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Report Produced: 12/18/2025 12:59 PM

Report Question ID Question Discussion Answer Year
20180022

Reportability/Histology: Is a focal high grade squamous intraepithelial lesion (HSIL/moderate to severe dysplasia/VIN II-III) in the vulva reportable for cases diagnosed in 2018? See discussion.

Since high grade squamous intraepithelial lesion (HGSIL) is reportable for the vulva in 2018 (per SINQ 20130185) but VIN II-III is not reportable, we need to clarify this reporting format seen in our area.

Report when stated to be high grade squamous intraepithelial lesion of the vulva. The 2018 SEER Manual says to assign 8077/2. HGSIL is a synonym for squamous intraepithelial neoplasia, grade III for vulva and vagina only.

 2018
20180069

Solid Tumor Rules (2018)/Behavior--Brain and CNS: The Behavior coding instructions in the Non-Malignant Central Nervous System (CNS) Equivalent Terms and Definitions section refer to Table 1 for help coding behavior when the other priority order instructions do not apply; however, the behavior cannot be reasonably determined using Table 1 alone for all WHO Grade I neoplasms. Should an additional default, such as the ICD-O-3 or Tables 5 and 6, be used to determine behavior? See Discussion.

Similar to an issue previously submitted SINQ 20180063, Table 1 (WHO Grades of Select CNS Neoplasms) in the Non-Malignant CNS Equivalent Terms and Definitions section states WHO Grade I tumors are always non-malignant. However, this does not mean that the tumors listed in Table 1 as WHO Grade I are always benign (/0). Some tumors listed with a WHO Grade I have a behavior of /1 (borderline) per the ICD-O-3 and/or Tables 5 and 6. The Behavior coding instructions do not currently indicate these are the appropriate sources to use when the pathologist and/or physician do not comment on the behavior of these tumors. In our area, pathologists do not explicitly state the behavior for these tumors; the pathologist only assigns the WHO Grade.

There is no way for us to know what behavior to assign WHO grade II tumors when the pathologist does not provide that information. Defaulting to either benign or malignant is incorrect. Please follow back with the pathologist to determine behavior.

The behavior must be non-malignant, meaning /0 or /1, or the tumor is a WHO Grade 1, to be reportable as non-malignant CNS tumor. Refer to Table Instructions under Table 1, WHO Grades of Select CNS Neoplasms that says to use non-malignant CNS rules for all WHO Grade 1 tumors and to use the appropriate rules for WHO Grade 2 tumors

Use ICD-O and all updates if not listed in Table 6 according to non-malignant CNS Histology Rule H3 (for single tumor) and Rule H8 (for multiple tumors) when only one histology is present.

 2018
20180030

First Course of Treatment/Surgery of Primary Site--Melanoma: How do you code UVB therapy treatment for melanoma?

Code UVB therapy for melanoma as photodynamic therapy under Surgery of Primary Site for skin. Assign code 11 [Photodynamic therapy (PDT)] if there is no pathology specimen. Assign code 21 [Photodynamic therapy (PDT)] if there is a pathology specimen. Use text fields to document details.

 2018
20180037

Date of Diagnosis--Colon: If a patient has a positive Cologuard test, is the date of diagnosis the date of the cologuard test or the date of the biopsy?

Do not use the date of a positive Cologuard test as the date of diagnosis.

 2018
20180096

Reportability/Histology--Small intestine: Is a neuroendocrine microtumor of the duodenum a reportable tumor? See Discussion.

This comment was added to the pathology report by the pathologist: A focus of neuroendocrine microtumor measured 350 micrometers, qualifying as a neuroendocrine microtumor. Focus was immunohistochemically positive for chromogranin and synaptophysin and negative for gastrin. The Ki-67/CD45 immunostain showed <1% positivity in microtumor.

Neuroendocrine microtumor of the duodenum is reportable as 8240/3. "Microtumor" pertains to the size/amount of NET and not to a histologic type.

 2018
20190030

Summary Stage 2018/Extension--Prostate: Can imaging be used to code SEER Summary Stage 2018? MRI shows tumor involved the seminal vesicles and the patient did not have surgery. AJCC does not use imaging to clinically TNM stage a prostate case.

Note 5 was changed in Version 2.0.

Per Note 5 of the 2018 SEER Summary Stage Prostate chapter: Imaging is not used to determine the clinical extension. If a physician incorporates imaging findings into their evaluation (including the clinical T category), do not use this information.

This note was changed in Version 2.0 (2021 changes) to be in line with how AJCC stages; therefore, AJCC and Summary Stage agree.

 2019
20190058

Solid Tumor Rules (2018)/Histology--Cervix Uteri: What is the histology code and what H Rule applies for a diagnosis of papillary squamotransitional cell carcinoma of the cervix? See Discussion.

It appears that the first Other Sites applicable rule is H16 (and Table 2) instructing the use of histology code 8323 (mixed cell adenocarcinoma). However, this really is not an adenocarcinoma tumor but is a mixed squamous and transitional cell carcinoma. The 2018 ICD-O-3 Histology Update Table provides a new term for a but does not indicate whether that new term would also include a papillary squamotransitional cell carcinoma of the cervix.

Code papillary squamotransitional cell carcinoma (PSCC) as 8120/3 using the 2018 Other Sites Solid Tumor Rules, Rule H11. PSCC is a distinctive subcategory of squamous cell carcinoma of the uterine cervix. WHO Classification of Tumors of Female Reproductive Organs say that squamotransitional cell tumors show papillary architecture with fibrovascular cores lines by multilayered atypical epithelium.

 2019
20190039

Solid Tumor Rules (2018)/Histology--Lung: What is the histology code of invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes? See Discussion.

11/01/2018, lung, left upper lobe, wedge resection: Invasive moderately differentiated adenocarcinoma, predominantly papillary subtype, with minor acinar and lepidic subtypes. Would this be 8260/3 since the acinar and lepidic subtypes are described as minor or would this be 8255/3 because there is papillary plus two other subtypes/variants described as subtypes?

Code as adenocarcinoma, papillary predominant (8260/3) according to the Lung Solid Tumor Rules, Coding Multiple Histologies, which says to code the specific histology. The most specific histology may be described as component, majority/majority of, or predominantly, where predominantly describes the greater amount of tumor.

 2019
20190070

Histology--Heme & Lymphoid Neoplasms: How is the histology coded for a when the pathologist notes the low grade B-cell lymphoma raises the possibilities of extranodal marginal zone lymphoma of mucosa associated tissue (MALT lymphoma) and lymphoplasmacytic lymphoma (LPL)? See Discussion.

Rule PH28 confirms the more specific histologies are ignored if this is truly a low grade B-cell lymphoma (i.e., non-Hodgkin lymphoma, NOS) since both MALT lymphoma and LPL are more specific types of low grade B-cell lymphomas. This leaves only a diagnosis of low grade B-cell lymphoma with plasmacytic differentiation to consider.

SINQ 20130033 states a low grade B-cell lymphoma with plasmacytic differentiation should be coded as 9680/3 (diffuse large B-cell lymphoma (DLBCL)). However, DLBCL is a high grade B-cell lymphoma, not a low grade B-cell lymphoma.

If the pathologist classifies this as a non-specific low grade B-cell lymphoma, and clarifies that this may represent a more specific type of low grade B-cell lymphoma (MALT lymphoma or LPL), should the histology be coded to a high-grade lymphoma (DLBCL) or non-Hodgkin lymphoma, NOS?

Code low grade B-cell lymphoma with plasmacytic differentiation as 9591/3 (Non-Hodgkin lymphoma, NOS). Plasmacytic differentiation is commonly seen with B-cell neoplasms. If further information identifies a more specific histology, the abstract can be updated to reflect the more specific histology.

In the latest WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th ed., there is confirmation that DLBCL is a high grade B-cell neoplasm. We will update the SINQ question.

 2019
20190057

Reportability/Histology--Penis: Are and (PeIN) equivalent to PeIN3 and thus reportable? See Discussion.

Appendix E1 of the 2018 SEER manual references a similar diagnosis as being reportable for vulva and vagina only. However, the WHO Classification of Tumors of the Urinary System and Male Genital Organs (4th ed) does include high grade penile intraepithelial neoplasia as a synonym for 8077/2.

Penile intraepithelial neoplasia, grade III (PeIN III) and squamous cell carcinoma in situ of the penis are reportable. If possible, query the physicians as to whether "high grade penile intraepithelial lesion" or are synonymous with one of the reportable terms. If no further information can be obtained, report the case as C609 8077/2, and use text fields to document the details.

 2019