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Report this case as a malignant thymoma. Our expert pathologist consultant reviewed this case and in his opinion, the "separate tumor nodules within peri-thymic adipose tissue" fit registry reporting criteria for separate tumor nodules making this a malignant thymoma.

Elephantiasis nostras verrucosa (ENV) is not reportable. ENV is a rare form of chronic lymphedema caused by any number of conditions including neoplasms, trauma, radiation treatment, congestive heart failure, obesity, hypothyroidism, chronic venous stasis, and parasitic infection.

If a SLN biopsy is performed but no RLN dissection is performed, assign as follows.

Date of Regional Lymph Node Dissection: Leave blank as this field records the date non-sentinel regional node dissection was performed.

Date of Regional Lymph Node Dissection Flag: Assign code 11 (Not applicable: No proper value is applicable in this context (for example, no regional lymph node dissection was performed; autopsy only cases).

Regional Nodes Examined: Indicate the number of SLNs examined as this is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

Regional Nodes Positive: Indicate the number of SLNs positive as this is cumulative from all procedures that remove lymph nodes through the completion of surgeries in the first course of treatment.

We are aware of the issue and have been in discussion with standard setters (SEER, NPCR, AJCC, and NAACCR). At this time, we recommend coding:

Histology: 8441/2

Extent of Disease (EOD) Primary Tumor: 000

Summary Stage: 0

AJCC Clin/Path T would be 88, since all in situ lesions are not applicable.

Edits will not allow you to have a 8441/2 with a T1. Also, EOD is not currently set up to derive the correct T value, unless you code 100.

The change to address the issue will take effect in 2021.

Code 8046 using Coding Instruction 2 that says to: Code the histology described as differentiation or features/features of ONLY when there is a specific ICD-O code for the "NOS with ____ features" or "NOS with ____ differentiation."

Note: Do not code differentiation or features when there is no specific ICD-O code.

In the example, no ambiguous terminology is used. If ambiguous terminology is used indicating a more specific term, you would code to the specific histology.

For single primaries only, code removal of involved contralateral breast under the data item Surgical Procedure/Other Site (NAACCR Item # 1294), this is, code 1, according to the 2018 SEER Manual:

Assign code 1

When the involved contralateral breast is removed for a single primary breast cancer

This would also apply when Surgery of the Primary Site code is 30 (subcutaneous mastectomy) for breast. If uninvolved, assign code 0 to Surgical Procedure of Other Site

SEER registries should follow the instructions according to the SEER Manual.

Please see the corrected levels below for the note. Note 4: If a Breslow's depth is given in the pathology report and there is no other indication of involvement, the following guidelines may be used (Note: If a physician documents a different Clark's Level than provided by these guidelines, go with the physician's Clark Level)

Code 000: Level I (In situ)

Code 100: Level II (< 0.75 mm Breslow's Depth)

Code 200: Level III (0.76 mm to 1.50 mm Breslow's Depth)

Code 300: Level IV (> 1.50 mm Breslow's Depth)

Thank you for bringing this to our attention.

The NAACCR Guidelines for ICD-O-3 Histology Code and Behavior Update Implementation, effective January 1, 2018, state: Currently in ICD-O-3, when a topography (C code) is listed in parentheses next to the morphology term, it indicates morphology is most common to that site. It may occur in other sites as well. Many of the new codes, terms, and behaviors listed in this update are site-specific and do not apply to all sites.

Please review the Comments to determine which histology codes are specific to sites. You may use sites not listed as the suggested site; however, it will generate an edit error for review and verification of the appropriate site.

Code chronic myeloid leukemia (CML) BCR-ABL1-positive as 9875/3.

According to the WHO Classification of Tumors of Hematopoietic and Lymphoid Tissues, 4th edition, CML BCR-ABL1-positive is characterized by the chromosomal translocation t(9;22) which results in the formation of the Philadelphia (Ph) chromosome containing the BCR-ABL1 fusion gene. The diagnosis requires detection of the Ph chromosome and/or BCR-ABL1. If the mutation is detected, regardless of percentage, it is positive. Quantitative levels of BCR-ABL are used to monitor response to tyrosine kinase inhibitor therapy.

Accession two primaries, adenocarcinoma [8140/3] of the prostate [C619] and small cell neuroendocrine carcinoma [8041/3] of the prostate [C619] per Rule M17 of the Other Sites Solid Tumor Rules 2018, as these are different histologies with different histology codes at the second number.

Adenocarcinoma of prostate often manifests as a small cell carcinoma following treatment or as a progression of disease. It is important to capture these tumors as new primaries.