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Report Produced: 09/16/2025 21:09 PM

Report Question ID Question Discussion Answer Year
20220021

Solid Tumor Rules/Multiple Primaries--Brain and CNS:  How many primaries are accessioned, and what M Rule applies, for a 2012 diagnosis of left cerebral transitional meningioma (9537/0) that transforms to an atypical meningioma (9539/1) in 2022? See Discussion.

The patient underwent a resection of the transitional meningioma in 2012, but residual tumor was left behind. The patient was on surveillance until imaging showed growth of the residual tumor. The resection in 2022 proved atypical meningioma.

Rule M2, the first rule that applies, indicates this situation represents a single primary (a single tumor). However, Rule M4 states the transformation from a benign meningioma to a borderline meningioma would only be a single primary if the meningioma was a NOS.

This patient has microscopic confirmation of a meningioma showing different subtypes/variants (listed in Column 3, Table 6). Should this be accessioned as multiple primaries based on the transformation and distinctly different histologies?

Non-malignant CNS rule M4 applies, this is a single primary. This scenerio is covered in Example 2: A meningioma 9530/0 transforms into an atypical meningioma 9539/1. 

 2022
20220009

First Course Therapy/Reason for No Surgery of Primary Site:  What code should be used for Reason for No Surgery of Primary Site in 2020 in situations affected by the pandemic when abstracting all sites?  See Discussion.

Example:  Patient scheduled for left nephrectomy on 3/10/20 due to left renal papillary renal cell carcinoma diagnosed on 2/11/20 via needle core biopsy. Abstract indicated surgery was cancelled due to the pandemic. Abstract also indicated the surgery was not rescheduled.

There is no available code that fits this situation. We recommend assigning code 6 (Surgery of the primary site was not performed; it was recommended by the patient’s physician, but was not performed as part of the first course of therapy. No reason was noted in patient record.) and documenting the situation in a text field.

 2022
20220036

Solid Tumors Rules/Histology--Head and Neck:  How is histology coded for head and neck primaries when a tumor is diagnosed as an invasive squamous cell carcinoma with multiple subtypes?  See Discussion.

Example Case 1:  2022 mobile tongue tumor biopsy shows squamous cell carcinoma, basaloid non-keratinizing type.

Example Case 2:  2022 base of tongue mass biopsy shows squamous cell carcinoma, basaloid non-keratinizing type, p16 positive.

Table 5, Note 2 (Head and Neck Equivalent Terms and Definitions) instructs us to code non-keratinizing squamous cell carcinoma which is p16 positive to 8085 (Squamous cell carcinoma HPV-positive), ignoring the non-keratinizing subtype. Does p16 or HPV positivity also take priority over multiple subtypes (basaloid non-keratinizing type)?

Assign 8083/3, basaloid squamous cell carcinoma (BSCC), in both examples. It is more important to capture the variant than to code 8085 or 8086.

WHO Classification of Head and Neck Tumors, 5th ed., states that BSCC is a distinctive form of SCC, characterized by prominent basaloid morphology, squamous differentiation, and aggressive behavior.  Some primary sites capture p16 status as a Site Specific Data Item; you may record the p16 results when that is the case.

 2022
20220028

Reportability/EOD--Ovary:  Bilateral ovary shows gonadoblastoma with germ cell neoplasia in situ (9064/2). Pathology report clearly states in situ. Is this case reportable?

If this case is reportable, how would you code Extent of Disease (EOD) Primary Tumor and SEER Summary Stage (SS)? In situ code 000 for primary tumor and code 0 for SS 2018 is not given as an option. 

Report germ cell neoplasia in situ (9064/2). Assign 999 for EOD Primary Tumor and assign 9 for SS2018.

This particular histology is in the Soft Tissue Abdomen and Thoracic schema where EOD PT 000 and SS2018 0 are not available. This histology will be moved to the Ovary schema after redefining certain schemas and thus making the more accurate choices for EOD and SS2018 available. The schema redefine is planned for 2024 implementation.

 2022
20220025

Reportability/Histology--Anal Canal:  For cases diagnosed in 2021, is anal intraepithelial neoplasia (AIN) II reportable?   There is conflicting information regarding the reportability for AIN II.  SINQ 20210048 says to report AIN II but the 2021 SEER Manual Appendix E states intraepithelial neoplasia (8077/2 and 8148/2) must be unequivocally stated as grade III to be reportable.

AIN II is reportable for 2021. Squamous intraepithelial neoplasia, grade II is listed in ICD-O-3.2 as 8077/2 making it reportable for cases diagnosed in 2021. AIN is a type of squamous intraepithelial neoplasia.

The wording in Appendix E of the 2021 SEER manual (must be unequivocally stated as grade III to be reportable) was left over from earlier versions and is not correct for 2021 diagnoses. Follow the guidance in SINQ 20210048.

 2022
20220020

Histology--Thyroid: What is the correct histology code for a thyroidectomy with final diagnosis of “Right lower lobe: papillary microcarcinoma, conventional type, 0.8 cm. Isthmus: papillary microcarcinoma, follicular variant, 0.2 cm. Left lobe: Papillary carcinoma, conventional, unencapsulated.” See Discussion.

We were previously told that papillary microcarcinoma is coded to 8260 (papillary thyroid carcinoma) and not papillary microcarcinoma (8341). That is an area of confusion. 

Based on the information provided, code histology to follicular variant of papillary thyroid carcinoma (8340/3).  The tumor is a mix of papillary and follicular variants.

 2022
20220010

EOD 2018/Heme & Lymphoid Neoplasms--Myeloid Sarcoma:  How is Extent of Disease (EOD) Primary Tumor coded for a myeloid sarcoma with multifocal skin involvement?  See Discussion.

Patient has a diagnosis of myeloid sarcoma presenting as multiple erythematous papules and nodules on back, chest, right arm & shoulder. Oncologist did not mention any evidence or suspicion of an associated AML diagnosis.

HemeRetic schema EOD Primary Tumor Note 1 states that myeloid sarcoma can be coded as localized (code 100) or systemic (code 700). It is not clear what would qualify as systemic disease for myeloid sarcoma.

Assign code 100, localized, using the 2018 EOD Primary Tumor, HemeRetic schema, for the myeloid sarcoma with skin involvement since only the skin is involved.  Use code 700, distant or disseminated, when multiple organs are involved.

 2022
20220040

Laterality--Brain and CNS: Can Laterality be coded as 5 (midline) for a sella turcica meningioma (or tuberculum sellae meningioma) when no other statement regarding tumor laterality is documented? See Discussion.

Laterality is often not noted for these sella turcica meningiomas; therefore, Laterality is often coded as 9 (Unknown). Because the sella turcica appears to be a midline structure in the base of the skull, is Laterality code 5 (midline) more appropriate when additional information is unavailable?

You may assign code 5 (Paired site: midline tumor) for laterality of a meningioma of the sella turcica (C700).

The 2022 SEER manual states in Laterality coding instruction 5: Assign Laterality code 5 only when the primary site is C700, C710-C714, C722-C725, C443, C445.  Do not assign code 5 to sites not listed in 5.a.  

Note that code 9 is for paired sites and there is no information concerning laterality.

Document laterality information in the appropriate text field. Note: Laterality does not factor into the CNS Solid Tumor rules.

 2022
20220030

Histology--Lung:  Is it acceptable to code histology as 8042/3 for a 2020 lung primary when the pathology report states only "oat cell carcinoma?" See Discussion.

In the old 2007 Multiple Primaries/Histology rules, Lung Equivalent Terms and Definitions section, oat cell carcinoma (8042) was listed as one of the obsolete terms that was no longer recognized for small cell carcinoma.  That note is not in the current 2018 Solid Tumor Manual lung chapter, and ICDO-3.2 lists oat cell carcinoma as the preferred term for code 8042/3.  Would rule H4, Note 2 apply -- only one histology present, if not listed in Table 3 use ICD-O and all updates, to code oat cell carcinoma as 8042/3?

While oat cell carcinoma is an outdated term, if that is all the pathology report states, code histology as 8042/3. 

Yes, Rule H4 applies: the diagnosis was a single histology. H4 instructs you to refer to the solid tumor H table, and if the term is not found there, check ICD-O and ICD-O updates. All possible histologic types that could occur in the lung may not be included in the table.

 2022
20220002

Solid Tumor Rules (2018, 2021)/Histology--Cervix:  For cases diagnosed 1/1/2022 and later, how is histology coded for the following three cervix cases relating to p16? See Discussion.

The 2022 SEER Manual indicates the p16 status (positive or negative) can be used to code more the specific histology for squamous cell carcinoma, human papilloma virus (HPV) positive (8085) and squamous cell carcinoma, HPV negative (8086). However, the histology coding instructions in the Other Sites schema have not been updated and the 2022 SEER Manual does not cover all situations commonly encountered in the registry. Does the clarification regarding p16 apply to these other situations?

  1. How is histology coded when the final diagnosis of the most representative specimen is adenocarcinoma (NOS), but the immunohistochemistry is p16 negative? Is this adequate to code histology to 8484/3 (adenocarcinoma, HPV-independent, NOS)? The pathologist did not specifically indicate this was HPV-independent adenocarcinoma, and the clarification in the 2022 SEER Manual does not include this more specific adenocarcinoma histology.
  2. How is histology coded when the Pap smear is positive for squamous cell carcinoma, p16 positive, but the most representative specimen from the primary tumor (the subsequent cervix biopsy) is only stated to be squamous cell carcinoma (NOS)? The p16 studies were not repeated on the most representative specimen, and the existing 2007 Multiple Primaries/Histology (MP/H) General Rules indicate to code the histology from the most representative specimen over a cytology report. Following the existing 2007 MPH General Rules, the histology should be 8070 (squamous cell carcinoma, NOS). However, this does not account for the p16 status of the tumor.
  3. How is histology coded when a biopsy of a metastasis (e.g., a lymph node metastasis) proved squamous cell carcinoma, p16 negative, but a subsequent biopsy of the primary cervix tumor proved squamous cell carcinoma (NOS) without additional IHC studies? Again, the 2007 MP/H General Rules confirm the primary site specimen should be used to code the histology, resulting in a diagnosis of 8070 (squamous cell carcinoma, NOS), but this ignores the p16 status of the tumor.

For cases diagnosed beginning 1/1/2022, assign histology based on new codes and terms for the examples of cervical cancer using the available p16 results as follows.

1.  Adenocarcinoma, HPV-independent, NOS (C53._) (8484/3)

2.  Carcinoma, squamous cell, HPV-associated (C53._) (8085/3)

3.  Carcinoma, squamous cell, HPV-independent  (C53._) (8086/3)

The 2022 SEER Manual states: Beginning with cases diagnosed 01/01/2022 forward, p16 test results can be used to code squamous cell carcinoma, HPV positive (8085) and squamous cell carcinoma, HPV negative (8086).  Use the available results as the rules for Other Sites have not been updated yet. The SSDI Manual data item p16 for Cervix schema also states that p16 is based on testing results and not a physician statement.  We can address these situations in a future version of the Solid Tumor Rules. The Other Sites rules will provide document priority when coding hsitology: biopsy vs. resection, cytology vs. histology, primary site vs. mets or regional site. 

 2022