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.
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--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.
Diagnostic Confirmation--Heme & Lymphoid Neoplasms: How
is Diagnostic Confirmation coded for hematopoietic and lymphoid neoplasms (heme)
when immunophenotyping, genetics, etc. confirm the diagnosis.
Assign Code 3 (Positive histology PLUS positive immunophenotyping or genetic testing) for
1. Cases with positive histology for the neoplasm being abstracted (including acceptable ambiguous terminology and provisional diagnosis), AND
Immunophenotyping, genetic testing, or JAK2 is listed in the Definitive Diagnosis in the Heme Database, AND
Testing
Confirms
the neoplasm OR
Identifies a more specific histology (not preceded by ambiguous terminology)
Peripheral blood smear followed by flow cytometry (most commonly done with CLL/SLL, 9823/3)
2. A not otherwise specified (NOS) histology diagnosed and not a provisional diagnosis, AND genetic/immunophenotyping was performed and positive
Refer to the current version of the Heme Manual for specific notes and examples when coding Diagnostic Confirmation.
Reportability/Behavior--Ovary: Is ovarian mucinous
borderline tumor with foci of multifocal intraepithelial carcinoma reportable?
Report ovarian mucinous borderline tumor with foci of
multifocal intraepithelial carcinoma. The foci of intraepithelial carcinoma
makes this reportable. See the list of synonyms for in situ in the SEER Manual,
Behavior Code data item.
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--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.
Solid Tumor
Rules/Multiple Primaries--Testis: How many primaries and what M Rule applies
when metastatic seminoma is diagnosed greater than 40 years after a left
testicular teratoma with yolk sac tumor and embryonal carcinoma? See
Discussion.
The patient was diagnosed with a left testis primary in the early 1980s that did not include a seminoma component per the information available. The slides were not available for review. In 2024, the patient was found to have a metastatic seminoma involving multiple pelvic lymph nodes and the prostate. The right testicular ultrasound was negative. The managing physician noted this was both a "relapsed seminoma" and a "Stage IIC seminoma."
Should the new diagnosis of metastatic seminoma be accessioned as a new primary based on the histology differences? Or is this situation similar to SINQ 20160073 in which this is a single primary even though the metastases are a distinctly different histology?
Without evidence of a new testicular tumor, record this as a single primary now with metastatic disease (seminoma). The seminoma may not have been identified in the original tumor and treatment was based on the histologies found. This allowed the seminoma to metastasize.
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