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Atypical intradermal smooth muscle neoplasm (AISMN), previously termed "cutaneous leiomyosarcoma," is not reportable. It is classified as a borderline, /1, neoplasm.

Gelfoam tract embolization for a CT-guided renal biopsy is not treatment. It is a method to plug the biopsy track to reduce the risk of hemorrhage.

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.

Report this case as a malignant thymoma. Our expert pathologist consultant reviewed this case and in his opinion, the "separate tumor nodules within peri-thymic adipose tissue" fit registry reporting criteria for separate tumor nodules making this a malignant thymoma.

Assign primary site C119 (nasopharynx) for occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes that are positive for Epstein "Barr virus (EBV+) (regardless of p16 status) encoded small RNAs (EBER) identified by in situ hybridization.

Assign primary site C109 (oropharynx) for occult head and neck tumors with cervical metastasis in Levels I-VII, and other group lymph nodes, p16 positive with histology consistent with HPV-mediated oropharyngeal carcinoma (OPC).

Assign code 3 to Systemic/Surgery Sequence and document the intraoperative treatment in the text field. Surgery is defined as a Surgical Procedure to the Primary Site (codes 10-90), Scope of RLN Surgery (codes 1-7), or Surgical Procedure of Other Site (codes 1-5) in the 2018 SEER Manual. In this case, the treatment was after the first surgical procedure.

The instruction regarding C476 has been removed from the Solid Tumor rules. Benign and borderline neoplasms coded to C470-C479 are not reportable at this time.

Assign C720 for an intradural schwannoma at L2-4. That should allow you to use the correct EOD and Summary Stage 2018 schemas.

Based on your question, a review of the AJCC manual was done to clarify how these nodes would be coded. A review of Extent of Disease (EOD) Regional Nodes and EOD Mets was also done. That information is correct and in line with AJCC 8th edition. We apologize that SS2018 was not updated accordingly and thank you for bringing this issue to our attention.

Per AJCC, infraclavicular and intramammary nodes are ipsilateral for the N category. Contralateral or bilateral involvement are included in the M category.

The following will be applied to the planned 2020 update of the SS2018 manual.

Code 3

Ipsilateral will be added to Infraclavicular and Intramammary

Infraclavicular (subclavicular) (ipsilateral)

Intramammary (ipsilateral)

Code 7

The following will be added under Distant lymph nodes

Infraclavicular (subclavicular) (contralateral or bilateral)

Intramammary (contralateral or bilateral)

Accession as multiple primaries using Rule M7 of the Solid Tumor Rules for Non-Malignant Central Nervous System that says to assign multiple primaries for cerebral meninges C700 AND spinal meninges C701. The Non-malignant CNS H coding section, Priority Order for using Documentation to Identify Histology" lists final DX and synoptic report as requried by CAP as being equal in priority. Use whichever report provides more specific information. See the General Instructions, page 13.

For the case described here, use the size from the CT scan. Physical exam includes what can be seen by a clinician either directly or through a scope. A tumor size obtained visually via cystoscopy is part of a physical exam. Therefore, the imaging (CT) tumor size is preferred. Use text fields to describe the details.