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20250015 | Solid Tumor Rules/Behavior--Brain and CNS: Why was the Behavior of solitary fibrous tumor (SFT)/hemangiopericytoma, WHO Grade 1 changed from /0 to /1 in the 2025 Solid Tumor Rules (STR) updates? See Discussion. |
In previous STR versions and the ICD-O-3.2, SFT/hemangiopericytoma, WHO G1 is 8815/0 and only SFT/hemangiopericytoma, WHO G2 was 8815/1. However, Table 6 (Non-Malignant CNS, Specific Histologies, NOS, and Subtypes/Variants) was changed in the 2025 updates to indicate both G1 and G2 SFT/hemangiopericytoma are 8815/1. No date range was provided for this change in the STR and the behavior of this tumor was not updated by the standard setters in other references (i.e., ICD-O-3.2). The behavior of G1 SFT/hemangiopericytoma was not updated in the 2025 ICD-O-3.2 updates. If the ICD-O-3.2 was the source of this change, should this have been documented in the 2025 NAACCR Implementation Guidelines? However, the 2025 NAACCR Implementation Guidelines indicates, "There are no ICD-O-3 changes for 2025." Is this behavior change in 2025 Solid Tumor Rules updates an error? Should the behavior of SFT/hemangiopericytoma, WHO G1 remain /0? |
For cases diagnosed 2025 and later: Assign behavior /1 for solitary fibrous tumor unless stated to be malignant. A review by the Cancer PathCHART expert neuropathologists found behavior code /0 is incorrect and both solitary fibrous tumor grade 1 and grade 2 are coded as 8815/1. WHO Classification of Central Nervous System Tumors, 5th edition, assigns behavior as /1 and no longer recommends terms solitary fibrous tumor/hemagiopericytoma and hemagiopericytoma. The STR table is correct. Future updates to ICD-O should reflect this behavior. WHO Classification of Tumours, Central Nervous System Tumours, 5th ed. was reviewed by the CPC expert pathologists for implementation for cases diagnosed January 1, 2025. Reminder: Comparing the CPC Validity Status included in the 2024 CPC*Search to that included in the 2025 SMVL (that table that drives the edits) is incorrect. CNS Tumors were not reviewed for 2024 implementation, they were reviewed for 2025 implementation. There will be a 2025 CPC*Search and a /1 will be designated as a Valid. |
2025 |
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20250020 | Solid Tumor Rules/Histology--Vulva: Can instructions and descriptions from registry manuals be used to determine p16 status for the human papillomavirus (HPV)-related histology codes in the Solid Tumor Rules (STR)? Does it have to state that p16 is “positive” or “over-expressed” only? See Discussion. |
The STR states that p16 can be used to code HPV-associated and HPV-independent histologies for selected sites depending on diagnosis year but contains no instructions about how to interpret p16 staining results on pathology reports. These are often stated in various ways in our area, depending on the pathology lab and different pathologists. The SSDI Manual and SEER Coding and Staging Manual each have some instructions and code definitions for p16, including: - Code 0 for p16 expression of weak intensity or limited distribution - Code 0: p16 Negative; Nonreactive - Code 1: p16 Positive; Diffuse, Strong reactivity - IHC for p16 expression is a surrogate marker for HPV infection Example: 2023 squamous cell carcinoma of the vulva, partial vulvectomy; pathology states vulvar intraepithelial neoplasia-3, p16 immunohistochemistry demonstrates block-like expression, which supports the diagnosis. The next path report states invasive squamous cell carcinoma, stain for p16 is strong and diffuse in the lesion, supporting the above diagnosis. Neither path report specifically states "HPV-related," so are p16 "expression" and "strong and diffuse" staining enough to code the histology as 8085/3 for this case? |
Refer to the College of American Pathologists (CAP) protocols to determine how to interpret p16 staining results on pathology reports. Per the Vulva CAP Protocol, p16 positive is defined as diffuse or block-like expression. Since the pathology report states "block-like expression," code the histology as 8085/3 (invasive squamous cell carcinoma, HPV-associated). |
2025 |
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20250009 | 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. |
2025 | |
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20250018 | Solid Tumor Rules/Histology/Behavior--Brain and CNS: How are histology and behavior coded when the Integrated Diagnosis is "Meningioma, WHO Grade 2," and the Histological Classification is "Meningioma with elevated mitotic activity, hypercellularity, necrosis, and sheeting architecture?" See Discussion. |
We are increasingly seeing pathologists use this terminology to describe WHO G2 meningiomas, but the histology term "Atypical meningioma" is not being used, and a more specific "Histological Classification" of other WHO Grade 2 meningiomas (i.e., chordoid or clear cell meningioma) is not given. Can the combination of meningioma, WHO Grade 2 plus the histological classification listing multiple features of an atypical meningioma be used to code morphology to 9539/1? Or is this just a meningioma, NOS 9530/0 despite the WHO Grade 2 classification? |
Code meningioma, NOS (9530/0) based on the integrated diagnosis and histological classification. WHO Classification of Central Nervous System Tumors, 5th edition, states that brain invasion is a criterion for the diagnosis of CNS WHO grade 2 meningioma, and there is no statement of brain invasion, atypical meningioma, or other WHO grade 2 lesions. WHO has not proposed behavior codes based on WHO grade alone. |
2025 |
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20250017 | SEER Manual/First Course Therapy--Neoadjuvant Therapy: How is Neoadjuvant Therapy--Treatment Effect coded for bladder cancers? The College of American Pathologists (CAP) Protocol for the Examination of Cystectomy Specimens From Patients With Carcinoma of the Urinary Bladder does not provide a clear distinction between the SEER site-specific codes for Neoadjuvant Therapy Treatment Effect for All Other Schemas, codes 2, 3, and 4, as compared to the CAP Treatment Effect Post Neoadjuvant Chemotherapy (BCG not included) categories. See Discussion. |
CAP Protocol for the Examination of Cystectomy Specimens From Patients With Carcinoma of the Urinary Bladder/Treatment Effect Post Neoadjuvant Chemotherapy (BCG not included) selections o No known presurgical neoadjuvant therapy o Complete response: Absence of histologically identifiable residual cancer cells and extensive fibrosis of the tumor bed after presurgical neoadjuvant therapy (TRG1) o Strong response: Predominant fibrosis of the tumor bed, with residual cancer cells occupying less than 50% of this area (TRG2) o Weak or no response: Residual cancer cells occupying ≥50% of the tumor bed or absence of regressive changes (TRG3) o Other (specify): _________________ SEER Coding Instruction for Site-Specific Codes for Neoadjuvant Therapy Treatment Effect - Schemas: All Other Schemas selections 0 Neoadjuvant therapy not given/no known presurgical therapy 1 Complete pathological response Present: No viable cancer cells/no residual invasive carcinoma identified Residual in situ carcinoma only 2 Near complete pathological response Present: Single cells or rare small groups of invasive cancer cells 3 Partial or minimal pathological response Present: Residual invasive cancer with evident tumor regression, but more than single cells or rare small groups of cancer cells 4 Poor or no pathological response Absent: Extensive residual cancer with no evident tumor regression 6 Neoadjuvant therapy completed and surgical resection performed, response not documented or unknown Cannot be determined 7 Neoadjuvant therapy completed and planned surgical resection not performed 9 Unknown if neoadjuvant therapy performed Unknown if planned surgical procedure performed after completion of neoadjuvant therapy
Death Certificate only (DCO) |
Code Neoadjuvant Therapy--Treatment Effect using the surgical pathology report only. Carefully review the pathology report gross description and comments to assist with assignment of codes. Review of neoadjuvant therapy data items is currently underway. |
2025 |
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20250014 | Race/Spanish Surname or Origin: How are Race 1 and Spanish Surname or Origin coded for the following race/ethnicity statements: "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS"? See Discussion. |
One of the largest hospital systems in our area includes "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS" as dropdown items for patients to self-select for race/ethnicity. This hospital system serves 51 hospitals and 1,000 clinics across Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. If "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" is the only item selected with no additional text info available, how should Race 1 and Spanish Surname or Origin be coded? If "FIRST NATIONS" is the only item selected without additional text info available, should Race 1 be coded as 03? |
Assign code 01 (White) for Race 1 when described as Indigenous-Latino/a or Indigenous-Latinx. Indigenous-Latinx is an umbrella term for Indigenous migrants to the United States from Latin America including South and Central America, the Caribbean, and Mexico (for example, Maya, Mixteco, Purépecha, Taino, Zapoteco, etc.). Latin America is listed in Appendix D of the 2025 SEER Manual as White. Assign code 6 (Spanish, NOS; Hispanic, NOS; Latino, NOS) for Spanish Surname or Origin for Indigenous-Latino/a or Indigenous-Latinx in the absence of more specific information. Code 6 description includes the statement, There is evidence, other than surname or birth surname (maiden name), that the person is Hispanic but he/she cannot be assigned to any of the categories 1-5. Assign code 03 (American Indian or Alaska Native) when described as First Nations. First Nations usually refers to Indigenous peoples for ethnic groups who are the original or earliest known inhabitants of an area. The term ‘First Nations’ can be applied to individuals, but technically refers only to those who have Indian status under Canadian law as part of a recognized community. Within Canada, the term First Nations is generally used for Indigenous peoples other than Inuit and Métis. Outside Canada, the term can refer to Indigenous Australians, U.S. tribes within the Pacific Northwest, as well as supporters of the Cascadian independence movement. |
2025 |
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20250016 | Reportability--Head & Neck: Are high-grade squamous dysplasia / “severe” squamous dysplasia or glandular intraepithelial neoplasia reportable for all Head & Neck subsites? If so, what year did they become reportable? In reviewing SINQ 20240003, 20230047, and 20230046, it appears that at least the larynx, mandible, and tongue have been reportable since 2021. However, 8077/2 and 8148/2 histology codes are not included in the Solid Tumor Rules (STRs) (2025 update) for Head and Neck, either in Tables 1-9 or the H Rules. |
High grade squamous dysplasia (8077/2) is reportable for head and neck sites for cases diagnosed as of 01/01/2021. High grade glandular intraepithelial neoplasia / glandular intraepithelial neoplasia grade III (8148/2) and high grade squamous intraepithelial neoplasia / squamous intraepithelial neoplasia grade III (8077/2) are reportable for head and neck sites for cases diagnosed as of 01/01/2001. Refer to other standard setters’ criteria for reportability as appropriate. |
2025 | |
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20250010 | 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. |
2025 | |
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20250001 | Reportability/Histology--Endometrium: Are the following terms and diagnoses synonymous with endometrioid intraepithelial neoplasia (EIN) and therefore reportable? 1. Atypical glandular epithelium 2. Isthmic-type mucosa with focal severe atypia 3. Simple hyperplasia without atypia 4. EIN/complex atypical hyperplasia (EIN/CAH) or focal EIN/CAH (on biopsy but the resection pathology or operative note states no EIN/CAH/atypical hyperplasia) |
We have questions regarding reportability of some terms/diagnoses after a review of EIN cases back to 2021. While some seem synonymous with EIN, others have different terms in the pathology report though the physician is treating as if they have the diagnosis. 1. Atypical glandular epithelium Scenario: Endometrium biopsy with ablation performed at Facility A on 8/7/2024 showed atypical glandular epithelium. Patient was sent to Facility B where the total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) on 9/20/2024 showed other reactive fibrosis and obliterated architecture compatible with history of ablation. Is atypical glandular epithelium synonymous with and coded as EIN? 2. Isthmic-type mucosa with focal severe atypia Scenario: Endometrium biopsy showed isthmic-type mucosa with focal severe atypia. Then Facility B did TAH/BSO that showed no evidence of high grade dysplasia, atypical hyperplasia, or carcinoma. 3. Simple hyperplasia without atypia Scenario: Endometrial biopsy pathology states simple hyperplasia without atypia and the TAH/BSO is either negative or has the same histology; however, the treating physician is stating EIN. 4. EIN/CAH or focal EIN/CAH Scenario: Biopsy showed EIN/CAH but the total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) pathology or the Mirena IUD treatment operative note states no EIN/CAH/Atypical hyperplasia. Are these reportable, similar to an in situ when the re-excision lumpectomy or mastectomy is negative or no residual disease? |
Reportability for EIN became effective in 2021. 1. Do not report atypical glandular epithelium. Atypical glandular epithelium, also referred to as atypical glandular cells (AGC), refers to abnormal looking cells that may be found in the tissue lining the inside of the endometrium or the cervix. While not malignant (in situ or invasive), they can be associated with a range of lesions in the female reproductive system. 2. Do not report isthmic-type mucosa with focal severe atypia. The NCI data dictionary defines atypia as an abnormality in cells in tissue. Report the case when further defined as atypical hyperplasia. 3. Do not report simple hyperplasia without atypia. WHO Classification of Tumors online, Female Genital Tumors (5th ed.), defines endometrial hyperplasia without atypia as a proliferation of endometrial glands of irregular size and shape without significant atypia. There is no ICD-O code for this term. Simple endometrial hyperplasia without atypia is an acceptable related term for endometrial hyperplasia without atypia. Pathology has priority over a physician statement. 4. Report EIN/CAH or focal EIN/CAH (8380/2) based on the biopsy. WHO Classification of Tumors online, Female Genital Tumors (5th ed.), defines EAH/EIN as a simultaneous change of epithelial cytology and an increased number of endometrial glands in a defined region. The preferred term is atypical hyperplasia of the endometrium; terms not recommended include complex atypical endometrial hyperplasia; simple atypical endometrial hyperplasia; endometrial intraepithelial neoplasia.
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2025 |
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20250003 | 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. | 2025 |
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