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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?

There was a single right fallopian tube tumor with two distinct morphologies. The diagnosis comment states, “The combined morphologic and immunohistochemical features are best classified as primary fallopian tube high grade serous carcinoma with a somatically derived yolk sac tumor.”

In the Heme Manual, published October 2025, the ambiguous terminology used to determine reportability for heme and lymphoid neoplasms (Case Reportability Instructions) was updated and "consistent with" was removed. However, this is an ambiguous term that is used to describe reportability (and not just histology). The term "consistent with" was previously included as a reportable ambiguous term used to report cases prior to this update.

The updated Heme Manual is clear regarding "consistent with" now being a definitive diagnosis for the purpose of coding histology. However, the Note under instruction 4 states, "Do not apply these changes to casefinding, reportability, or staging." Is "consistent with" an exception to this Note? Or should it be re-added to the ambiguous terms related to reportability?

PI-RADS 4 and 5 are reportable per the SEER Manual and can be used to code the diagnosis date. When further work-up does not shortly follow the MRI, and no information is available to the central registry to account for the delay, should the date of the biopsy be used to code diagnosis date?

The PI-RADS 4/5 statement is an ambiguous terminology diagnosis, and this is a reference of last report. Is there a time cut-off registry should consider when there is a months-long delay and no info available to account for the biopsy delay? Using the PI-RADS diagnosis in these cases makes it appear as if any first course treatment is often greater than 1 year after "diagnosis," when it is really only approximately 6 months after the biopsy.

Which source should be used to code diagnosis date in these cases?:

Case 1: 01/04/2023 MRI identified both PI-RADS 4 and 5 lesions bilaterally. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 05/20/2024 biopsy proved adenocarcinoma. The patient underwent a prostatectomy approximately 6 months after biopsy on 01/13/2025. Biopsy diagnosis followed MRI diagnosis more than 16 months later and the plan was for active treatment.

Case 2: 02/05/2024 MRI identified a PI-RADS 5 lesion. No work-up immediately followed and there is no chart information to account for the delay. The patient was seen again by urology and a 08/29/2024 biopsy proved adenocarcinoma. After consultation with the urologist, active surveillance was recommended on 01/27/2025. Biopsy diagnosis followed MRI diagnosis more than 6 months later and the plan was for active surveillance.

Patient was diagnosed with smoldering myeloma in October 2021 and put on surveillance. In May 2024, the patient became symptomatic and started chemotherapy.

Is the date of diagnosis in 2021, with date of first treatment with chemotherapy in 2024? Or is active surveillance first course and treatment with chemotherapy as second course in 2024?

Historically, synchronous ductal and lobular tumors have been accessioned as a single primary. These were previously covered under Rule M10, which was removed from the (STR) Manual 2026 Update. While the previous iteration of Rule M10 was problematic, the main issue related to the lack of a timing component within the rule (i.e., indicating it applied to synchronous ductal and lobular tumors).

Using the current Breast STR, when there are two (or more) simultaneous tumors which are not mixed lobular and ductal within each tumor, the applicable M Rule is Rule M13: Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3. To apply the M Rules, a provisional histology must be assigned to EACH tumor so we cannot code each tumor as 8522 before we start applying the M Rules. These provisional histologies would be 8500 and 8520, and these are on different rows in Table 3.

Code A280 is defined as a total removal of the ovarian tumor or removal of a single ovary (oophorectomy) WITH a hysterectomy. The unilateral removal of both the fallopian tube and ovary [(salpingo-) oophorectomy] is included in surgery codes A350-A370. However, the SEER Note under code A280 states, "Also use code A280 for current unilateral (salpingo-) oophorectomy with previous history of hysterectomy." Should this SEER Note read, "Also use code A280 for current unilateral oophorectomy with previous history of hysterectomy"?