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.
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.
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.
Reportability--Head & Neck: Are high-grade squamous dysplasia / “severe” squamous dysplasia or glandular intraepithelial neoplasia reportable for all Head & Neck subsites? If so, what year did they become reportable? In reviewing SINQ 20240003, 20230047, and 20230046, it appears that at least the larynx, mandible, and tongue have been reportable since 2021. However, 8077/2 and 8148/2 histology codes are not included in the Solid Tumor Rules (STRs) (2025 update) for Head and Neck, either in Tables 1-9 or the H Rules.
High grade squamous dysplasia (8077/2) is reportable for head and neck sites for cases diagnosed as of 01/01/2021. High grade glandular intraepithelial neoplasia / glandular intraepithelial neoplasia grade III (8148/2) and high grade squamous intraepithelial neoplasia / squamous intraepithelial neoplasia grade III (8077/2) are reportable for head and neck sites for cases diagnosed as of 01/01/2001. Refer to other standard setters’ criteria for reportability as appropriate.
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.
Sequence Number--Central/Reportability--Heme &
Lymphoid Neoplasms: Is a hematolymphoid disease included in the sequencing if it
was not reportable at the time of diagnosis?
Do not include the disease in the sequencing if the
original hematolymphoid disease was not reportable at time of diagnosis.
The 2025 SEER Manual Sequence Number--Central
Coding Instruction 1.a advises: A ‘reportable’ primary refers to the
site/histology/behavior of the tumor and the years when reporting was required.
Review of the reportability requirements in effect during the diagnosis year
will be needed.
SEER Manual/Surgery of Primary Site--Ovary: Should "(salpingo)" be removed in the SEER Note under Ovary surgery code A280? See Discussion.
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"?
Assign code A280 for current unilateral oophorectomy with hysterectomy or with a previous history of hysterectomy.
We will remove the text ‘(salpingo-)’ from the Ovary surgery code A280 SEER Note in the next release of SEER Manual.
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