| Report | Question ID | Question | Discussion | Answer | Year |
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20250015 | Solid Tumor Rules/Behavior--Brain and CNS: Why was the Behavior of solitary fibrous tumor (SFT)/hemangiopericytoma, WHO Grade 1 changed from /0 to /1 in the 2025 Solid Tumor Rules (STR) updates? See Discussion. |
In previous STR versions and the ICD-O-3.2, SFT/hemangiopericytoma, WHO G1 is 8815/0 and only SFT/hemangiopericytoma, WHO G2 was 8815/1. However, Table 6 (Non-Malignant CNS, Specific Histologies, NOS, and Subtypes/Variants) was changed in the 2025 updates to indicate both G1 and G2 SFT/hemangiopericytoma are 8815/1. No date range was provided for this change in the STR and the behavior of this tumor was not updated by the standard setters in other references (i.e., ICD-O-3.2). The behavior of G1 SFT/hemangiopericytoma was not updated in the 2025 ICD-O-3.2 updates. If the ICD-O-3.2 was the source of this change, should this have been documented in the 2025 NAACCR Implementation Guidelines? However, the 2025 NAACCR Implementation Guidelines indicates, "There are no ICD-O-3 changes for 2025." Is this behavior change in 2025 Solid Tumor Rules updates an error? Should the behavior of SFT/hemangiopericytoma, WHO G1 remain /0? |
Updated February 2026 For cases diagnosed 2025 and later: Assign behavior /1 for solitary fibrous tumor unless stated to be malignant or have metastasized. A review by the Cancer PathCHART expert neuropathologists found behavior code /0 is incorrect and both solitary fibrous tumor grade 1 and grade 2 are coded as 8815/1. WHO Classification of Central Nervous System Tumors, 5th edition, assigns behavior as /1 and no longer recommends terms solitary fibrous tumor/hemagiopericytoma and hemagiopericytoma. The STR table is correct. Future updates to ICD-O should reflect this behavior. WHO Classification of Tumours, Central Nervous System Tumours, 5th ed. was reviewed by the CPC expert pathologists for implementation for cases diagnosed January 1, 2025. Reminder: Comparing the CPC Validity Status included in the 2024 CPC*Search to that included in the 2025 SMVL (that table that drives the edits) is incorrect. CNS Tumors were not reviewed for 2024 implementation, they were reviewed for 2025 implementation. There will be a 2025 CPC*Search and a /1 will be designated as a Valid. |
2025 |
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20250026 | Solid Tumor Rules/Histology--Esophagus: Are SMARCA4- deficient malignant neoplasms (8020/3) valid for esophagus or other sites besides lung? See Discussion. |
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? |
Assign 8020/3 for SMARCA4- deficient malignant neoplasms of the esophagus. The WHO Classification of Digestive System Tumors, 5th edition, lists undifferentiated carcinoma as 8020/3. Undifferentiated carcinoma of the esophagus is characterized by the frequent loss of SMARCA4 or SMARCA2 by immunohistochemistry. SINQ 20200057 was updated in August 2025 and assigns code 8044/3 for Thoracic SMARCA4-deficient undifferentiated tumor (SMARCA4-UT). The 2025 Solid Tumor Manual includes SMARCA4-deficient or SMARCB1-deficient tumors for thoracic and sinonasal sites (8044/3). Assigning histology to other individual sites should be on a case-by-case basis. |
2025 |
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20250007 | Reportability/Behavior: Our registry collects some borderline (behavior /1) cases that are not reportable to SEER or any other standard setters. Can we assign a behavior code of /2 to these cases? |
Do not assign a behavior code of /2 to these cases unless you have a way to flag them so that they are not reported to the standard setters as in situ cases. Work with your state central registry to ensure that these cases are not unintentionally included in state case submission. |
2025 | |
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20250014 | Race/Spanish Surname or Origin: How are Race 1 and Spanish Surname or Origin coded for the following race/ethnicity statements: "INDIGENOUS-LATINO/A OR INDIGENOUS-LATINX" and "FIRST NATIONS"? See Discussion. |
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? |
Assign code 01 (White) for Race 1 when described as Indigenous-Latino/a or Indigenous-Latinx. Indigenous-Latinx is an umbrella term for Indigenous migrants to the United States from Latin America including South and Central America, the Caribbean, and Mexico (for example, Maya, Mixteco, Purépecha, Taino, Zapoteco, etc.). Latin America is listed in Appendix D of the 2025 SEER Manual as White. Assign code 6 (Spanish, NOS; Hispanic, NOS; Latino, NOS) for Spanish Surname or Origin for Indigenous-Latino/a or Indigenous-Latinx in the absence of more specific information. Code 6 description includes the statement, There is evidence, other than surname or birth surname (maiden name), that the person is Hispanic but he/she cannot be assigned to any of the categories 1-5. Assign code 03 (American Indian or Alaska Native) when described as First Nations. First Nations usually refers to Indigenous peoples for ethnic groups who are the original or earliest known inhabitants of an area. The term ‘First Nations’ can be applied to individuals, but technically refers only to those who have Indian status under Canadian law as part of a recognized community. Within Canada, the term First Nations is generally used for Indigenous peoples other than Inuit and Métis. Outside Canada, the term can refer to Indigenous Australians, U.S. tribes within the Pacific Northwest, as well as supporters of the Cascadian independence movement. |
2025 |
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20250023 | First Course Treatment/Hormone Therapy--Multiple Myeloma: How is dexamethasone coded when given for multiple myeloma? See Discussion. |
The treatment regimen consisting of carfilzomib, lenalidomide, and dexamethasone (KRd) in SEER*Rx says not to code dexamethasone. I have a patient with multiple myeloma who received the KRd protocol in 2018 and the treatment regimen consisting of carfilzomib, daratumumab, and dexamethasone (KdD) (not in SEER Rx) in 2025. SEER RX says to code dexamethasone when it is given for multiple myeloma but also not to code dexamethasone when given as part of the KRd regimen (which is for multiple myeloma). I can follow the KRd instructions if that is what should take priority, but then would I code dexamethasone for the KdD regimen? KdD is not in SEER*Rx and it seems counterintuitive to code it for KdD and not for KRd. |
Code dexamethasone in KRd regimen (and any other regimen for multiple myeloma containing dexamethasone) as hormonal therapy. Please note that majority of the regimens for multiple myeloma are not in SEER*Rx currently. The SEER*Rx entry for KRd regimen was updated to indicate that dexamethasone should be coded. The change was done to correct the contradiction with the SEER manual which states, "Code the hormonal agent given as part of combination chemotherapy (e.g., R-CHOP), whether it affects the cancer cells or not" and the SEER*Rx entry for dexamethasone which directs to code it for multiple myeloma. |
2025 |
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20250029 | EOD 2018/EOD Regional Nodes--Oropharynx: Is code 550 missing “< equal to 6 cm” in the data item EOD Regional Nodes for Oropharynx HPV-Associated, Version 9? Otherwise, bilateral or contralateral lymph nodes with extranodal extension (ENE) that are >6 cm could fit into 550 OR 650. |
Code 550 is missing “< equal to 6 cm.” In addition, code 650 should include ipsilateral lymph nodes as well. Revised codes: Code 550 CLINICAL ASSESSMENT only Bilateral or contralateral lymph nodes, < equal to 6 cm WITH clinical evidence of ENE Code 650 CLINICAL ASSESSMENT only Ipsilateral, Bilateral or Contralateral lymph nodes > 6 cm WITH or WITHOUT clinical evidence of ENE These changes will be implemented in Version 3.4 (October 2026). We apologize for the error. |
2025 | |
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20250018 | Solid Tumor Rules/Histology/Behavior--Brain and CNS: How are histology and behavior coded when the Integrated Diagnosis is "Meningioma, WHO Grade 2," and the Histological Classification is "Meningioma with elevated mitotic activity, hypercellularity, necrosis, and sheeting architecture?" See Discussion. |
We are increasingly seeing pathologists use this terminology to describe WHO G2 meningiomas, but the histology term "Atypical meningioma" is not being used, and a more specific "Histological Classification" of other WHO Grade 2 meningiomas (i.e., chordoid or clear cell meningioma) is not given. Can the combination of meningioma, WHO Grade 2 plus the histological classification listing multiple features of an atypical meningioma be used to code morphology to 9539/1? Or is this just a meningioma, NOS 9530/0 despite the WHO Grade 2 classification? |
Code meningioma, NOS (9530/0) based on the integrated diagnosis and histological classification. WHO Classification of Central Nervous System Tumors, 5th edition, states that brain invasion is a criterion for the diagnosis of CNS WHO grade 2 meningioma, and there is no statement of brain invasion, atypical meningioma, or other WHO grade 2 lesions. WHO has not proposed behavior codes based on WHO grade alone. |
2025 |
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20250021 | Reportability--Heme & Lymphoid Neoplasms: Is a diagnosis of smoldering Waldenström macroglobulinemia (WM) reportable? See Discussion. |
The bone marrow was involved by lambda-restricted atypical B-cell and plasma cell populations with MYD88 mutation. Together these populations represent 10-15% of the bone marrow cellularity. While the bone marrow biopsy pathology alone did not provide a reportable diagnosis, the oncologist clinically diagnosed this as smoldering WM in the medical record. Is a diagnosis of smoldering WM similar to a diagnosis of smoldering multiple myeloma (MM), a reportable Heme neoplasm, since smoldering neoplasms may be considered to meet the neoplasm’s threshold in the bone marrow but is otherwise asymptomatic? |
Report smoldering WM (9761/3) using the Hematopoietic and Lymphoid Neoplasms Manual and Database (Table B9). Smoldering WM is defined as a poorly described asymptomatic disorder with a high risk of progressing to symptomatic WM requiring treatment. The term “smoldering” refers to the process meaning it is progressing, perhaps slowly, or even at a slower pace than might be expected. Smoldering WM resembles smoldering MM. |
2025 |
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20250020 | Solid Tumor Rules/Histology--Vulva: Can instructions and descriptions from registry manuals be used to determine p16 status for the human papillomavirus (HPV)-related histology codes in the Solid Tumor Rules (STR)? Does it have to state that p16 is “positive” or “over-expressed” only? See Discussion. |
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? |
Refer to the College of American Pathologists (CAP) protocols to determine how to interpret p16 staining results on pathology reports. Per the Vulva CAP Protocol, p16 positive is defined as diffuse or block-like expression. Since the pathology report states "block-like expression," code the histology as 8085/3 (invasive squamous cell carcinoma, HPV-associated). |
2025 |
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20250004 | Reportability/Histology--Heme & Lymphoid Neoplasms: Is a diagnosis of myeloid stem cell disorder or myeloid stem cell neoplasm reportable when the differential diagnosis includes only reportable neoplasms? If so, how should histology be coded? See Discussion. |
Pathologists are increasingly using the terms "myeloid stem cell disorder" and "myeloid stem cell neoplasm" to describe reportable myeloid neoplasms. If the pathologist uses these terms and indicates the differential diagnosis includes only reportable neoplasms such as myelodysplastic syndrome, myeloproliferative neoplasm, and acute myeloid leukemia (AML), should this be accessioned as a reportable primary? Example: The 01/2023 peripheral blood shows high grade myeloid stem cell disorder, and the differential diagnosis includes chronic myelomonocytic leukemia(CMML) and AML. The patient refused further work-up and expired several days later. No additional information is available. |
Report the case when the differential diagnosis includes only reportable neoplasms in the absence of additional information. We are unable to provide general instructions for provisional diagnoses as each situation will need to be reviewed and assessed individually when no further work-up information is available.
Assign myeloid leukemia, NOS (9860/3) to the case described in the example. Assign a generic histology code because a specific histology code cannot be assigned when there are several differential diagnoses. Since the differential diagnoses include a chronic and an acute leukemia, code as myeloid leukemia, NOS since it is not clear if this is chronic or acute. |
2025 |
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