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Since this HSIL diagnosis is specified as VIN II, do not report it.

WHO includes both VIN II and VIN III as synonyms for HSIL of the vulva. HSIL is reportable and VIN III is reportable. VIN II is not reportable.

Since the first diagnosis is in situ, and the later diagnosis is invasive, the 2019 diagnosis is a new primary even though it may be the same non-treated tumor.

For cases diagnosed 2018 and later, abstract multiple primaries according to the 2018 Breast Solid Tumor Rules, Rule M17 that states

Abstract multiple primaries when an invasive tumor occurs more than 60 days after an in situ tumor in the same breast.

Note 1: The rules are hierarchical. Only use this rule when none of the previous rules apply.

Note 2: Abstract both the invasive and in situ tumors.

Note 3: Abstract as multiple primaries even if physician states the invasive tumor is disease recurrence or progression.

Note 4: This rule is based on long-term epidemiologic studies of recurrence intervals. The specialty medical experts (SMEs) reviewed and approved these rules. Many of the SMEs were also authors, co-authors, or editors of the AJCC Staging Manual.

Severe dysplasia alone is not reportable. No further instructions apply because this term is not reportable.In order to use the instructions for behavior, you must first have a reportable neoplasm.

If carcinoma in situ is mentioned and there is microinvasion, code the behavior as /3 according to the instructions in the SEER manual.

You are correct, do not accession severe dysplasia as equivalent to carcinoma in situ unless the pathologist also states the severe dysplasia is equivalent to carcinoma in situ (e.g., ).

Serous tubal intraepithelial neoplasm (neoplasia) (STIN) is not equivalent to serous tubal intraepithelial carcinoma (STIC). Report STIN only when stated to be high grade. STIC is reportable. Do not report STIL.

According to our expert pathologist consultant, STIL and STIN are broad descriptive terms that reflect proliferation of epithelial cells with varying degrees of atypia, with the most developed, STIC, reflecting convincing neoplastic change.

Sequence the brain tumor in the 60-87 series when you do not know the behavior. If you have reason to believe the brain tumor was malignant, sequence it in the 00-59 series.

Self-reported information is the highest priority for coding race. That is because the race information for the U.S. population comes from census data and that information is self-reported. For national cancer statistics, in order for the numerator (cancer cases) and the denominator (population) to be comparable, use self-reported race information whenever it is available. We will add this clarification to the SEER manual.

Segments 2, 3, and 4 correspond to the left lobe of the liver. Segments 5, 6, 7 and 8 correspond to the right lobe of the liver. Segment 1 is the caudate lobe, which has completely different drainage and vascularization, is separate from the larger right and left lobes.

For cases diagnosed 1998-2003: Since segments 5 and 7 are both in the right lobe, assign EOD-extension code 30 for the case above, unless there is mention of vascular invasion. Be sure to record the size of the largest primary tumor.

Tumor size and vascular invasion are the most important factors for AJCC 6th edition staging.

SEGA (Subependymal giant cell astrocytoma) is reportable if diagnosed in 2004 or later. Tuberous sclerosis complex (TSC) is not a neoplasm and is not reportable. SEGA is a neoplasm that commonly occurs in TSC patients.

Refer to the reportability instructions on pages 5-7 in the SEER manual, https://seer.cancer.gov/manuals/2016/SPCSM_2016_maindoc.pdf

SEER will answer the question about the number of primaries to accession. Submit questions about stage to the CoC CAnswer Forum.

For cases diagnosed 2007 or later: Accession two primaries: a mixed adenocarcinoma, acinar and papillary types [8255/3] and a bronchioloalveolar carcinoma, non-mucinous [8252/3].

The steps used to arrive at this decision are:

Determine the histology code for each tumor prior to applying the Multiple Primary Rules to determine the number of primaries to accession. There are two non-small cell carcinomas, NOS; the histology code for these two tumors will be 8046/3. There is a single adenocarcinoma with acinar and papillary subtypes tumor, the histology for this tumor will be 8255. There is a single bronchioloalveolar carcinoma, non-mucinous subtype tumor; the histology for this tumor will be 8252/3.

Open the Multiple Primary and Histology Coding Rules manual. Choose one of the three formats (i.e., flowchart, matrix or text) under the Lung Multiple Primary rules to determine the number of primaries.

Start at the MULTIPLE TUMORS module, Rule M3, because this patient has multiple tumors. The rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3] are multiple primaries.

Perform a second pass through the Multiple Primary rules to determine whether the two non-small cell carcinomas [8046/3] are multiple primaries or manifestations of the same primaries identified in Step 3.

Start at Rule M3 again because this patient has multiple tumors. Again, these rules are intended to be reviewed in consecutive order within the module (from Rule M3 to Rule M12 in this case). Stop at the first rule that applies to the case you are processing. This patient's non-small cell carcinomas, NOS [8046/3] are a single primary when compared to the adenocarcinoma with acinar and papillary subtypes [8255/3] and non-mucinous bronchioloalveolar carcinoma [8252/3]. Both of these histologies are more specific types of non-small cell carcinoma per the Lung Histology Groups and Specific Types Chart (Chart 1).

You can also apply Rule M10 for both non-small cell carcinoma, NOS [8046/3] compared to adenocarcinoma with acinar and papillary subtypes [8255/3] and non-small cell carcinoma, NOS [8046/3] compared to non-mucinous bronchioloalveolar carcinoma [8252/3].

SEER has not established a priority for assigning the Reason for No Surgery of Primary Site codes. Assign the code which best describes the reason surgery was not performed.

Example: Assign code 2, Contraindicated due to patient risk factors. According to the physician, this is the reason that surgery was not performed.