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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+.

Abstract a single primary using Solid Tumor Rules, Malignant CNS and Peripheral Nerves, Rule M10 based on the information provided.  Rule M10 applies as both non-contiguous tumors are of the same histology; i.e., on the same row in Table 3. As MPNST can arise in many sites, look for information about the precise location and tissue type in which the tumor arose. For example, if the tumors are stated to arise in soft tissue, follow the Multiple Primary Rules for Other Sites.

Both WHO Classification of Central Nervous System Tumors and WHO Classification of Soft Tissue and Bone Tumors state that MPNST is a malignant spindle cell tumor often arising from a peripheral nerve, from a pre-existing benign nerve sheath tumor, or in a patient with neurofibromatosis type 1 (NF1).

Future updates will move C470-C479 from CNS to other sites module.

This case does not fall into the standard rules. WHO criteria for diagnosing pituitary adenoma have recently changed (per 5th Ed WHO CNS book) and we will likely see more PitNET’ s than pituitary adenomas in the future.  PitNET may be invasive or non-invasive but the likelihood of the pathologists providing this information is low. Since we don’t know if the 2018 adenoma was a PitNET based on current criteria or if it transformed to the malignant neoplasm, err on the side of caution and abstract a second primary per M5.

This issue is new, and we’ve received numerous questions concerning pathologist reviewing older cases of pituitary adenoma and reclassifying them as PitNET using the new criteria.

Abstract three primaries based on this scenario.

1 – 2020, SCC LUL lung

2 – 2022, Adenocarcinoma lung, described as metastatic pulmonary, based on biopsy of right hilar node (Rule M8)

3 – 2022, SCC RLL lung (Rule M11)

Assign 8077/2 for high-grade squamous intraepithelial lesion, VIN 3 in this case.  The WHO Classification of Female Genital Tumors, 5th edition, states that squamous intraepithelial lesions (SILs) of the vulva are also known as vulvar intraepithelial neoplasia, HPV-associated.  The term squamous cell carcinoma in situ is not recommended.

Assign code 8742/2 (lentigo maligna) for “early lentiginous melanoma in situ.” ICD-O-3.2 lists the preferred term for 8742/2 as lentigo maligna (C44._).

Assign as Stage IV as recommended by our expert hematological oncologist. This is a rare occurrence and this type of presentation does not fit the definition of intraocular extension. Stage IV is probably the best stage for this type of presentation, since there are two extranodal organs involved, even though they involve a bilateral site.

EOD Primary Tumor: 700

SS: 7 (Distant)

Assign 9380/1 for low grade glioma diagnosed 1/1/2018 forward and for low grade glioma diagnosed prior to 1/1/2018 assign code 8000/1 on the advice of our expert neuropathologists. The site/type combination of C71 _ and 9380/1 will flag histology/site/behavior edits which should be overridden.

Low grade glioma is an umbrella term or non-specific diagnosis, primarily seen on radiologic reports such as CT scans and MRIs. Often, the patient is actively followed with scans and surgical intervention delayed or not recommended. WHO Classification of Central Nervous System Tumors, 5th edition, does not recognize this term and indicates that tissue diagnosis (including genetic testing) is needed to provide a specific diagnosis. Since biopsy of these “neoplasms” is not routinely done, a definitive diagnosis is not available. Literature searches yielded conflicting information with some stating low grade gliomas are malignant with an indolent clinical course while others felt they were benign. Until such time as WHO proposes a code for this neoplasm, our expert neuropathologists recommend coding glioma, NOS with borderline behavior 9380/1. 

Assign margin status as “positive” when stated as approximates margins as recommended by our expert pathologists. Approximating means coming right up to inked margin without the margin transecting the tumor.

This is a single primary according to the Solid Tumor Rules.

1. Breast Solid Tumor Rule M18 applies to the occurrence of the second right breast tumor (single primary).
2. Apply the Solid Tumor Rules, General Instructions, that state the rules are NOT used for tumor(s) described as metastases. Tumor in a metastatic site is not counted when applying the Solid Tumor rules. In this case, the physician stated that this is a right breast primary with widespread metastasis to the left breast.