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For cases diagnosed 1998-2003:

Code the EOD-Extension field to 85 [Metastasis] and the SEER Summary Stage 2000 field to 7 [Distant] for both types of tumor. Each kidney and each eye are staged separately in the AJCC, 6th ed., but for SEER we would abstract these diagnoses as one case and code the EOD and stage fields to distant to reflect the involvement of both eyes or both kidneys.

For cases diagnosed 2007 or later:

For date of diagnosis, use the date of the PET scan for both primaries. For the left tumor, assign diagnostic confirmation code 8 [Clinical diagnosis only] and assign histology code 8000/3 [malignant neoplasm].

The left lung mass is reported as a separate primary because there is one tumor in each lung. According to Rule M6, when there is one tumor in the left lung and one tumor in the right lung, each tumor is a separate primary. Tumor and mass are equivalent terms for purposes of the multiple primary rules.

For cases diagnosed prior to January 1, 2008, enter the date of the lymph node biopsy (excisional biopsy or biopsy NOS) as the Date Therapy Initiated for a lymphoma when the biopsy is the first or only therapy performed.

Code Reason for No Surgery of Primary Site as 0 [Surgery of the primary site was performed] and the biopsy of a lymph node is coded to 25 in Surgery to Primary Site.

Do not code a fine needle aspiration or core needle biopsy in Surgery of Primary Site.

This is reportable as 9591/3, B-cell lymphoma, NOS.All diagnoses in the differential are all B-cell lymphomas. The pathologist knows it a B-cell lymphoma but has not determined the subtype. If at a later time a specific lymphoma is determined, update the histology code accordingly. 

For cases diagnosed 2007 or later, assign code 8260/3 [Papillary adenocarcinoma] according to rule H14.

For thyroid cancer only, the term micropapillary does not refer to a specific histologic type. It means that the papillary portion of the tumor is minimal or occult, usually less than 1 cm. in diameter.

Assign 8077/2 for high-grade squamous intraepithelial lesion, VIN 3 in this case.  The WHO Classification of Female Genital Tumors, 5th edition, states that squamous intraepithelial lesions (SILs) of the vulva are also known as vulvar intraepithelial neoplasia, HPV-associated.  The term squamous cell carcinoma in situ is not recommended.

PIN III is not reportable in accordance with the 2018 SEER Manual; however, carcinoma in situ of the prostate is reportable as they represent different histology codes. The casefinding list is used to search for reportable cases and is not the same as a reportable list.

For cases diagnosed 1998-2002:

Code the Reason for No Cancer-Directed Surgery field to 1 [Cancer-directed surgery was not recommended] for patients who present with either a primary site or histology for which surgery is not a standard treatment. Also use code 1 for those patients who present with distant disease for a primary site that is typically treated surgically. Patients with distant metastasis typically do not have surgery performed as part of first course of treatment.

Code 2 [Contraindicated due to other conditions] is used when surgery would normally be recommended for the site (given the current stage of the tumor) but other medical conditions pose too much of a risk for the patient to undergo surgery.

Malignant perivascular epithelioid cell tumor (PEComa) is reportable because it is malignant. Assign 8005/3 to malignant PEComa.

We consulted an ICD-O-3 expert who explained that some PEComas such as angiomyolipoma and lymphangiomyomatosis have specific ICD-O codes and their malignant counterparts may be coded to 8860/3 and 9174/3 respectively. There are no separate ICD-O codes for other specific PEComas, e.g., clear cell “sugar” tumor of lung, clear cell myomelanocytic tumor of the falciform ligament and some “unusual” clear cell tumors occurring in other organs—or for PEComa, NOS. These PEComas may therefore be coded to 8005 as clear cell tumors NOS; in other words as clear cell tumors that are not clear cell variants of carcinomas, sarcomas, or other specific tumor type.

Please note, PEComa is non-specific as to behavior. Unless the pathologist states that it is malignant, (as was the case for this question), the default code is 8005/1 (non-reportable).

Assign code 8120/3, urothelial carcinoma, NOS, to urothelial plasmacytoma carcinoma of the bladder.  The WHO classification describes plasmacytoid variants of urothelial carcinoma. There is no specific ICD-O-3 code for these variants; however, and 8120/3 must be used.