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In the Heme Manual, published October 2025, the ambiguous terminology used to determine reportability for heme and lymphoid neoplasms (Case Reportability Instructions) was updated and "consistent with" was removed. However, this is an ambiguous term that is used to describe reportability (and not just histology). The term "consistent with" was previously included as a reportable ambiguous term used to report cases prior to this update.

The updated Heme Manual is clear regarding "consistent with" now being a definitive diagnosis for the purpose of coding histology. However, the Note under instruction 4 states, "Do not apply these changes to casefinding, reportability, or staging." Is "consistent with" an exception to this Note? Or should it be re-added to the ambiguous terms related to reportability?

Patient was diagnosed with smoldering myeloma in October 2021 and put on surveillance. In May 2024, the patient became symptomatic and started chemotherapy.

Is the date of diagnosis in 2021, with date of first treatment with chemotherapy in 2024? Or is active surveillance first course and treatment with chemotherapy as second course in 2024?

Code A280 is defined as a total removal of the ovarian tumor or removal of a single ovary (oophorectomy) WITH a hysterectomy. The unilateral removal of both the fallopian tube and ovary [(salpingo-) oophorectomy] is included in surgery codes A350-A370. However, the SEER Note under code A280 states, "Also use code A280 for current unilateral (salpingo-) oophorectomy with previous history of hysterectomy." Should this SEER Note read, "Also use code A280 for current unilateral oophorectomy with previous history of hysterectomy"?

Historically, synchronous ductal and lobular tumors have been accessioned as a single primary. These were previously covered under Rule M10, which was removed from the (STR) Manual 2026 Update. While the previous iteration of Rule M10 was problematic, the main issue related to the lack of a timing component within the rule (i.e., indicating it applied to synchronous ductal and lobular tumors).

Using the current Breast STR, when there are two (or more) simultaneous tumors which are not mixed lobular and ductal within each tumor, the applicable M Rule is Rule M13: Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3. To apply the M Rules, a provisional histology must be assigned to EACH tumor so we cannot code each tumor as 8522 before we start applying the M Rules. These provisional histologies would be 8500 and 8520, and these are on different rows in Table 3.

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?

SINQ 20200057 states to use SMARCA4-deficient malignant neoplasms newly identified to use 8020/3 in this example for lung. The annotated histology list shows this histology followed by (C34._) for 2023 forward. An esophagus pathology states the following, "The histologic features and immunohistochemical profile are those of a SMARCA2/SMARCA4-deficient malignant neoplasm." Is the 8020/3 histology valid for esophagus or other sites?

Patient had a left thigh soft tissue mass excision on 7/24/24 and was diagnosed with superficial CD34 positive fibroblastic tumor. Margins were narrowly free of disease. Tumor size was 5.5 cm x 4.4 cm x 3.9 cm. The diagnosis was confirmed.

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?

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?