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Do not record WHO/ISUP grade in the grade/differentiation field.

Designated fields for this grade system are being proposed for future implementation.

WHO classifies intraductal carcinoma of the prostate 8500/2. According to WHO, "the hallmark of intraductal carcinoma of the prostate is a proliferation of prostate carcinoma cells that is within and may significantly expand the native prostatic ducts and acini, with the basal cell layer at least partially preserved." Further, differentiation between intraductal carcinoma and infiltrating high-grade carcinoma of the prostate may require basal cell stains. Under Prognosis, WHO states: " intraductal carcinoma of the prostate on prostate biopsies is often associated with high-grade cancer (with a mean Gleason score of 8) ."

So while it may seem counter-intuitive, assign behavior code /2 when the diagnosis is intraductal carcinoma of the prostate.

Assign histology code 8254/3.

The 2007 MP/H Lung rules do not include coding guidelines for mixed mucinous and non-mucinous tumors. Lung Table 1 (in the Terms and Definitions, pages 37-38, http://seer.cancer.gov/tools/mphrules/mphrules_definitions.pdf ) is very specific about which histologies can be coded to mixed adenocarcinoma (8255/3). Mucinous is not included per the note at the end of Table 1. Per WHO 3rd and 4th Ed Tumors of the Lung, mixed mucinous and non-mucinous tumors of the lung are classified as 8254/3.  Mixed invasive mucinous and non-mucinous adenocarcinoma is a synonym for BAC, mucinous and non-mucinous.

Code to metaplastic carcinoma, 8575/3. According to our expert pathologist consultant, "The term 'metaplastic stroma' implies that at least a portion of the carcinoma has undergone a 'metaplastic' change from epithelial in appearance to 'stromal' in appearance. I assume this is what CAP means by 'Invasive mammary carcinoma with matrix production,' which the WHO equates to metaplastic carcinoma."

Assign 8574/3 according to Other Sites rule H17 for basaloid carcinoma with squamous and neuroendocrine differentiation.

There is no combination code that includes basal cell, squamous, and neuroendocrine. We can combine basal cell with squamous, 8094/3, or carcinoma with neuoendocrine differentiation, 8574/3. Rule H17 directs us to assign the higher code, 8574/3.

This answer pertains to cases diagnosed prior to 2018. For 2018 and later cases, refer to the Non-Malignant CNS Solid Tumor Rules.

Note: This answer updates previous answers which have been removed from the SEER Inquiry System.

Intraosseous meningiomas are not reportable. You are correct, these are rare meningiomas originating in bone. The term "sphenoid wing meningioma" is sometimes used for an intraosseous meningioma of the sphenoid bone. Yes, it's possible to have a meningioma of the sphenoid wing on imaging that arises from the meninges NOT the bone. Read the available information carefully. When the site of origin is described as "along the sphenoid wing" or "overlying the sphenoid wing" report the meningioma. These descriptions indicate that the meningioma originates from the meninges covering bone rather than the bone itself. Meningioma arising in bone is rare enough, that when present, we would expect it to be clearly stated as such. In the absence of a statement indicating origin in bone, the meningioma is most likely arising from meninges covering the bone.

The primary site is unclear. The lesion is intracranial, but this may not be the primary site. In the absence of any additional information, assign C390, 8020/3. According to WHO, sinonasal undifferentiated carcinoma can involve the nasal cavity, maxillary antrum, and/or ethmoid sinus.

SMARCB1 (INI-1) is a tumor-suppressor gene located on chromosome 22q11.2. Tumors that showed loss of expression were SMARCB1-deficient tumors which are characterized by nests, sheets, and cords of cells without any histologic evidence of specific (eg, squamous or glandular) differentiation.

Clark's level can be used to assign in situ, localized or regional summary stage.

If there is a discrepancy between the Clark’s level and the pathologic description of extent, use the higher Summary Stage code.

According to our expert pathologist consultant, yes, seminoma could transform to a mixed germ cell tumor with a somatic type malignancy. He advises us to code this case as 9061/3.

From our expert pathologist consultant: This occurs as "reprogramming" of the initial germ cell tumor/seminoma cell. The process is not understood, but genetic studies support this progression concept. Most often the next step is teratoma. It is out of the teratoma that the somatic malignancy usually comes. I do wonder about the possibility that this was really an embryonal carcinoma which resembles a seminoma - occasionally this can be a difficult separation. I wonder if they radiated the scrotum following the orchiectomy, also, given the scrotal recurrence.

Code the histology to 8574/3 for Ductal carcinoma with neuroendocrine features.

Ductal carcinoma is also called "invasive breast carcinoma of no special type." WHO classifies Invasive breast carcinoma with neuroendocrine differentiation as 8574/3.