This is a document containing changes only. Do not use in place of the Solid Tumor Rules.
See the May 2023 Revisions
See the December 2022 Revisions
See the September 2021 Revisions
See the December 2020 Revisions
See the November 2020 Revisions
See the July 2019 Revisions
See the April 2019 Revisions
See the 2018 Revisions
General Instructions
- “What You Need to Know About the Solid Tumor Rules” section
- “Head and Neck” added to statement about peripheral nerves
Breast
Terms and Definitions
- New Section: New for 2024
- Table 2: Histology Combination Codes
- “In situ lobular mixed with other types of in situ carcinoma 8524/2” row: deemed biologically impossible per Cancer PathCHART review (see notes)
- Table 3: Specific Histologies, NOS, and Subtypes/Variants
- New footnote added
- "Carcinoma NST 8500" row
- “Solid carcinoma/solid adenocarcinoma 8230/3”: per Cancer PathCHART review, should be coded to 8500 beginning 1/1/2024 (see notes)
- “Medullary carcinoma 8510” row:
- Subtype/variant deleted: “Medullary carcinoma with lymphoid stroma 8512” (per Cancer PathCHART expert review)
- “Metaplastic carcinoma 8575” row:
- “Metaplastic carcinoma spindle-cell type/spindle cell carcinoma 8032”: per Cancer PathCHART review, should be coded to 8575 beginning 1/1/2024 (see notes)
- Subtype/variant deleted: “Sarcomatoid carcinoma 8033” (per Cancer PathCHART expert review)
Histology Coding Rules
- Priority Order for Using Documentation to Identify Histology:
- “Core biopsy” added to Exception box: “If the initial diagnosis is based on histology from FNA, core biopsy, smears…”
- New H Rule (Single Tumor: In Situ Only module): “Code in situ lobular carcinoma 8520/2 when there is a combination of lobular carcinoma in situ and one histology other than DCIS AND…”
- New H Rule (Single Tumor: In Situ Only module): “Code the histology that comprises greater than 50% of the tumor when two histologies are in situ lobular AND any histology other than DCIS.”
- H Rule: “Code the invasive histology when both invasive and in situ components are present…”
- Note 2 clarified
- New H Rule (Single Tumor: Invasive and In Situ components Module): “Code duct and lobular 8522/3 when the final diagnosis is any of the following…”
- Rule added to specifically address invasive and in situ
- Subsequent rules renumbered
- H Rule (Single Tumor: Invasive Only Module): “Code duct carcinoma and lobular carcinoma 8522/3 when the final diagnosis is invasive carcinoma NST/duct carcinoma and invasive lobular carcinoma…”
- Rule modified to only address invasive behaviors (mix of invasive and in situ moved to new rule in the Invasive and In Situ module)
- H Rule (Single Tumor: Invasive Only Module): “Code the subtype/variant (specific histology) ONLY when there is a NOS/NST and a subtype/variant AND the subtype/variant is documented to be greater than 90% of the tumor.”
- Example 2: Spindle cell type carcinoma removed from example
Multiple Primary Rules
- Rule M5: Abstract multiple primaries when the patient has a subsequent tumor after being clinically disease-free for greater than five years…
- Note 1 updated to clarify that the rule only applies to tumors in the same breast.
- Rule M10: Abstract a single primary when there are multiple tumors of carcinoma NST/duct and lobular.
- Note 5 added
Colon
Terms and Definitions
- Table 1: Specific Histologies, NOS, and Subtypes/Variants
- Gastrointestinal stromal tumor 8936/3 row, synonyms added:
- “GIST, spindle cell type”
- “Succinate dehydrogenase-deficient gastrointestinal stromal tumor”
- Gastrointestinal stromal tumor 8936/3 row, synonyms added:
Histology Coding Rules
- H Rule: “Code invasive mucinous adenocarcinoma 8480 when the diagnosis is any of the following…”
- Bullet added to Note 2: “The pathologist has staged the LAMN as T3 or T4”
Head and Neck
Terms and Definitions
- Table 1: Tumors of Nasal Cavity, Paranasal Sinuses and Skull base
- “Squamous cell carcinoma 8070” row:
- Subtypes added:
- “Basaloid squamous cell carcinoma 8083”
- “Papillary squamous cell carcinoma 8052”
- “Verrucous Carcinoma 8051”
- Subtypes added:
- “Squamous cell carcinoma 8070” row:
- Table 3: Tumors of Pyriform Sinus, Hypopharynx, Larynx, Trachea, and Parapharyngeal Space
- “Chondrosarcoma 9220/3” row:
- Subtype added: “Chondrosarcoma, grade 1 9222/3 (cases diagnosed 1/1/2022 forward)”
- "Liposarcoma 8850/3” row:
- Synonyms deleted
- Subtype added: “Liposarcoma, well differentiated 8851/3”
- 8240 row: Term updated to "Neuroendocrine tumor, NOS"
- Synonym added: "Well-differentiated neuroendocrine carcinoma"
- “Chondrosarcoma 9220/3” row:
- Table 5: Tumors of the Oropharynx, Base of Tongue, Tonsils, Adenoids
- Note added regarding coding SCC with HPV status
- “Squamous cell carcinoma 8070” row:
- Subtypes added:
- “Basaloid squamous cell carcinoma 8083”
- “Lymphoepithelial carcinoma 8082”
- “Papillary squamous cell carcinoma 8052”
- “Squamous cell carcinoma, spindle cell 8074”
- “Verrucous carcinoma/Carcinoma cuniculatum 8051”
- Subtypes added:
- Table 9: Paraganglioma of Carotid Body, Extra-adrenal, Larynx, Middle Ear, Vagal Nerve
- Rows added:
- “Aortic body paraganglioma (C75.5)”
- “Parasympathetic paraganglioma”
- “Sympathetic paraganglioma”
- “Middle Ear Paraganglioma” Row:
- “Jugular” added as a synonym
- Rows added:
- Table 10: Paired Sites
- Row added: “Carotid body C754”
Kidney
Terms and Definitions
- Table 1: Specific Histologies, NOS, and Subtypes/Variants
- New row: “Medullary carcinoma 8510” (removed from RCC subtypes)
- "Neuroendocrine tumor (NET) 8240” row:
- Note added
- “Extra-adrenal paraganglioma 8693” added as a subtype/variant
- “Renal cell carcinoma NOS 8312” row:
- Subtypes/variants added:
- ELOC (formerly TCEB1) mutated RCC 8311*
- Eosinophilic solid and cystic RCC 8311*
- Fumarate hydratase-deficient RCC ALK-rearranged RCC 8311*
- T(6;11) RCC 8311*
- TFE3-rearranged RCC 8311*
- TFEB-altered RCC 8311*
- Xp11 translocation RCC 8311*
- Note regarding 8311 terms updated
- Subtypes/variants added:
- Table 2: Neoplasms which are Not Reportable
- Rows added:
- “Oncocytic tumor, NOS (no code)”
- “Ossifying renal tumor of infancy 8967/0”
- Synonyms added for the following rows:
- “Adult cystic teratoma 8959/0”
- “Angiomyolipoma 8860/0”
- “Congenital mesoblastic nephroma 8960/1”
- “Juxtaglomerular cell tumor 8361/0”
- “Papillary adenoma 8260/0”
- “Paraganglioma 8700/0” row:
- Note added
- Rows added:
Multiple Primary Rules
- Rule M7: Abstract multiple primaries when separate/non-contiguous tumors are two or more different subtypes/variants in Column 3…
- Note 2 updated with new terms for 8311
Lung
Terms and Definitions
- Equivalent Terms/Definitions:
- “Sarcoma NOS 8800 and all subtypes of sarcoma NOS” added to the exclusions for NSCLC
- Table 3: Specific Histologies, NOS, and Subtype/Variants
- Note 1 Definition of NSCLC clarified
- Note 2 added
- “Adenocarcinoma 8140” row: Note added
Histology Coding Rules
- Coding Histology Section
- Note about exception added to #4 (Do not code histology described as pattern…)
- H Rule: “Code the histology that comprises the greatest percentage of tumor when…”
- Note 3 and Example 3 added regarding coding “patterns”
Malignant Brain and CNS
Terms and Definitions
- Introduction: Added “Note 10: Use Malignant CNS Rules for histologies other than paraganglioma arising in C47_.”
- Table 3: Specific Histologies, NOS, and Subtypes/Variants
- Rows added:
- “Cauda equina neuroendocrine tumor 8693/3”
- “Glioma, NOS 9380”
- “Neuroepithelial tumor, malignant 8000/3” row:
- Note added
- Rows added:
Multiple Primary Rules
- New M Rules (and rules renumbered):
- M Rule: “Abstract a single primary when a neoplasm is originally diagnosed as glioma, NOS and subsequently recurs in residual tumor with a more specific histology.”
- M Rule: “Abstract a single primary when separate, non-contiguous tumors are Glioma NOS and a subtype/variant of Glioma NOS.”
- M Rule: “Abstract multiple primaries when a patient has a glial tumor and is subsequently diagnosed with a glioblastoma multiforme 9440 (GBM).”
- “Glioma NOS 9380” added to Note 1
- M Rule: “Abstract multiple primaries when separate/non-contiguous tumors are on different rows…”
- Note added regarding 8000
Melanoma
Terms and Definitions
- Table 2: “Lentigo maligna/Hutchinson melanotic freckle 8742/2 / Lentigo maligna melanoma/Melanoma in Hutchinson melanotic freckle 8742/3” combined on one line
Non-Malignant Brain and CNS
Terms and Definitions
- Table 6: Specific Histologies, NOS, and Subtypes/Variants
- “Hemangioma 9120/0” row:
- “Cavernoma” added as a synonym
- “Venous hemangioma” 9122/0 added as a subtype/variant
- “Neuroepithelial tumor, benign 8000/0” row:
- Note added
- “Neuroepithelial tumor, NOS 8000/1” moved from column 3 to column 2
- “Hemangioma 9120/0” row:
Multiple Primary Rules
- Throughout M Rules:
- “Hemangioma 9120/0” row:
- Notes added clarifying MVNT and papillary glioneuronal tumor are different histologies with the same ICD-O code.
- Notes added clarifying DNET and PLNTY are different histologies with the same ICD-O code.
- M Rule: “Abstract multiple primaries when separate/non-contiguous tumors are on different rows…”
- Note added regarding 8000
- “Hemangioma 9120/0” row:
Other
Terms and Definitions
- Changes from 2007 MPH Rules
- C479 added to paraganglioma primary sites excluded from the Other Sites Rules (#6)
- New section: “New for 2024”
- New tables added:
- Table 9a: Guidelines for Assigning Primary Site for Liver and Intrahepatic Bile Duct C220, C221
- Table 22: Thymus Histologies
- Table 23: Penis and Scrotum Histologies
- Table 2: Mixed and Combination Codes
- Synonyms for 8340 added
- Row added: “Mixed medullary and poorly differentiated carcinoma / mixed medullary and anaplastic carcinoma / Mixed medullary and oncocytic carcinoma 8346”
- “Combined hepatocellular carcinoma and cholangiocarcinoma 8180” row: C221 added
- Table 4: Testis Histologies
- “Germ cell tumor, NOS 9064” row:
- Note 2 added
- “Germ cell tumor, NOS 9064” row:
- Table 5: Esophagus Histologies
- Row added: “Gastrointestinal stromal tumor 8936”
- Table 6: Stomach Histologies
- Coding Notes for Stomach added
- “Adenocarcinoma, NOS 8140” row:
- Note added regarding Paneth cell carcinoma
- “Paneth cell carcinoma” added as a synonym for 8140 (removed as a synonym from 8576)
- Subtypes/variants added:
- “Adenocarcinoma, diffuse type 8145/3”
- “Adenocarcinoma, intestinal type 8144/3; Intestinal type adenoma, high grade 8144/2”
- Row added: “Gastrointestinal stromal tumor 8936
- Table 7: Small Intestine and Ampulla of Vater Histologies
- Row added: “Gastrointestinal stromal tumor 8936
- Table 9: Liver and Intrahepatic Bile Duct Histologies
- “Coding Notes for Cholangiocarcinoma”: Limited to cases diagnosed prior to 1/1/2023
- “Cholangiocarcinoma 8160/3” row: "C220” added
- “Combined hepatocellular carcinoma and cholangiocarcinoma 8180/3” row: “C221” added
- “Hepatocellular carcinoma 8170” row
- “/3” and “C220” added
- New synonyms added for the subtype/variant 8174 (all terms were previously synonyms for 8170)
- Table 10: Gallbladder and Extrahepatic Bile Duct Histologies
- “Adenocarcinoma 8140” row: “Pancreatobiliary-type carcinoma 8163” added as a subtype/variant
- “Bile duct carcinoma 8160” row: “C240” added
- Table 11: Pancreas Histologies
- Rows added:
- “Mixed neuroendocrine non-neuroendocrine neoplasm 8154”
- “Neuroendocrine carcinoma, NOS 8246”
- “Neuroendocrine tumor, NOS 8240”
- “Intraductal papillary mucinous neoplasm 8453” row:
- Synonym deleted: “Intraductal oncocytic papillary neoplasm with an associated invasive carcinoma 8453/3”
- Synonym added: “Intraductal papillary mucinous neoplasm with associated invasive carcinoma 8453/3”
- Rows added:
- Table 12: Thyroid Histologies
- Thyroid Coding Note added
- “Medullary thyroid carcinoma 8345” row: “Medullary microcarcinoma” added as a synonym
- “Oxyphilic adenocarcinoma 8290” row:
- Synonyms added:
- “Encapsulated angioinvasive oncocytic carcinoma of the thyroid”
- “Minimally invasive oncocytic carcinoma of the thyroid”
- “Widely invasive oncocytic carcinoma of the thyroid”
- Synonyms added:
- “Papillary thyroid carcinoma, NOS 8260”
- Synonyms added:
- “Clear cell papillary thyroid carcinoma”
- “Spindle cell papillary thyroid carcinoma”
- “Warthin-like papillary thyroid carcinoma”
- Synonyms added:
- “Poorly differentiated thyroid carcinoma 8337/3”
- Synonym added: “Differentiated high-grade thyroid carcinoma”
- Table 13: Ovary Histologies
- Rows added:
- “Adenocarcinoma, NOS 8140”
- “Mixed cell adenocarcinoma 8323”
- Rows deleted:
- “Clear cell carcinoma NOS 8310” (moved to subtype/variant of 8140)
- "Endometrioid adenocarcinoma 8380" (moved to subtype/variant of 8140)
- “Mucinous carcinoma 8480” (moved to subtype/variant of 8140)
- “Carcinosarcoma, NOS 8980/3” row:
- Note added
- “Germ cell tumor, NOS 9064” row:
- New term added for 9085
- “Serous carcinoma, NOS 8441” row:
- “Serous borderline tumor, micropapillary variant” term removed from code 8460/2
- Rows added:
- Table 15: Fallopian Tube Histologies
- “Carcinosarcoma 8980/3” row:
- Note added
- “Carcinosarcoma 8980/3” row:
- Table 16: Uterine Corpus Histologies
- “Endometrioid adenocarcinoma, NOS 8380” row:
- Synonym added: “Endometrial adenocarcinoma/carcinoma”
- “Mixed cell adenocarcinoma 8323” row: Note 2 added
- “Endometrioid adenocarcinoma, NOS” row: Note added
- “Carcinoma, undifferentiated NOS 8020/3 row: Note added
- “Mucinous carcinoma, NOS 8480” row: Note added
- “Neuroendocrine carcinoma NOS 8246/3 row: Note added
- “Endometrioid adenocarcinoma, NOS 8380” row:
- Table 17: Uterine Cervix Histologies
- “Carcinosarcoma 8980/3” row:
- Note added
- Endometrioid adenocarcinoma, NOS 8380” row:
- Synonym added: “Endometrial adenocarcinoma/carcinoma”
- “Carcinosarcoma 8980/3” row:
- Table 18: Vagina Histologies
- “Carcinosarcoma 8980/3” row:
- Note added
- Endometrioid adenocarcinoma, NOS 8380” row:
- Synonym added: “Endometrial adenocarcinoma/carcinoma”
- “Carcinosarcoma 8980/3” row:
- Table 20: Soft Tissue Histologies
- “Liposarcoma, NOS 8850/3” row:
- Histology code for Myxoid pleomorphic liposarcoma corrected to 8859/3
- “Liposarcoma, NOS 8850/3” row:
- New tables
- Table 22: Thymus Histologies
- Table 23: Penis and Scrotum Histologies
Urinary
Terms and Definitions
- Table 1: ICD-O Primary Site Codes
- “Littre glands” added to Urethra C680
- Table 2: Specific Histologies, NOS, and Subtypes/Variants
- Row added: “Neuroendocrine carcinoma 8246/3”
- Subtypes moved: “Large cell neuroendocrine tumor/combined large cell neuroendocrine carcinoma 8013”
- “Small cell neuroendocrine carcinoma 8041/3” (removed from its own row)
- Row added: “Neuroendocrine tumor, NOS 8240/3” (removed as a subtype of 8041)
- Synonyms: “Neuroendocrine tumor, grade 1”, “Neuroendocrine carcinoma, low grade”, “Well differentiated neuroendocrine carcinoma”
- Subtype: “Neuroendocrine tumor, grade 2 8249/3”
- Row deleted: “Small cell neuroendocrine carcinoma 8041” (8041 moved to 8246 row)
- “Squamous Cell Carcinoma 8070” row:
- Synonym added: “Pure squamous carcinoma of urothelial tract”
- “Urothelial carcinoma 8120” row:
- Synonyms added:
- “Conventional urothelial carcinoma”
- “Large nested urothelial carcinoma”
- “Tubular and microcystic urothelial carcinoma”
- Terms added to existing subtypes/variants histology codes:
- “low-grade papillary urothelial carcinoma with inverted growth pattern 8130/2”
- “non-invasive papillary urothelial carcinoma, high-grade 8130/2”
- “non-invasive papillary urothelial carcinoma, low-grade 8130/2”
- “Plasmacytoid urothelial carcinoma 8122/3”
- “poorly differentiated urachal carcinoma 8020/3”
- Synonyms added:
- Row added: “Neuroendocrine carcinoma 8246/3”