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Multiple Primary and Histology Coding Exercises Case #1 Patient has a right colon resection after a polyp with invasive carcinoma was found on a screening colonoscopy. Pathology report reads: Final Diagnosis: Tumor Site: Ascending colon. Histologic type: Adenocarcinoma arising in a villous adenoma. How many primaries? Which rule? What is the histology? Which rule? Case #2 Patient has a left hemicolectomy for a colon cancer that was found on colonoscopy. Pathology report reads: Tumor #1: Tumor Site: Transverse colon. Histologic type: Adenocarcinoma. Tumor #2: Tumor Site: Descending colon. Histologic type: Adenocarcinoma. How many Primaries? Which rule? What is the Histology? Which rule? KCR Abstractor’s Training February 10-12, 2016 Presented By: Nicole Catlett, CTR Case #3 Patient has a right hemicolectomy performed after a cancer was found on colonoscopy. The pathology report reads: Tumor #1 Tumor site: Ascending colon Histologic type: Invasive Adenocarcinoma arising in a tubulovillous adenoma. Extent: Invasion of muscularis propria. pT2 Tumor #2 Tumor site: Ascending colon Histologic type: Invasive Adenocarcinoma. Extent: Invasion through bowel wall into pericolic fat. pT3. How many primaries? Which rule? What is Histology? Which rule? Case #4 Patient has a colonoscopy where multiple polyps are seen in the left colon. Patient then has a left hemicolectomy. The pathology report reads: Tumor #1 Tumor Site: Descending colon. Histologic type: Tubulovillous adenoma with invasive adenocarcinoma present. Tumor #2 Tumor Site: Descending colon. Histologic type: Adenomatous polyp with focus of invasive adenocarcinoma. How many primaries? Which rule? What is Histology? Which rule? KCR Abstractor’s Training February 10-12, 2016 Presented By: Nicole Catlett, CTR Case #5 Patient has a history of Adenocarcinoma of Transverse Colon diagnosed 5 years ago s/p segmental resection. The patient now has been diagnosed with invasive mucinous adenocarcinoma in the Sigmoid colon. How many primaries? Which rule? What is the Histology? Which rule? Case #6 Patient has history of Ascending Colon Adenocarcinoma that was diagnosed 3 years ago s/p segmental resection. The patient now has Adenocarcinoma with signet ring features found at the anastomotic site. The pathology report does not state the percentage of signet ring adenocarcinoma anywhere on the report. How many primaries? Which Rule? What is histology? Which rule? KCR Abstractor’s Training February 10-12, 2016 Presented By: Nicole Catlett, CTR