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Code follicular carcinoma, minimally invasive, oncocytic variant of the thyroid to follicular carcinoma, oncocytic variant (8290/3).  The term "variant" is commonly used in thyroid histologies and if appropriate, used to determine histology code. The WHO Classification of Tumors of Endocrine Organs, 4th edition, lists synonyms for 8290/3 as Hürthle cell carcinoma; oncoycytic carcinoma; oxyphilic carcinoma; follicular carcinoma, Hürthle cell type; and follicular carcinoma, oncocytic variant.

Do not report the case in this scenario based on the diagnosis alone of mild cytologic atypia and glandular crowding, at most endometrioid intraepithelial neoplasia.  "At most" is not an ambiguous term for reportability.  It appears that "at most" in this case refers to the worst possible option within other possible options (differential diagnosis).  Differential diagnoses are "educated guesses" or hypotheses and are usually not reportable unless proven otherwise.  As there is no clear statement of the diagnosis in this case, we recommend that you seek additional information, for example, clinical diagnosis, treatment, and patient care.

Determining first course treatment is based on knowing the treatment plan and its course as to whether it was completed as initially planned. Read the medical record, scans, labs, and physician notes. First course of therapy ends when the treatment plan is completed as planned.  Alternatively, first course of therapy ends when there is documented disease progression, recurrence, or treatment failure.  A change to a drug in a different group or a change to a different treatment modality indicates the end of the first course of treatment.  While a physician/clinician statement of progression, additional imaging, or other procedures that assess treatment efficacy, or increase in tumor burden can be used to denote progression, recurrence, or failure, a change to the initial treatment plan is a signal to to the registrar to suspect the end of first course of therapy.  Once the initial treatment plan is changed, everything after the change is subsequent treatment.

In the scenario provided, code FOLFIRINOX as first course of treatment.  Based on the information provided, the Abraxane, Gemzar, and SBRT are second course and everything that followed that is second or subsequent course. The physician noted progressive disease and a new treatment regimen was started -- this is a clear indication of the end of the first course of treatment. The planned treatment course was FOLFINOX and surgery. Once that initial treatment plan is changed, everything after the change is no longer first course of treatment. Use text fields to document the details.

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.

Code the residence where the student is living for exchange students temporarily living in the U.S.  Code the temporary address if known or the Post Office Box if unknown.  We will add this scenario to the next release of the SEER manual.

Report this 2022 case of ALK-positive histiocytosis using histology code 9751/3, Langerhans cell histiocytosis, disseminated. Use text fields to document that this is a case of ALK-positive histiocytosis. This term may be assigned a new code once the 5th edition of the Hematopoietic WHO Blue Book is released.

Report papillary renal neoplasm with reverse polarity as 8260/3. According to the WHO Classification of Urinary and Male Genital Tumors, 5th edition, this is a distinctive pattern of papillary renal cell carcinoma that has been recently recognized. These tumors have recurrent mutations of KRAS, differing from typical papillary renal cell carcinoma. We recommend that you include with reverse polarity in your histology text to differentiate this entity from others classified in 8260/3.

Primitive myxoid mesenchymal tumor of infancy (PMMTI) is reportable. PMMTI is listed in the new WHO 5th edition Classification of Soft Tissue and Bone Tumors under round cell sarcomas. This is a variant of BCOR sarcomas. There is a new ICD-O histology code assigned for cases diagnosed in 2022 or later (9368/3). Code this 2019 case to round cell sarcoma, undifferentiated 8803/3. Use text fields to explain the details.

Assign code 8000/0.  This is an emerging histology and not yet recognized by the World Health Organization. Document the details in text fields. It might also be useful to document this SINQ question in text.

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.