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Update the histology and behavior based on the invasive tumor when an invasive tumor is diagnosed within 5 years of an in situ tumor in the same breast. This will be updated in the 2021 revisions of the Breast Solid Tumor Rules.

UPDATE JUNE 2026

Assign code 5 in Diagnostic Confirmation. We consulted with an expert hematopathologist who stated that SPEP would qualify for a diagnostic confirmation code of 5. He also stated that normally a SPEP is followed by a bone marrow biopsy.

Per the Hematopoietic Database under the Abstractor Notes:

Serum protein electrophoresis (SPEP) can be used as a definitive diagnostic method in the absence of a bone marrow biopsy. Normally a positive SPEP is followed by a bone marrow biopsy. If a bone marrow biopsy is not done, or the tissue is insufficient from a bone marrow biopsy and the physician states the patient does have multiple myeloma based on the SPEP, diagnostic confirmation would be 5.

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.

Update August 2026:

See SINQ 20240038 for an update. This original answer no longer applies.

This case does not fall into the standard rules. WHO criteria for diagnosing pituitary adenoma have recently changed (per 5th Ed WHO CNS book) and we will likely see more PitNET’ s than pituitary adenomas in the future. PitNET may be invasive or non-invasive but the likelihood of the pathologists providing this information is low. Since we don’t know if the 2018 adenoma was a PitNET based on current criteria or if it transformed to the malignant neoplasm, err on the side of caution and abstract a second primary per M5.

This issue is new, and we’ve received numerous questions concerning pathologist reviewing older cases of pituitary adenoma and reclassifying them as PitNET using the new criteria.

Typically, the final diagnosis of the reviewing pathologist is the one used to determine whether the case is SEER reportable. If two or more reviewing pathologists disagree as to whether the case should be reportable, determine reportability based on the following priority order:

1) If the patient is treated for cancer, the case is reportable.

2) If the patient is not treated for cancer, use the amended diagnosis on the original pathology report if the hospital pathologist used the reviewing pathologists' opinions in establishing his new diagnosis.

3) If there is not an amended diagnosis for the original hospital pathology report, use the clinician's opinion regarding what the diagnosis is to determine whether the case is reportable.

Tumoral melanosis (TM) alone is not reportable. It is not listed in ICD-O-3. TM can be associated with a regressed melanoma, but it can also occur with other cutaneous tumors. The case is reportable if there is a diagnosis of melanoma.

Tubular adenoma with high grade dysplasia and focal invasion is reportable. Assign the histology code and behavior as 8210/3 (Adenocarcinoma in tubular adenoma).

NAACCR Guidelines for ICD-O-3 Implementation discuss the term high grade dysplasia (without invasion). High grade dysplasia and related terms are under review and study for consideration as a reportable neoplasm. Registries should check with their state reporting legislation to see if included in the reporting requirements.

Trichoblastic carcinoma of the skin is not reportable. The WHO classification lists trichoblastic carcinoma as a synonym for basal cell carcinoma, 8090/3. Basal cell carcinoma of the skin is not reportable. See page 11 in the SEER manual, http://seer.cancer.gov/manuals/2015/SPCSM_2015_maindoc.pdf.

This very interesting case is not reportable to either facility. Since the right lower lobe nodule was resected prior to transplantation, the case does not belong to your patient. Ideally, the cancer should be assigned to the donor; however, donor information is confidential.

This would be a Diagnostic Confirmation of 8 based on the physician's diagnosis.

The Pathology report mentions plasma cell neoplasm only. By itself, plasma cell neoplasm is not reportable because it includes a variety of diseases, some that are not reportable, and some that are (See Hematopoietic Database under Plasma Cell Neoplasm.)

The physician probably has other information, including imaging, which may show lytic lesions. He/she is probably using clinical findings, plus findings from the bone marrow, and diagnosing this patient with multiple myeloma.