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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.

In the SEER Program Coding and Staging Manual 2023, under clinical tumor size (page 115, item #12), it states: “For breast tumors, clinical size may be recorded based on the size of a non-mass enhancement (NME). NME is defined as an enhancing abnormality that is not associated with the three-dimensional volume of a mass, shape, and outlining, and it is separate from Background Parenchymal Enhancement (BPE).” This guidance does not appear to have been carried forward into the Tumor Size Summary coding instructions.

Lymphangioleiomyomatosis (LAM) became reportable (9174/3) for diagnoses 2023 and later. While this neoplasm was only added to the Lung schema in the Solid Tumor Rules manual, this is a mesenchymal neoplasm which may arise outside of the lung and the reportability change was not limited to LAM of the lung.

How should primary site be coded when a left pelvic lymph node dissection for an unrelated high-grade serous carcinoma of the right fallopian tube incidentally proved LAM in the pelvic lymph nodes? The pelvic lymph nodes were the only site of involvement; there was no evidence of lung involvement. As this is a mesenchymal tumor, should the primary site default to C499 (Soft tissue, NOS) according to the default primary site rule for sarcomas described in the SEER Manual? Or should the primary site be coded to C775 (Pelvic lymph nodes) as this was the only proven site of involvement?

Smoldering multiple myeloma is reportable. However, it is unclear if a diagnosis of borderline smoldering multiple myeloma should be accessioned when no further follow-up with the physician is possible. The physician stated the patient, "most likely has borderline smoldering multiple myeloma, but mostly MGUS," and further noted the definition of smoldering myeloma requires at least 10% of plasma cells involved with the neoplasm and some areas of the patient's bone marrow does meet the 10% plasma cell threshold. The physician noted the patient does not need treatment because of the favorable cytogenetics and lack of organ dysfunction.

Should the term "borderline" be ignored and the case accessioned? Or is a borderline smoldering myeloma non-reportable?

According to the AJCC CAnswer Forum (https://cancerbulletin.facs.org/forums/node/160948), celiac axis nodes are considered regional for the liver. However, for liver primaries, Extent of Disease (EOD) regional lymph nodes list the following as regional lymph nodes:

• Caval
• Hepatic, NOS
  • Hepatic artery
  • Hepatic pedicle
  • Inferior vena cava
  • Porta hepatis (portal) (hilar) [in hilus of liver]
• Periportal
• Portal vein
• Regional lymph node(s), NOS

Based on this information, should celiac axis lymph nodes be considered as regional for liver primaries when coding EOD Regional Nodes?

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.”

The bone marrow was involved by lambda-restricted atypical B-cell and plasma cell populations with MYD88 mutation. Together these populations represent 10-15% of the bone marrow cellularity. While the bone marrow biopsy pathology alone did not provide a reportable diagnosis, the oncologist clinically diagnosed this as smoldering WM in the medical record.

Is a diagnosis of smoldering WM similar to a diagnosis of smoldering multiple myeloma (MM), a reportable Heme neoplasm, since smoldering neoplasms may be considered to meet the neoplasm’s threshold in the bone marrow but is otherwise asymptomatic?