First Course of Therapy/Hormone Therapy--Meningioma: Should Sandostatin be coded as treatment for a Grade 1 meningioma? Patient had surgery and was somatostatin receptor 2 (SSTR2) positive by immunohistochemistry.
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.
Solid Tumor Rules/Histology--Fallopian Tube: How is histology coded for a high-grade serous carcinoma with admixed yolk sac tumor of the right fallopian tube? See Discussion.
There was a single right fallopian tube tumor with two distinct morphologies. The diagnosis comment states, “The combined morphologic and immunohistochemical features are best classified as primary fallopian tube high grade serous carcinoma with a somatically derived yolk sac tumor.”
Assign high-grade serous carcinoma of the fallopian tube (8461/3). There is currently no code to capture this rare mixed histology. Yolk sac tumors rarely occur in the fallopian tubes of postmenopausal patients and are associated with poor outcome. It is important to document the findings in the appropriate text field.
Reportability--Head & Neck: Are high-grade squamous dysplasia / “severe” squamous dysplasia or glandular intraepithelial neoplasia reportable for all Head & Neck subsites? If so, what year did they become reportable? In reviewing SINQ 20240003, 20230047, and 20230046, it appears that at least the larynx, mandible, and tongue have been reportable since 2021. However, 8077/2 and 8148/2 histology codes are not included in the Solid Tumor Rules (STRs) (2025 update) for Head and Neck, either in Tables 1-9 or the H Rules.
High grade squamous dysplasia (8077/2) is reportable for head and neck sites for cases diagnosed as of 01/01/2021. High grade glandular intraepithelial neoplasia / glandular intraepithelial neoplasia grade III (8148/2) and high grade squamous intraepithelial neoplasia / squamous intraepithelial neoplasia grade III (8077/2) are reportable for head and neck sites for cases diagnosed as of 01/01/2001. Refer to other standard setters’ criteria for reportability as appropriate.
Diagnostic Confirmation--Heme & Lymphoid Neoplasms: How
is Diagnostic Confirmation coded for hematopoietic and lymphoid neoplasms (heme)
when immunophenotyping, genetics, etc. confirm the diagnosis.
Assign Code 3 (Positive histology PLUS positive immunophenotyping or genetic testing) for
1. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis), AND
Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme Database, AND
Testing
Confirms
the neoplasm OR
Identifies a more specific histology (not preceded by ambiguous terminology)
Peripheral blood smear followed by flow cytometry (most commonly done with CLL/SLL, 9823/3)
2. A not otherwise specified (NOS) histology diagnosed and not a provisional diagnosis, AND genetic/immunophenotyping was performed and positive
Refer to the current version of the Heme Manual for specific notes and examples when coding Diagnostic Confirmation.
Reportability/Histology--Adrenal Gland: Is a case of pheochromocytoma reportable? The adrenal resection that was sent out for expert review final diagnosis is: Pheochromocytoma Impression with comment: Benign Pheochromocytoma based on Pheochromocytoma of the Adrenal gland Scaled Score (PASS) of 4.
Report pheochromocytoma (8700/3). According to WHO Classification of Endocrine and Neuroendocrine Tumors, 5th edition, patients with pheochromocytomas are currently considered to have a lifelong risk of metastases and therefore conceptually they are all considered ‘malignant.’
SEER Manual/Reportability/Histology: Is severe dysplasia reportable? This is commonly listed as a synonym for high grade dysplasia. Is this term "severe dysplasia" reportable in the sites where high grade dysplasia is reportable? This is listed as a synonym, but it is not clear. See Discussion.
We are seeing cases on this in head and neck. The College of American Pathologists Oral Cancer Protocol is showing this as keratinizing dysplasia, severe (carcinoma in situ) and nonkeratinizing dysplasia, severe (carcinoma in situ). SINQ Question 20230047 shows it as reportable for head and neck.
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.
Reportability/Behavior--Ovary: Is ovarian mucinous
borderline tumor with foci of multifocal intraepithelial carcinoma reportable?
Report ovarian mucinous borderline tumor with foci of
multifocal intraepithelial carcinoma. The foci of intraepithelial carcinoma
makes this reportable. See the list of synonyms for in situ in the SEER Manual,
Behavior Code data item.
Solid Tumor Rules/Histology--Lung: How is histology coded and which H Rule applies for a lung adenocarcinoma when the greatest percentage of the adenocarcinoma is stated to be, "solid; complex glands (cribriform and fused glands) (50%)"? See Discussion.
In 01/2023, right lower lobectomy final diagnosis proved
a single adenocarcinoma tumor with the histological patterns described as
acinar (20%), papillary (30%) and solid; complex glands (cribriform and fused
glands) (50%). There is no H Rule applicable to a complex glandular pattern
adenocarcinoma. Is this equivalent to a solid predominant adenocarcinoma (8230)
per Rule H7? Or is the predominant adenocarcinoma a mixed subtype coded as 8255
per Rule H9?
Histology code 8255/3 best identifies this histology. Complex glands in lung tumors are often associated with a poor prognosis and represent a high-grade pattern in lung cancer grading systems. This histology is not currently recognized as a variant by WHO.
EOD 2018/EOD Regional Nodes--Oropharynx: Is code 550 missing “< equal to 6 cm” in the data item EOD Regional Nodes for Oropharynx HPV-Associated, Version 9? Otherwise, bilateral or contralateral lymph nodes with extranodal extension (ENE) that are >6 cm could fit into 550 OR 650.
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.
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