| Report | Question ID | Question | Discussion | Answer | Year |
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20250005 | Reportability/Behavior--Ovary: Is ovarian mucinous borderline tumor with foci of multifocal intraepithelial carcinoma reportable? |
Report ovarian mucinous borderline tumor with foci of multifocal intraepithelial carcinoma. The foci of intraepithelial carcinoma makes this reportable. See the list of synonyms for in situ in the SEER Manual, Behavior Code data item. |
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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20250027 | Reportability/Histology--Heme & Lymphoid Neoplasms: Is a 2024 diagnosis of borderline smoldering multiple myeloma reportable? See Discussion. |
Smoldering multiple myeloma is reportable. However, it is unclear if a diagnosis of borderline smoldering multiple myeloma should be accessioned when no further follow-up with the physician is possible. The physician stated the patient, "most likely has borderline smoldering multiple myeloma, but mostly MGUS," and further noted the definition of smoldering myeloma requires at least 10% of plasma cells involved with the neoplasm and some areas of the patient's bone marrow does meet the 10% plasma cell threshold. The physician noted the patient does not need treatment because of the favorable cytogenetics and lack of organ dysfunction. Should the term "borderline" be ignored and the case accessioned? Or is a borderline smoldering myeloma non-reportable? |
Update February 2026, note added: Report this case as smoldering myeloma (9732/3) based on the plasma cell 10% threshold and favorable cytogenetics and lack of organ dysfunction (9732/3). According to the College of American Pathologists Plasma Cell Malignancies Protocol, in order to code smoldering multiple myeloma, both criteria must be met: • Serum monoclonal protein (IgG or IgA) ≥3gm/dL, or urinary monoclonal protein ≥ 500 mg per 24h and/or clonal bone marrow plasma cells 10-60% • Absence of myeloma defining events or amyloidosis. Note: This case was answered by our expert pathologist and applies to this case only. Registrars should not use the plasma cell threshold to determine reportability or histology. The diagnosis must come from the pathologist or the managing physician. |
2025 |
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20250030 | First Course of Therapy/Hormone Therapy--Meningioma: Should Sandostatin be coded as treatment for a Grade 1 meningioma? Patient had surgery and was somatostatin receptor 2 (SSTR2) positive by immunohistochemistry. |
Code Sandostatin (octreotide acetate) as hormonal therapy when given including: · SSTR 2 positive meningioma (NCCN, 2025: smaller studies support the use of targeted therapy including somatostatin) · Neuroendocrine tumor (NET) (NCCN, 2025: Tumor control: antitumor effect is supported by studies for well-differentiated G1/G2 gastro-entero-pancreatic NET. In lung/thymic NET, somatostatin analogues may be considered if metastatic or SSTR positive). The SEER*Rx entry for Octreotide Acetate was updated as studies showed somatostatin analogs may shrink tumors or inhibit further growth. |
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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20250031 | SEER Manual/Reportability/Histology: Is severe dysplasia reportable? This is commonly listed as a synonym for high grade dysplasia. Is this term "severe dysplasia" reportable in the sites where high grade dysplasia is reportable? This is listed as a synonym, but it is not clear. See Discussion.
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We are seeing cases on this in head and neck. The College of American Pathologists Oral Cancer Protocol is showing this as keratinizing dysplasia, severe (carcinoma in situ) and nonkeratinizing dysplasia, severe (carcinoma in situ). SINQ Question 20230047 shows it as reportable for head and neck. |
Report severe dysplasia for selected sites. Not all high grade dysplasia and severe dysplasia are reportable. Refer to the list of examples in the SEER Manual Reportability Section and Appendix E, Reportable and Non-reportable Examples. Check also for other standard setters, state, and local reportability requirements. High grade dysplasia, severe dysplasia, and carcinoma in situ are equivalent terms with behavior /2. Refer to ICD-O, WHO Classification of Tumors, and the SEER Solid Tumor Rules for preferred histology terms and codes. For example, WHO Classification of Head and Neck Tumors, 5th edition, states carcinoma in situ in the oral cavity is synonymous with severe dysplasia though it is not a recommended term. |
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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20250012 | Solid Tumor Rules/Histology--Lung: How is histology coded and which H Rule applies for a lung adenocarcinoma when the greatest percentage of the adenocarcinoma is stated to be, "solid; complex glands (cribriform and fused glands) (50%)"? See Discussion. |
In 01/2023, right lower lobectomy final diagnosis proved a single adenocarcinoma tumor with the histological patterns described as acinar (20%), papillary (30%) and solid; complex glands (cribriform and fused glands) (50%). There is no H Rule applicable to a complex glandular pattern adenocarcinoma. Is this equivalent to a solid predominant adenocarcinoma (8230) per Rule H7? Or is the predominant adenocarcinoma a mixed subtype coded as 8255 per Rule H9? |
Histology code 8255/3 best identifies this histology. Complex glands in lung tumors are often associated with a poor prognosis and represent a high-grade pattern in lung cancer grading systems. This histology is not currently recognized as a variant by WHO. |
2025 |
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20260004 | Solid Tumor Rules/Multiple Primaries--Breast: How many primaries and which Breast Solid Tumor Rules (STR) M Rule applies when a patient has synchronous, separate/non-contiguous breast tumors which are a ductal carcinoma and a separate lobular carcinoma? See Discussion. |
Historically, synchronous ductal and lobular tumors have been accessioned as a single primary. These were previously covered under Rule M10, which was removed from the (STR) Manual 2026 Update. While the previous iteration of Rule M10 was problematic, the main issue related to the lack of a timing component within the rule (i.e., indicating it applied to synchronous ductal and lobular tumors). Using the current Breast STR, when there are two (or more) simultaneous tumors which are not mixed lobular and ductal within each tumor, the applicable M Rule is Rule M13: Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3. To apply the M Rules, a provisional histology must be assigned to EACH tumor so we cannot code each tumor as 8522 before we start applying the M Rules. These provisional histologies would be 8500 and 8520, and these are on different rows in Table 3. |
Accession two primaries when a patient has synchronous, separate ductal and lobular tumors using Rule M13, Breast STRs, 2026 Update. Ductal carcinoma (8500/3) and lobular carcinoma (8520/3) are distinct histology terms and codes that are in different rows in Table 3. This is a modification of Rules M10 and H28 from prior versions of the STR Manual. |
2026 |
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20260003 | Solid Tumor Rules/Histology--Thyroid: What is the correct histology for invasive encapsulated follicular variant of papillary thyroid carcinoma (IEFVPTC)? The 2026 Solid Tumor Rules (STR) Manual, Other Sites Table 12, conflicts with the ICD-O-3.2. See Discussion. |
STR Manual, Table 12, Thyroid Histologies, includes "Invasive encapsulated follicular variant of papillary thyroid carcinoma" as histology 8340/3 and is on its own row from other papillary thyroid carcinomas (PTC). A new footnote was added which states, "IEFVPTC and Infiltrative follicular variant of papillary thyroid carcinoma (a PTC subtype) share a histology code, but they are distinctly different histologies. They are on different rows of the table and are different primaries." However, IEFVPTC (and its synonyms) are listed in the ICD-O-3.2 as 8343/3, and 8343/3 was listed as a subtype/variant of papillary thyroid carcinoma in previous versions of the STR Manual. |
Assign histology as 8340/3 for IEFVPTC using the STR Manual, 2026 Update. Rule M18, Note 2, of the Other Sites STR state: Invasive encapsulated follicular variant of papillary thyroid carcinoma and Infiltrative follicular variant of papillary thyroid carcinoma share a histology code (8340) but are distinctly different entities. They are on separate rows of the table. WHO Classification of Endocrine and Neuroendocrine Tumors, 5th ed., indicates that after classic PTC, the follicular variant of PTC (FVPTC) is the second most common histological subtype of PTC. Two major forms are known, infiltrative FVPTC and invasive encapsulated FVPTC. The majority of follicular PTCs are encapsulated FVPTCs, whereas infiltrative FVPTC is quite rare and clinically behaves like classic PTC. |
2026 |
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