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Report Produced: 11/10/2026 04:46 AM

Report Question ID Question Discussion Answer Cancer Site Category Data Item Category Year
20210062

Histology/Reportability--Heme and Lymphoid Neoplasms: Is a case that is compatible with low grade myelodysplastic syndrome with multilineage dysplasia (MDS-MLD) reportable, and if so, is the histology plasma cell myeloma or myelodysplastic syndrome (MDS)? See Discussion.

HL-7 e-path report, Final Diagnosis

High normocellular marrow with maturing trilineage hematopoiesis, multilineage dyspoiesis, compatible with MDS-MLD and involvement by plasma cell neoplasm/myeloma, IgA kappa positive, approximately 20-25% of total cellularity present. See comment.

Comments

Correlation with other relevant laboratory (amount and type of serum and urine paraprotein levels, renal function tests, serum calcium level, and anemia) and radiologic (lytic bone lesions) findings is recommended for complete interpretation.  Dyspoiesis of all lineages is seen and the findings are compatible with low grade myelodysplastic syndrome (MDS-MLD), assuming that other possible causes are excluded. Correlation with cytogenetic and molecular studies is recommended for complete characterization

This case is reportable. Assign MDS, NOS (9989/3) based on the information provided for this case.  “Compatible with” can be used for reportability; however, it cannot be used for assigning histology.  There is no confirmed diagnosis of plasma cell myeloma/neoplasm; the comment specifically addresses the need for further evaluation of this case.

 Heme & Lymphoid Neoplasms Histology 2021
20031125

Histology/Reportability/Behavior Code--Testis: Is a mature teratoma that is metastatic to lymph nodes reportable? See Description.

Pathology report states, "Histologic sections reveal lymph node metastases, consisting predominantly of mature teratoma. In addition, there are cells scattered through the fibrous stroma which exhibit mild cytologic atypia but have low N:C ratios. The largest metastasis grossly measures 10cm. In addition extracapsular extension is identified. Diagnosis: Lymph Nodes--Metastatic Testicular Carcinoma Involving Multiple Lymph Nodes." The morphology code for mature teratoma is 9080/0. The pathologist does not classify this as an immature teratoma (9080/3). Is this reportable?

Yes, this metastatic teratoma is reportable.

This is a malignant teratoma by virtue of the lymph node metastases. Code the histology as 9080/3 [Teratoma, malignant, NOS]. Primary site is testis [C62_].

 N/A Behavior, Histology 2003
20140026

Histology: Are all well differentiated neuroendocrine carcinomas (carcinoid) tumors coded to 8240 or 8246? When do you use code 8246?

Code 8246 is correct when the mass/lesion is referred to as neuroendocrine "carcinoma" or NEC. Use code 8240 when the mass/lesion is referred to as a neuroendocrine "tumor" or NET G1. The difference is the word tumor versus carcinoma. Carcinoid is most often used interchangeably with neuroendocrine tumor and not with neuroendocrine carcinoma.

N/A Histology 2014
20110059

Histology: How do you code histology for "malignant myopericytoma"?

Report malignant myopericytoma as 8824/3 for cases diagnosed 2021 and later.

 N/A Histology 2011
20100024

Histology: How is this field coded for a perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential that is malignant based on the presence of metastases? See Discussion.

In 11/2006 the patient had surgery for a 6cm mass in the RUQ arising in the falciform ligament. The pathologic final diagnosis was: Perivascular epithelioid cell neoplasm (PEComa) of uncertain malignant potential. In 10/2009 a liver biopsy showed metastatic perivascular epithelioid cell neoplasm.

Assign histology code 8005/3 [malignant clear cell tumor]. According to our expert pathology consultant, this is the best histology code available at this time for the occasional tumor which is designated as malignant. The appearance of metastatic disease clearly defines this case as malignant.

 N/A Histology 2010
20220007

Histology:  Is there any guidance on using STRATA Oncology testing (molecular tumor profiling tests), such as StrataNGS and StrataEXP, to code SSDIs, histology, etc? I do not see anything in STR, SEER Program Manual, SINQ, or CAnswerForum. We are seeing the testing with our 2021 paths.

We recommend that you do not use information from these molecular tumor profiling tests until they become a standard diagnostic tool. If/when that happens, we will add information to the various manuals.

 N/A Histology 2022
20021042

Hormone Therapy--Breast: Should Zoladex (gosrelin) or Lupron (leuprolide acetate) be coded as treatment for breast cancer when the physician does not indicate whether or not these drugs are intended as cancer-directed therapy? See discussion.

According to an oncologist at the research hospital in our region, these drugs are given in combination with chemotherapy for two reasons:

1) To preserve ovarian function.

2) The agents may be more effective in treating breast cancer when given in conjunction with chemotherapy than with chemotherapy alone.

For cases diagnosed 1/1/2003 to 12/31/2010: Code Zoladex (gosrelin) and Lupron (leuprolide acetate) as 01 [Hormone therapy administered as first course therapy] only when stated to be given as part of the first course of cancer-directed therapy. If you do not know whether these drugs were given to preserve ovarian function or as an adjunct to chemotherapy (i.e, there is no treatment plan), do not code as Hormonal treatment given.

Breast N/A 2002
20210072

Hormone Therapy--Breast:  How are hormone therapy (HT) and other related data items coded when a patient had a previous breast primary and is still on HT when diagnosed with a new breast primary? See Discussion.

In this scenario, we record that HT began for the second primary on the date of diagnosis, and the Systemic/Surgery Sequence ends up usually being coded 4 because the HT continues even if the specific agent may be changed. This does not seem to meet the definition of neoadjuvant therapy for the second primary so we approach the staging and grade coding as just clinical/pathological? For example, if the tumor size at surgery is a little larger than estimated on imaging, we would use the pathologic size for our staging. The tumor size and grade of the second primary are not being changed by the ongoing HT. Do we have the right approach?

For this example: 1. Code HT as treatment on the date of diagnosis for the second primary. 2. Code Systemic/Surgery Sequence as 4. 3. Do not code neoadjuvant data items as neoadjuvant started/completed. The HT given would not qualify for neoadjuvant therapy since the intent of the HT was not neoadjuvant. The HT would affect the second primary, but it is still not neoadjuvant. 4. Code clinical and pathological tumor size accordingly, based on the imaging and the pathological findings. 5. Code Extent of Disease data items based on the pathological findings since pathological findings take priority over clinical and this is not neoadjuvant therapy.

 Breast Hormone Therapy 2021
20260019

Immunotherapy--Heme & Lymphoid Neoplasms: Should Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone be coded for myelodysplastic dysplastic syndrome (MDS) and if so, how should it be coded? See Discussion.

Patient failed treatment with Azacitidine for MDS with multilineage dysplasia (9985/3) diagnosed 1/2024, and on re-biopsy of bone marrow 11/2025, histology is now MDS with excess blasts (9989/3). These diagnoses are the same primary using the Hematopoietic and Lymphoid Neoplasms (Heme) Database. The physician has prescribed treatment of Anti-Thymocyte Globulin (ATG)/Cyclosporine/Prednisone. SEER*Rx Database says not to code as ATG and Cyclosporine are antirejection medications post-transplant, but the oncologist is using this combination for treatment.

Code ATG/Cyclosporine as biological response modifier (BRM)/Immunotherapy as first course of treatment using the current Heme Manual. Based on changes to the 2026 Heme rules for coding treatment, heme and lymphoid neoplasms are now treated differently than Solid Tumors when it comes to treatment failure.

It can be used for treatment of selected MDS cases particularly those with low-risk disease, HLA-DR15 histocompatibility type, bone marrow hypoplasia. Prednisone should not be coded as it is not disease modifying agent in MDS. It is usually given to reduce/treat infusion reactions/serum sickness associated with ATG infusion.

We will update SEER*Rx.

 Heme & Lymphoid Neoplasms Immunotherapy 2026
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.

 Heme & Lymphoid Neoplasms Immunotherapy, Other therapy 2025