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The 2027 version of the Hematopoietic Manual (release October 2026) will include the following in the Case Reportability Instructions, pg. 40:

4. “Consistent with” for reportability and casefinding is now a definitive diagnosis and is no longer ambiguous terminology. This is for hematopoietic neoplasms ONLY.

a. “Consistent with” has become a very common way for pathologists to document diagnoses for Hematopoietic neoplasms. In order to ensure that hematopoietic cases are being reported, “consistent with” has now become definitive terminology for casefinding and reportability (see Histology Coding Instructions for assigning histology).

b. Do not apply this instruction to casefinding and reportability for Solid Tumors.

5. Report the case when the diagnosis of a hematopoietic neoplasm is preceded by one or more of the ambiguous terms listed below:

a. This instruction pertains to reportability and case finding only. See the Histology Coding Instructions, #3-5 for instructions on assigning histology with ambiguous terminology (note that “consistent with” has been removed. See Note #4) .

• Apparently
• Appears
• Comparable with
• Compatible with
• Favor(s)
• Malignant appearing

Code the first course of treatment as active surveillance. Chemotherapy is second course of treatment based on this scenario due to progression.

We will add clarification about this type of scenario to the Heme Manual for the 2027 update.

Accession two primaries when a patient has synchronous, separate ductal and lobular tumors using Rule M13, Breast STRs, 2026 Update. Ductal carcinoma (8500/3) and lobular carcinoma (8520/3) are distinct histology terms and codes that are in different rows in Table 3. This is a modification of Rules M10 and H28 from prior versions of the STR Manual.

Assign code A280 for current unilateral oophorectomy with hysterectomy or with a previous history of hysterectomy.

We will remove the text ‘(salpingo-)’ from the Ovary surgery code A280 SEER Note in the next release of SEER Manual.

Report severe dysplasia for selected sites. Not all high grade dysplasia and severe dysplasia are reportable. Refer to the list of examples in the SEER Manual Reportability Section and Appendix E, Reportable and Non-reportable Examples. Check also for other standard setters, state, and local reportability requirements.

High grade dysplasia, severe dysplasia, and carcinoma in situ are equivalent terms with behavior /2. Refer to ICD-O, WHO Classification of Tumors, and the SEER Solid Tumor Rules for preferred histology terms and codes. For example, WHO Classification of Head and Neck Tumors, 5th edition, states carcinoma in situ in the oral cavity is synonymous with severe dysplasia though it is not a recommended term.

Code Sandostatin (octreotide acetate) as hormonal therapy when given including:

· SSTR 2 positive meningioma (NCCN, 2025: smaller studies support the use of targeted therapy including somatostatin)

· Neuroendocrine tumor (NET) (NCCN, 2025: Tumor control: antitumor effect is supported by studies for well-differentiated G1/G2 gastro-entero-pancreatic NET. In lung/thymic NET, somatostatin analogues may be considered if metastatic or SSTR positive).

The SEER*Rx entry for Octreotide Acetate was updated as studies showed somatostatin analogs may shrink tumors or inhibit further growth.

Code 550 is missing “< equal to 6 cm.” In addition, code 650 should include ipsilateral lymph nodes as well.

Revised codes:

Code 550

CLINICAL ASSESSMENT only

Bilateral or contralateral lymph nodes, < equal to 6 cm WITH clinical evidence of ENE

Code 650

CLINICAL ASSESSMENT only

Ipsilateral, Bilateral or Contralateral lymph nodes > 6 cm WITH or WITHOUT clinical evidence of ENE

These changes will be implemented in Version 3.4 (October 2026). We apologize for the error.

Code the primary site to pelvic lymph nodes (C775) as it is the only site involved with this extrapulmonary lymphangioleiomyomatosis (E-LAM).

Update February 2026, note added:

Report this case as smoldering myeloma (9732/3) based on the plasma cell 10% threshold and favorable cytogenetics and lack of organ dysfunction (9732/3). According to the College of American Pathologists Plasma Cell Malignancies Protocol, in order to code smoldering multiple myeloma, both criteria must be met:

• Serum monoclonal protein (IgG or IgA) ≥3gm/dL, or urinary monoclonal protein ≥ 500 mg per 24h and/or clonal bone marrow plasma cells 10-60%

• Absence of myeloma defining events or amyloidosis.

Note: This case was answered by our expert pathologist and applies to this case only. Registrars should not use the plasma cell threshold to determine reportability or histology. The diagnosis must come from the pathologist or the managing physician.

Assign 8020/3 for SMARCA4- deficient malignant neoplasms of the esophagus.

The WHO Classification of Digestive System Tumors, 5th edition, lists undifferentiated carcinoma as 8020/3. Undifferentiated carcinoma of the esophagus is characterized by the frequent loss of SMARCA4 or SMARCA2 by immunohistochemistry.

SINQ 20200057 was updated in August 2025 and assigns code 8044/3 for Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). The 2025 Solid Tumor Manual includes SMARCA4-deficient or SMARCB1-deficient tumors for thoracic and sinonasal sites (8044/3).

Assigning histology to other individual sites should be on a case-by-case basis.