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Assign code 8891/3 (epithelioid leiomyosarcoma) as cells were described as have an epithelioid morphology; whereas, myxoid was used as a descriptive term and not a specific histologic type.

Assign code 40, Pull through WITH sphincter preservation (colo-anal anastomosis).  The National Cancer Institute Dictionary of Cancer Terms defines coloanal anastomosis as a surgical procedure in which the colon is attached to the anus after the rectum has been removed. It is also called coloanal pull-through.

Code the Date of First Surgical Procedure as 01/01/2023 in the example provided where the shave biopsy is followed by wide excision. Beginning in 2023, significant changes were made in that shave, punch, and elliptical biopsies are coded as surgical procedure regardless of margin status. Appendix C Skin Surgery Codes state that an incisional biopsy would be a needle or core biopsy of the primary tumor.

Please see Appendix M: Case Studies for Coding Melanoma in STORE v23, Case study 2: Shave Biopsy followed by WLE (page 412), for an explicit example of how to code your example case.

We will clarify this in the upcoming release of the SEER manual,

Code Lupron as second course therapy and code active surveillance as first course therapy in this scenario. The 2023 SEER Manual states to code all treatment data items to 0 or 00 (Not done) when the physician opts for active surveillance, deferred therapy, expectant management, or watchful waiting.  Assign code 2 to Treatment Status. 

Active surveillance is not the same as "refusing treatment."  Active surveillance is a valid option offered to the patient.  The patient chose this option and later changed their mind.  This is not a refusal of recommended treatment.

Document all the details in the appropriate treatment text fields.

As a general rule, the surgeon is usually in a better position to determine the site of origin compared to the pathologist. The surgeon sees the tumor in its anatomic location, while the pathologist is often using information given to him/her by the surgeon and looking at a specimen removed from the anatomic landmarks. However, when a pathologist is looking at an entire organ, such as the pancreas, he/she may be able to pinpoint the site of origin within that organ.

In the case of pancreas body vs. neck, the neck is a thin section of the pancreas located between the head and the body. It may be a matter of opinion whether a tumor is located in the "body" vs. the "neck." In the situation you describe, we would give preference to the surgeon and assign the code for body of pancreas, C251.

Do not report cases of meningioma originating in the jugular bulb or petrous aspect of temporal bone or middle ear. These are not intracranial locations.  

This is a non-reportable meningioma arising in a meningocele within the middle ear. The jugular bulb is the confluence of the lateral venous sinuses situated in the jugular fossa. The precise location of this structure within the temporal bone is variable.The jugular bulb, petrous aspect of temporal bone, and middle ear are not intracranial locations, and therefore meningiomas arising in these areas are not reportable.  

Report as squamous cell carcinoma (8070/3) on the basis of “microscopic focus suspicious for superficial invasion.” "Severe dysplasia" is equivalent to "high grade dysplasia" in the Head and neck. As such, "severe squamous dysplasia" would be coded to 8077/2. However, in combination with the statement of "with microscopic focus suspicious for superficial invasion,” report as squamous cell carcinoma (8070/3) based on “microscopic focus suspicious for superficial invasion.” The 2023 SEER Manual instructs us to code the behavior as malignant (/3) if any portion of the primary tumor is invasive no matter how limited, i.e., microinvasion. Use text fields to record the details. 

Abstract a single primary using the Breast Solid Tumor Rules, Rule M10, assuming the tumors are in the same breast.  This rule is specific to multiple tumors of carcinoma NST/duct and lobular.  Timing is not a factor in this rule.  As stated in ‘New for 2023,’  the rules for determining single versus multiple primaries in tumors with carcinoma NST/duct and lobular carcinoma have been revised and now align with ICD-O-3.2.

Tumors occurring more than five years apart are multiple primaries and would have been caught at Rule M5. Thus, rule M10 pertains to tumors occuring less than five years apart.

Abstract a single primary when there are multiple tumors of carcinoma NST/duct and lobular using the current Breast Solid Tumor Rules, Rule M10, May 2023 Update, for cases diagnosed 01/01/2018 and forward in the examples provided.  The rule also notes to follow the H rules to determine the correct histology code when a mixture of behaviors is present in carcinoma, NST and lobular carcinoma. Rule M5 does not apply as the timeframe is less than 5 years in both examples.

The 2023 update for the Breast Solid Tumor Rules (released November 2022) states: The rules for determining single versus multiple primaries in tumors with carcinoma NST/duct and lobular carcinoma have been revised and now align with ICD-O-3.2.  Applicable Histology Rules have also been revised to reflect ICD-O-3.2 histology terminology and corresponding ICD-O codes.

EOD follows AJCC criteria in this situation and we have confirmed with AJCC that Stage T2a (superficial muscle) and Stage T2b (deep muscle) cannot be assigned when only a TURB is done.

For EOD Primary Tumor, Bladder, codes 200, 250, 300, 350, can only be used when

• Cystectomy is performed
• Muscularis propria is involved, AND
• Pathology report states superficial muscle (200, 250) or deep muscle (300, 350) is involved

If a TURB is done and there is mention of the muscularis propria invasion (superficial muscle or deep muscle), use EOD codes 370 or 400. If a TURB is done and the pathology report states superficial or deep muscle, ignore and coded as “invasion of muscularis propria, NOS” (EOD codes 370 or 400).

Instructions and code descriptions for EOD Primary Tumor have been updated to indicate this. These updated instructions and code descriptions will be available when SEER*RSA is updated for 2024, Version 3.1 (Sept/Oct 2023). These updates are included here for reference and can be applied for cases diagnosed 2018+.