Reportability/Histology--Heme
& Lymphoid Neoplasms: Is a diagnosis of myeloid stem cell disorder or
myeloid stem cell neoplasm reportable when the differential diagnosis includes
only reportable neoplasms? If so, how should histology be coded? See Discussion.
Pathologists are increasingly using the terms "myeloid stem cell disorder" and "myeloid stem cell neoplasm" to describe reportable myeloid neoplasms. If the pathologist uses these terms and indicates the differential diagnosis includes only reportable neoplasms such as myelodysplastic syndrome, myeloproliferative neoplasm, and acute myeloid leukemia (AML), should this be accessioned as a reportable primary?
Example: The 01/2023 peripheral blood shows high grade myeloid stem cell disorder, and the differential diagnosis includes chronic
myelomonocytic leukemia(CMML) and AML. The patient refused further work-up and expired several days later. No additional information is available.
Report the case when the differential diagnosis includes only reportable neoplasms
in the absence of additional information. We are unable to provide
general instructions for provisional diagnoses as each situation will need to be
reviewed and assessed individually when no further work-up information is available.
Assign myeloid
leukemia, NOS (9860/3) to the case described in the example. Assign a generic histology code because a specific
histology code cannot be assigned when there are several differential diagnoses. Since the differential
diagnoses include a chronic and an acute leukemia, code as myeloid leukemia, NOS since it is not clear if this is chronic or acute.
Reportability--Head & Neck: Are high-grade squamous dysplasia / “severe” squamous dysplasia or glandular intraepithelial neoplasia reportable for all Head & Neck subsites? If so, what year did they become reportable? In reviewing SINQ 20240003, 20230047, and 20230046, it appears that at least the larynx, mandible, and tongue have been reportable since 2021. However, 8077/2 and 8148/2 histology codes are not included in the Solid Tumor Rules (STRs) (2025 update) for Head and Neck, either in Tables 1-9 or the H Rules.
High grade squamous dysplasia (8077/2) is reportable for head and neck sites for cases diagnosed as of 01/01/2021. High grade glandular intraepithelial neoplasia / glandular intraepithelial neoplasia grade III (8148/2) and high grade squamous intraepithelial neoplasia / squamous intraepithelial neoplasia grade III (8077/2) are reportable for head and neck sites for cases diagnosed as of 01/01/2001. Refer to other standard setters’ criteria for reportability as appropriate.
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.
Immunotherapy/Other
Therapy--Heme & Lymphoid Neoplasms: Is the elimination of immunosuppression
treatment coded as other treatment? An example is when a post-transplant
patient develops a malignant myeloproliferative neoplasm that subsides when
immunosuppression drugs are stopped.
Do not code as a treatment. Record the cessation of
immunosuppressive drug treatment in text to explain the patient’s change in
disease status.
Reportability/Histology--Soft Tissue: Is superficial CD34 positive fibroblastic tumor reportable and if so what histology code should be used? See Discussion.
Patient had a left thigh soft tissue mass excision on 7/24/24 and was diagnosed with superficial CD34 positive fibroblastic tumor. Margins were narrowly free of disease. Tumor size was 5.5 cm x 4.4 cm x 3.9 cm. The diagnosis was confirmed.
Do not report superficial CD34-positive fibroblastic tumor (8810/1) of the thigh.
WHO Classification of Soft Tissue and Bone Tumors, 5th ed., defines superficial CD34-positive fibroblastic tumor as a distinctive low-grade neoplasm of the skin and subcutis, most frequently occurring in the lower extremities, especially thigh, followed by arm, buttock, shoulder, and rarely, vulva.
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.
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.
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