SEER Inquiry System - Search

Do not report superficial angiomyxoma (8841/0) or aggressive angiomyxoma (8841/0).  WHO Classification of Female Genital Tumors, 5th edition, defines deep (aggressive) angiomyoma as a benign, infiltrative, myxoid spindle cell neoplasm that occurs in deep soft tissue of the pelviperineal region.

Assign code 300 for EOD Prostate Pathologic Extension.

In this scenario, the patient has a localized cancer confirmed by radical prostatectomy; the needle core biopsies likely removed all the cancer. Unlike prostate, other sites’ extension information is collected in EOD Primary Tumor, as seen commonly with breast tumors where the results from the surgical resection are recorded with tumor confined to primary site.

Code the Date of First Surgical Procedure (NAACCR Item #1200) as the date the shave, punch, or elliptical biopsy was performed. This instruction applies to cutaneous lymphoma and Kaposi sarcoma as well. Beginning with cases diagnosed 2023 and after, shave, punch, or elliptical biopsies are coded as a surgical procedure regardless of margin status.

The instruction in the 2023 SEER Manual that states "shave or punch biopsies are most often diagnostic; code as a surgical procedure only when the entire tumor is removed and margins are free/gross disease is removed" has been deleted from the 2024 SEER Manual.  Refer also to the Appendix C Coding Guidelines for Kaposi Sarcoma of All Sites and Lymphoma for coding primary site.

Assign histology as adenocarcinoma, HPV-associated (8483/3) as designated in Table 17, Uterine Cervix Histologies, of the Other Sites Solid Tumor Rules. The WHO Classification of Female Genital Tumors, 5th edition, states that p16 immunohistochemistry is an effective (yet flawed) indirect test for HR-HPV infection, in line with the STRs that state p16 is a valid test to determine HPV status and can be used to code HPV-associated and HPV-independent histologies. In this scenario, "negative for high-risk human papilloma virus (HR-HPV) on Pap smear" would be cytology-based, and may have missed cytologically malignant cells. A subsequent, more definitive biopsy was performed and was found to be strongly positive for p16, therefore, the tumor should be coded as 8483/3.

Code alcohol ablation under Surgery of Primary Site 2023. Code alcohol embolization as Other Therapy when tumor embolization is performed using alcohol as the embolizing agent.

Alcohol ablation, also known as an ultrasound-guided percutaneous ethanol injection (PEI); is treatment that involves injecting concentrated alcohol directly into the tumor. Embolization uses special techniques to close off blood flow by introducing special medications or using other techniques designed to block blood vessels. Types of embolization are arterial embolization as with alcohol (ethanol), chemoembolization, and radioembolization. Refer to the current SEER Program Coding and Staging Manual when assigning surgery and embolization procedures.

Yes. DFSP with fibrosarcomatous overgrowth and DFSP with fibrosarcomatous component Grade 2 are synonymous with fibrosarcomatous DFSP (8832/3).  Our expert pathologist also advises that DFSP with focal myxoid features is the same as DFSP, myxoid (8832/3).

Answer updated April 2025

A change in the subcategory for a hormone drug does not indicate the end of First Course of Treatment because different hormone therapies generally achieve the same result. For example, some forms of breast cancer are estrogen-dependent and the various subcategories of hormone drugs used to treat them, such as gonadotropin-releasing factor agonists, aromatase inhibitors and estrogen antagonists, all achieve the same result - to block estradiol effects in these tumors.

Similarly, a change in immunotherapy is not a new course of treatment.

However, if a change to hormone therapy or immunotherapy is due to a change in the patient's ER, PR, or Her2 status, this could signify a new course of treatment.

The instruction in the SEER Manual is specific to chemotherapy. Chemotherapy is the only systemic treatment for which a change in the subcategory of a drug indicates the end of First Course of Treatment, due to the fact that different chemical agents damage cancer cells in different ways and at different phases in the cell cycle.

Code AML with monocytic differentiation as acute myeloid leukemia, NOS (9861/3) per consultation with our expert hematopathologist.

Acute monoblastic and monocytic leukemia (9891/3) and acute myelomonocytic leukemia (9867/3) are distinct entities according to the WHO. "AML with monocytic differentiation" is a descriptive diagnosis, whereas, "Acute monoblastic and monocytic leukemia" are specific diagnoses. In the WHO Classification of Tumours, Central nervous system tumours (4th Ed) in 2016, WHO began integrating information on molecular alterations that provide significant prognostic implications and/or a therapeutic target into the histology code/term itself. As a result it is also important to look at the molecular testing because acute myeloid leukemias can have different molecular mutations that could result in coding to a different histology code. In this case, there was no other information regarding additional immunophenotyping, so that is why AML, NOS was assigned.  Acute myeloid leukemia with monocytic differentiation has been added to the Hematopoietic and Lymphoid Neoplasm Database as an alternate name for 9861/3.

For the example provided: For 2023 cases and forward, if no part of the surgery was performed, code Surgery of Primary Site 2023 (NAACCR Item #1291) as code A000 or B000 (no surgical procedure of the primary site).  Code Reason for No Surgery of Primary Site (NAACCR Item #1340) as code 2 (surgery of the primary site was not recommended/performed because it was contraindicated due to patient risk factors (comorbid conditions, advanced age, progression of tumor prior to planned surgery, etc.).

In contrast, if any part of the surgery was performed, assign the Surgery of Primary Site 2023 (NAACCR Item #1291) code that best reflects the extent of the surgery performed.  Code Reason for No Surgery of Primary Site (NAACCR Item #1340) as code 0 (surgery of the primary site was performed).

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For cases prior to 2023, apply the same approach using Surgery of Primary Site (NAACCR Item #1290) instead of Surgery of Primary Site 2023 (NAACCR Item #1291).

Abstract a single primary using Breast Solid Tumor Rules, Rule M18, as none of the previous rules apply.

Undifferentiated carcinoma is a malignant epithelial tumour lacking overt evidence of a specific line of differentiation. Dedifferentiated carcinoma is composed of an undifferentiated carcinoma and a differentiated component. Dedifferentiated carcinoma (8020/3) as a morphology is associated with cancer of the endometrium and ovary rather than the breast.  Breast cancer shows a broad spectrum of morphology with extensive variation in histological type and grade, related to the complexity of carcinogenesis.  This includes initial genetic changes in the cell of origin, subsequent genetic and epigenetic alterations, and reprogramming that occur at various stages of development along with interaction of other factors that influence the process of differentiation.  This scenario likely represents the process of phenotypic change of a carcinoma at a later stage, better known as transdifferentiation.