system for these tumors.
First course treatment--Prostate: If a patient has a prostatectomy and the margins are positive, then several months later radiation is given because the PSA levels never decreased or have risen, is the radiation coded as first course of treatment or subsequent treatment?
Record the radiation as first course of treatment even though it was delayed for several months.
Radiation is highly effective when there is a small or microscopic amount of tissue left at the margin following prostatectomy. In most regions, radiation therapy is the standard of care for positive margins at prostatectomy.
MP/H Rules--Breast: How many primaries should be abstracted when a patient has a mass at 6:00 that showed poorly differentiated ductal carcinoma and a hypoechoic nodule at 9:00 that was excised with no real tumor present there though path showed angiolymphatic invasion by carcinoma throughout the entire specimen? See Discussion.
Palpable mass in right breast at 6:00. Path stated 'poorly differentiated ductal carcinoma with extensive necrosis and extensive angiolymphatic invasion. Focal high grade comedocarcinoma (1%)'. Another hypoechoic nodule was seen at the 9:00 position. This mass was excised from surrounding tissue. This mass was more like an inflammatory mass; there was no real tumor present there. Path report stated "Breast mass 9:00 excisional biopsy - angiolymphatic invasion by mammary carcinoma throughout the entire specimen."
Is this two primaries because of the two different histology codes: 8500 and 8010?
For cases diagnosed 2007 or later, abstract as a single primary using rule M3 (a single tumor is always a single primary). There was one tumor present according to the information provided. The second specimen was not a separate tumor ("There was no real tumor present there").
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.
Surgery of Primary Site--Brain and CNS: How is this field to be coded when a patient undergoes stereotactic biopsy of a brain tumor? Path specimen consists of four fragments of tissue measuring .7, .6 and .3 cm.
Assign code 20 [Local excision (biopsy) of lesion or mass. Specimen sent to pathology from surgical event 20].
MP/H Rules--Breast: Patient has 2 existing primaries, both of left breast and both were pure lobular carcinoma, one was diagnosed in 1994 and the other in 2005. Now a biopsy in 2008 of a supraclavicular lymph node (laterality unknown) and subcutaneous scalp tissue show metastatic DUCTAL carcinoma. Per path report, breast is the primary site. Slides from prior tumors were not reviewed. Should this be made a new primary or assumed to be metastasis from the prior breast tumors? See Discussion.
A modified radical mastectomy was performed on 10/6/94.
The 2007 MP/H rules tell us that multiple ductal and lobular tumors of breast are a single primary; however, the rules do not apply to metastatic tumors.
For cases diagnosed 2007 or later:
Abstract the 2008 diagnosis as a new primary.
Since the primary site is unproven but stated to be breast, and since the laterality is unknown, we cannot determine that the 2008 diagnosis is the same as the 2005 or the 1994 diagnosis.
Revise this case accordingly if more information becomes available.
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