Reportability/Histology--Soft Tissue: Is superficial CD34 positive fibroblastic tumor reportable and if so what histology code should be used? See Discussion.
Patient had a left thigh soft tissue mass excision on 7/24/24 and was diagnosed with superficial CD34 positive fibroblastic tumor. Margins were narrowly free of disease. Tumor size was 5.5 cm x 4.4 cm x 3.9 cm. The diagnosis was confirmed.
Do not report superficial CD34-positive fibroblastic tumor (8810/1) of the thigh.
WHO Classification of Soft Tissue and Bone Tumors, 5th ed., defines superficial CD34-positive fibroblastic tumor as a distinctive low-grade neoplasm of the skin and subcutis, most frequently occurring in the lower extremities, especially thigh, followed by arm, buttock, shoulder, and rarely, vulva.
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/Histology--Heme
& Lymphoid Neoplasms: Is a diagnosis of myeloid stem cell disorder or
myeloid stem cell neoplasm reportable when the differential diagnosis includes
only reportable neoplasms? If so, how should histology be coded? See Discussion.
Pathologists are increasingly using the terms "myeloid stem cell disorder" and "myeloid stem cell neoplasm" to describe reportable myeloid neoplasms. If the pathologist uses these terms and indicates the differential diagnosis includes only reportable neoplasms such as myelodysplastic syndrome, myeloproliferative neoplasm, and acute myeloid leukemia (AML), should this be accessioned as a reportable primary?
Example: The 01/2023 peripheral blood shows high grade myeloid stem cell disorder, and the differential diagnosis includes chronic
myelomonocytic leukemia(CMML) and AML. The patient refused further work-up and expired several days later. No additional information is available.
Report the case when the differential diagnosis includes only reportable neoplasms
in the absence of additional information. We are unable to provide
general instructions for provisional diagnoses as each situation will need to be
reviewed and assessed individually when no further work-up information is available.
Assign myeloid
leukemia, NOS (9860/3) to the case described in the example. Assign a generic histology code because a specific
histology code cannot be assigned when there are several differential diagnoses. Since the differential
diagnoses include a chronic and an acute leukemia, code as myeloid leukemia, NOS since it is not clear if this is chronic or acute.
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.
Reportability/Behavior:
Our registry collects some borderline (behavior /1) cases that are not
reportable to SEER or any other standard setters. Can we assign a behavior code
of /2 to these cases?
Do not assign a behavior code of /2 to these cases unless you
have a way to flag them so that they are not reported to the standard setters
as in situ cases. Work with your state central registry to ensure that these cases are not unintentionally included in state case submission.
Sequence Number--Central/Reportability--Heme &
Lymphoid Neoplasms: Is a hematolymphoid disease included in the sequencing if it
was not reportable at the time of diagnosis?
Do not include the disease in the sequencing if the
original hematolymphoid disease was not reportable at time of diagnosis.
The 2025 SEER Manual Sequence Number--Central
Coding Instruction 1.a advises: A ‘reportable’ primary refers to the
site/histology/behavior of the tumor and the years when reporting was required.
Review of the reportability requirements in effect during the diagnosis year
will be needed.
Immunotherapy/Other
Therapy--Heme & Lymphoid Neoplasms: Is the elimination of immunosuppression
treatment coded as other treatment? An example is when a post-transplant
patient develops a malignant myeloproliferative neoplasm that subsides when
immunosuppression drugs are stopped.
Do not code as a treatment. Record the cessation of
immunosuppressive drug treatment in text to explain the patient’s change in
disease status.
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.
Solid Tumor
Rules/Multiple Primaries--Testis: How many primaries and what M Rule applies
when metastatic seminoma is diagnosed greater than 40 years after a left
testicular teratoma with yolk sac tumor and embryonal carcinoma? See
Discussion.
The patient was diagnosed with a left testis primary in the early 1980s that did not include a seminoma component per the information available. The slides were not available for review. In 2024, the patient was found to have a metastatic seminoma involving multiple pelvic lymph nodes and the prostate. The right testicular ultrasound was negative. The managing physician noted this was both a "relapsed seminoma" and a "Stage IIC seminoma."
Should the new diagnosis of metastatic seminoma be accessioned as a new primary based on the histology differences? Or is this situation similar to SINQ 20160073 in which this is a single primary even though the metastases are a distinctly different histology?
Without evidence of a new testicular tumor, record this as a single primary now with metastatic disease (seminoma). The seminoma may not have been identified in the original tumor and treatment was based on the histologies found. This allowed the seminoma to metastasize.
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