November 2024 Revision History for the Solid Tumor Rules

• References to "2007 MPH rules" changed to "MPH rules"; "2018 Solid Tumor Rules" changed to "Solid Tumor Rules"
• References to "WHO 2010" updated to "5th edition"
• "Site-specific modules" renamed "site groups"
• All "Changes from 2007 MPH Rules" sections removed. Items in those sections were either deleted entirely or moved to the introduction.
• Many "New for 2022", "New for 2023" sections removed or moved to introduction, as well as old notes
• Equivalent or equal terms section: "Synchronous" added as an equivalent term with simultaneous
• References to "NED" removed
• Note moved from site groups to General Instructions: "Tables and rules refer to ICD-O rather than ICD-O-3. The version is not specified to allow for updates. Use the currently approved version of ICD-O."
• Note about biomarkers moved from Introduction to H Rules in all site groups.
• Note about coding histology from the most representative specimen moved to H rules.
• Table Names added to headers
• Coding Histology Section, #3B bullet 1: "pathologist" replaced by "surgeon"

• Preface simplified
• Sections added:
  • Cancer PathCHART Site-Morphology Combination Standards
  • Annual Updates
  • Solid Tumor Rules Site Groups by Diagnosis Year
• Section removed: What You Need to Know About the Solid Tumor Rules (now covered in another section)
• "How to use the Solid Tumor Rules" section: Redundant information removed; instructions simplified
• "How to Use the Equivalent Terms and Definitions" section:
  • Bullet removed: Changes from the 2007 Multiple Primary and Histology Rules
  • Bullet added: Information on coding and important changes
• "Timing Rules" section: 365 days changed to 1 calendar year
• "Definitions" section: Entries updated: "Overlapping tumor", "unilateral"

Equivalent Terms and Definitions

• Table 3: Specific Histologies, NOS/NST, and Subtypes/Variants:
  • "Adenomyoepithelioma with carcinoma 8983" row: Subtype/variant added: "Epithelial-myoepithelial carcinoma 8562"
  • "Metaplastic carcinoma NOS or of no special type (NST) 8575" row: Code for "Low grade adenosquamous carcinoma" corrected to 8570
  • New rows added:
    • "Neuroendocrine carcinoma NOS 8246/3" with subtype/variants:
      • "Carcinoma with neuroendocrine differentiation 8574/3"
      • "Large cell neuroendocrine carcinoma/large cell carcinoma 8013/3"
      • "Small cell neuroendocrine carcinoma/small cell carcinoma 8041/3"
    • "Neuroendocrine tumor NOS 8240/3" with subtype/variant 8249/3
  • Row deleted: "Small cell carcinoma 8041" and subtype/variants 8574/3 and 8246/3 (all moved to new NEC row)

Histology Coding Rules

• Single Tumor: In Situ Only section:
  • "Subtypes/variants" removed from Note 2
  • Note 3 added regarding WHO in situ terms
• Note added to H Rules that instruct to code the histology when one histology is present.

Equivalent Terms and Definitions

• Introduction section: Information about GIST removed from note
• Equivalent or Equal Terms section:
  • Examples added for "Carcinoma; adenocarcinoma" entry
  • Entries deleted:
    • Intramucosal, etc.
    • Serosa; visceral peritoneum
• Terms that are not Equivalent or Equal section:
  • Sub-bullet added to "Carcinoma 8010; adenocarcinoma 8140" entry
  • Sub-bullet deleted from "Component…" entry
  • Second sentence deleted from "Exophytic and polypoid" entry
• Table 1: Specific Histologies, NOS, and Subtypes/Variants: "Gastrointestinal stromal tumor 8936/3" row: Note changed to "Beginning with cases diagnosed 1/1/2021 forward, the word malignant is no longer required in order to be reportable."

Multiple Primary Rules

• Added notes:
  • "Synchronous tumors are tumors existing at the same time; concurrent; prior to first course treatment, simultaneous"
  • "Separate/non-contiguous tumors are tumors that arise independently of each other"
• M rule: Abstract a single primary when there is adenocarcinoma in situ and/or invasive in at least one polyp AND…
  • New bullet added: "Referred to as polyps carpeting the bowel, small bowel, intestines, etc."

Histology Coding Rules

• "Coding Histology" section: Bullet added to Instruction #4: "Phenotype"
• H Rule: Code low grade appendiceal mucinous neoplasm (LAMN) and high grade appendiceal mucinous neoplasm (HAMN) 8480/2 when…: Note 4 added

Equivalent Terms and Definitions

• "Equivalent or Equal Terms" section: Example added to "adenocarcinoma" bullet
• Table 1: Tumors of Nasal Cavity, Paranasal Sinuses and Skull base
  • Rows added:
    • "HPV-related multiphenotypic sinonasal carcinoma 8483/3"
    • "SMARCB1-deficient sinonasal carcinoma 8044"
  • "Lymphoepithelial carcinoma 8082" row: Synonym added: "Sinonasal lymphoepithelial carcinoma"
  • "Mucosal melanoma 8720" row:
    • Note added
    • Subtype/variants added:
      • "Desmoplastic mucosal melanoma 8745/3"
      • "Mucosal lentiginous melanoma 8746/3"
      • "Nodular melanoma 8721/3"
  • "Squamous cell carcinoma 8070" row:
    • Subtype/variants added:
      • "HPV-associated squamous cell carcinoma 8085"
      • "HPV-independent squamous cell carcinoma 8086"
    • "DEK-AFF2 SCC" added as a synonym for 8072
    • "Carcinoma cuniculatum" added as a synonym for 8051
• Table 2: Tumors of Nasopharynx
  • "Nasopharyngeal papillary adenocarcinoma 8260" row: Synonym added: "Low-grade nasopharyngeal papillary adenocarcinoma"
  • "Squamous cell carcinoma NOS 8070" row: Synonym added: "Nasopharyngeal carcinoma"
• Table 3: Tumors of Pyriform Sinus, Hypopharynx, Larynx, Trachea, and Parapharyngeal Space
  • "Chondrosarcoma 9220/3" row: Subtype/variants added:
    • "Clear cell chondrosarcoma 9242/3"
    • "Dedifferentiated chondrosarcoma 9243/3"
  • "Squamous cell carcinoma (SCC) 8070" row: Synonym added: "Hybrid verrucous carcinoma"
• Table 4: Tumors of Oral Cavity and Mobile Tongue
  • Rows added:
    • "Adenosquamous carcinoma 8560"
    • "Granular cell tumor 9580"
  • "Mucosal melanoma 8720" row:
    • Column 1 term updated from "Oral mucosal melanoma"
    • Synonym added: "Oral mucosal melanoma"
    • Subtype/variants added:
      • "Desmoplastic mucosal melanoma 8745/3"
      • "Mucosal lentiginous melanoma 8746/3"
      • "Nodular melanoma 8721/3"
  • "Squamous cell carcinoma 8070" row
    • Subtype/variants added:
      • "Basaloid squamous cell carcinoma 8083"
      • "Lymphoepithelial carcinoma 8082"
      • "Papillary squamous cell carcinoma 8052"
      • "Spindle cell squamous cell carcinoma 8074"
    • "Carcinoma cuniculatum" added as a synonym for 8051
• Table 5: Tumors of the Oropharynx, Base of Tongue, Tonsils, Adenoids
  • "lateral wall of mesopharynx" added to C102
  • "posterior wall of mesopharynx" added to C103
• Table 6: Tumors of Salivary Glands
  • "Acinic cell carcinoma 8550" row: Synonym deleted: "ACC"
  • "Adenocarcinoma 8140" row:
    • The term "Malignant dermal analogue tumor" removed from 8147
    • Subtype/variant added: Mucinous adenocarcinoma 8480
    • Subtype/variants removed:
      • "Cribriform adenocarcinoma 8201"
      • "Large cell carcinoma NOS/large cell undifferentiated carcinoma 8012"
      • "Lobular carcinoma 8520"
      • "Mucinous cystadenocarcinoma 8470"
      • "Salivary duct carcinoma 8500" and all synonyms (moved to its own row)
      • "Undifferentiated carcinoma 8020" (moved to its own row)
  • "Secretory carcinoma 8502" row: "Microsecretory adenocarcinoma" added as a synonym
  • Rows added:
    • "Polymorphous adenocarcinoma 8525"
    • "Salivary duct carcinoma 8500" along with subtype/variants:
      • "Micropapillary salivary duct carcinoma 8265/3"
      • "Mucin-rich salivary duct carcinoma 8481/3"
      • "Oncocytic salivary duct carcinoma 8290/3"
      • "Sarcomatoid salivary gland carcinoma 8033/3"
    • "Undifferentiated carcinoma 8020/3"
• Table 7: Tumors of Odontogenic and Maxillofacial Bone (Mandible, Maxilla)
  • "Ameloblastic carcinoma-primary type 9270/3" row: Synonym added: "Central intraosseous mucoepidermoid carcinoma"
  • "Sarcoma NOS 8800/3" row:
    • Note 1 updated
    • Subtype/variants added:
      • "Ameloblastic fibrosarcoma/ Ameloblastic fibrodentinosarcoma 9330/3"
      • "Chondrosarcoma, grade 1 9222/3"
      • "Chondrosarcoma, periosteal 9221/3"
      • "Clear cell chondrosarcoma 9242/3"
      • "Dedifferentiated chondrosarcoma 9243/3"
      • "Conventional osteosarcoma 9186/3"
      • "High-grade surface osteosarcoma 9194/3"
      • "Radiation-induced osteosarcoma 9184/3"
      • "Small cell osteosarcoma 9185/3"
      • "Telangiectatic osteosarcoma 9183/3"
      • "Rhabdomyosarcoma with TFCP2 rearrangement 8900/3"
• Table 8: Tumors of Ear
  • Rows added:
    • "Ceruminous adenocarcinoma 8420/3"
    • "Middle ear neuroendocrine tumor 8240/3"
  • "Endolymphatic sac tumor 8140" row: Synonym added: "Middle ear adenocarcinoma"

Multiple Primary Rules

• M Rule: Abstract multiple primaries when there are separate/non-contiguous tumors in any two of the following sites: Bullet added: "Aortic body C755 AND carotid body C754"

Histology Coding Rules

• NEW H Rule in both Single Tumor and Multiple Tumors Abstracted as a Single Primary modules: When the diagnosis is carcinoma ex pleomorphic adenoma AND the histologic type of the malignant component is provided, code the malignant component.

Equivalent Terms and Definitions

• Introduction: Note 3 regarding urothelial carcinoma rewritten
• Terms that are NOT Equivalent or Equal: Note 2 added to "Component is not equivalent to subtype/type/variant"
• Table 1: Specific Histologies, NOS, and Subtypes/Variants
  • Row added: "Paraganglioma 8700/3"
  • "Renal cell carcinoma NOS 8312" row: "Renal cell spindle cell carcinoma" added as a synonym
• Table 2: Neoplasms which are Not Reportable
  • "Oncocytic tumor, NOS (no code)" row: "Oncocytic tumor, low grade" added as a synonym

Equivalent Terms and Definitions

• Equivalent or Equal Terms: Definition of NSCLC updated
• Table 1: Coding Primary Site
  • Information in the intro text about lung anatomy moved to the table
  • "Lung NOS C349" row: Note updated
• Table 2: Combination/Mixed Histology Codes
  • "Combined small cell carcinoma 8045" row: "NET" removed from "Small cell carcinoma"
  • "Adenocarcinoma with mixed subtypes 8255/3" row: Notes 3 and 4 added
• Table 3: Specific Histologies, NOS, and Subtype/Variants
  • Important Note 1: Definition of NSCLC updated
  • "Epithelioid hemangioendothelioma 9133" row: "hemangioepithelioma" corrected to "hemangioendothelioma"
  • "Neuroendocrine tumor, NOS (NET) 8240" row: Synonym "Typical carcinoma" corrected to "Typical carcinoid"

Multiple Primary Rules

• M Rule: Abstract multiple primaries when there is NEC/NET and small cell carcinoma: Rule rewritten
• M Rule: Abstract a single primary when there are simultaneous multiple tumors in both lungs, same lung…: Note 3 rewritten as an exception

Histology Coding Rules

• H Rule (in both Single Tumor and Multiple Tumors Abstracted as a Single Primary): Code the histology when only one histology is present: Note 5 added regarding carcinoma in situ NOS
• H Rule: Code adenocarcinoma with mixed subtypes 8255…: Note 3 added regarding Cancer PathCHART
• H Rule: Code the appropriate combination code when all tumors have multiple histologies…: Note 2 added regarding Cancer PathCHART

Equivalent Terms and Definitions

• Table 3: Specific Histologies, NOS, and Subtypes/Variants
  • "Glioma, NOS 9380" row: Note 2 added
  • "Meningeal melanoma 8720" row: Subtype/variant removed: "Meningeal Melanomatosis 8728"
  • "Sarcoma NOS 8800" row:
    • Note 2 added
    • Subtype/variants added:
      • "Myxoid pleomorphic liposarcoma 8859"
      • "Round cell sarcoma with EWSR1-non-ETS fusion 9366"
      • "Sarcoma with BCOR genetic alterations 9268"
  • "Solitary fibrous tumor grade 3 8815/3" row: "/3" added to histology code 8815

Multiple Primary Rules

• M Rule: Abstract a single primary when separate, non-contiguous tumors are Glioma NOS and a subtype/variant of Glioma NOS: Note 1 added

Histology Coding Rules

• Priority Order for Using Documents to Identify Histology section: "imaging, histology from incisional biopsy" added to gray exception box

Equivalent Terms and Definitions

• Introduction: Note 2 updated ("vulva" added to list)
• Table 2: Specific Histologies, NOS, and Subtype/Variants
  • "Melanoma NOS 8720" row: Note 2 added

Multiple Primary Rules

• M Rule: Abstract multiple primaries when melanomas are diagnosed more than 60 days apart: Example added

Equivalent Terms and Definitions

• Table 4: Non-Reportable Neoplasms: "Glomus tympanicum, glomus jugulare" row: Definitions and Sites updated.
• Table 6: Specific Histologies, NOS, and Subtypes/Variants:
  • Row deleted: "Angiocentric glioma 9431/1" (moved to 9421 row as a subtype/variant)
  • Row added: "Low Grade glioma 9380/1"
  • "Diffuse astrocytoma, MYB- or MYBL1altered 9421/1" row: Subtype/variant added: "Angiocentric glioma / Angiocentric neuroepithelial tumor/ Monomorphous angiocentric glioma 9431/1"
  • "Hemangioma 9120/0" row: "Cavernous angioma" added as a synonym
  • "Papillary glioneuronal tumor 9509/1" row: "diffuse" added to Note 2
  • "Paraganglioma 8693/1" row: Note added
  • "Solitary fibrous tumor Grade 1 8815/1" row:
    • behavior code /1 added to histology code
    • Synonym added: "Solitary fibrous tumor/hemangiopericytoma Grade 2"

Multiple Primary Rules

• New M Rule in both Single Tumor and Multiple Tumors sections: Abstract a single primary when a neoplasm is originally diagnosed as low-grade glioma and subsequently recurs in residual tumor with a more specific histology.

Histology Coding Rules

• Priority Order for Using Documentation to Identify Histology: "imaging, histology from incisional biopsy" added to gray exception box

Equivalent Terms and Definitions

• Equivalent or Equal Terms section: Deleted: "Basal cell carcinoma; basal cell adenocarcinoma (Prostate primaries only, both are coded 8147)"
• Table 1: Paired Organs and Sites with Laterality: C413, C414 removed
• Table 2: Mixed and Combination Codes: Row added: "Mixed acinar-ductal carcinoma 8552"
• Table 4: Testis Histologies: "Germ cell tumor NOS 9064" row: "spermatocytic tumor NOS" added as a synonymous term for the subtype/variant 9063
• Table 5: Esophagus Histologies: Row added: "Mucosal melanoma 8720/3"
• Table 6: Stomach Histologies
  • "Adenomatous polyp, high grade 8210/2" row: "Adenocarcinoma in situ in adenomatous polyp" added as a synonym
• Table 7: Small Intestine and Ampulla of Vater Histologies
  • Adenomatous polyp, high grade 8210/2 row: "Adenocarcinoma in situ in adenomatous polyp" added as a synonym
• Table 8: Anus Histologies
  • Coding Note added
  • Row added: "Mucosal melanoma 8720/3"
• Table 9: Liver and Intrahepatic Bile Duct Histologies: Coding Note added
• Table 9a: Guidelines for Assigning Primary Site for Liver and Intrahepatic Bile Duct
  • Statement added: "Registrars are not required to review and re-code cases abstracted prior to 1/1/2024."
• Table 10: Gallbladder and Extrahepatic Bile Duct Histologies: "Bile duct carcinoma 8160" row: Synonyms added:
  • "Adenocarcinoma, biliary type (extrahepatic cholangiocarcinoma)"
  • "Extrahepatic cholangiocarcinoma"
• Table 11: Pancreas Histologies
  • "Intraductal oncocytic papillary neoplasm 8455/2" row: "/2" added to 8455
  • "Intraductal papillary mucinous neoplasm 8453" row: Note added
  • "Mucinous cystic neoplasm 8470" row: Note added
• Table 17: Uterine Cervix Histologies: Coding note added
• Table 18: Vagina Histologies
  • Coding note added
  • Row added: "Mucosal melanoma 8720/3"
• Table 19: Vulva Histologies
  • Coding note added
  • Row added: "Mucosal melanoma 8720/3"
  • "Squamous cell carcinoma NOS 8070" row: Subtype/variants added:
    • "Differentiated vulvar intraepithelial neoplasm 8071/2; Squamous cell carcinoma keratinizing 8071/3"
    • "Squamous cell carcinoma, non-keratinizing 8072"
    • "Vulvar intraepithelial neoplasm grade 2/vulvar intraepithelial neoplasm grade 3 8077/2"
• Table 22: Thymus Histologies
  • "Adenocarcinoma, NOS 8140" row:
    • "/3" behavior code added to subtype/variants 8144 and 8200
    • "/2" behavior code added to subtype/variant 8260
  • "Adenosquamous carcinoma 8560/3" row: "/3" behavior code added to histology
  • "Clear cell carcinoma 8310/3" row: "/3" behavior code added to histology
  • "Mucoepidermoid carcinoma 8430/3" row: "/3" behavior code added to histology
  • "Sarcomatoid carcinoma 8033/3" row: "/3" behavior code added to histology
  • "Squamous cell carcinoma NOS 8070" row: "/3" behavior code added to all subtype/variants
  • "Thymoma, NOS 8580/3" row: "/3" behavior code added to histology in column 1 and all subtype/variants
• Table 23: Penis and Scrotum Histologies
  • C630 added
  • Coding note added
  • Row added: "Mucosal melanoma 8720/3"
  • "Squamous cell carcinoma, NOS 8070" row:
    • Note 3 added
    • Subtype/variant added: "Warty-basaloid carcinoma/Warty carcinoma 8054 (C60._ only)"
    • "Warty carcinoma" removed from 8051 and added to 8054

Histology Coding Rules

• H Rule: Code the histology when only one histologic type is identified: Exceptions added

Equivalent Terms and Definitions

• "Multifocal/Multicentric Tumors of Urinary Sites section" simplified
• Table 2: Specific Histologies, NOS, and Subtypes/Variants:
  • "Adenocarcinoma NOS 8140" row
    • Synonyms added:
      • "Carcinoma of Cowper glands"
      • "Carcinoma of Skene glands"
      • "Littre gland adenocarcinoma"
    • Synonym deleted: "Mixed adenocarcinoma" (moved to its own row)
  • "Malignant melanoma 8720/3" row:
    • Synonym added: "Mucosal melanoma"
    • Subtype/variants added:
      • "Mucosal lentiginous melanoma 8746/3"
      • "Nodular melanoma 8721/3"
  • "Urothelial carcinoma 8120" row:
    • Synonym added: "Diverticular carcinoma 8120/3"
    • Note added to synonym "Plasmacytoid urothelial carcinoma" to limit to cases dx’d prior to 2024
    • Note added to subtype/variant "Plasmacytoid urothelial carcinoma" to apply to cases dx’d 2024 forward
  • Rows added:
    • "Mixed adenocarcinoma 8323/3"
    • "Mixed neuroendocrine-non-neuroendocrine carcinoma 8154/3"
    • "Paraganglioma 8693/3"
• Table 3: Non-Reportable Urinary Tumors: "Paraganglioma 8693/1" row: Note added: "(Cases diagnosed prior to 1/1/2021)"

Multiple Primary Rules

• M Rule: Abstract multiple primaries when the patient has micropapillary urothelial carcinoma 8131/3 AND a urothelial carcinoma 8120/3: Rule now applies to all urinary sites (previously limited to bladder)
• M Rule: Abstract a single primary when there are urothelial carcinomas in multiple urinary organs: "(with the exception of micropapillary)" added to Note 1
• M Rule: Abstract multiple primaries when separate/non-contiguous tumors are two or more different subtypes/variants…: Note 2 added

Histology Coding Rules

• Coding Histology section: Instruction #1, Example 2 removed (subsequent example renumbered)
• H Rules: Code the subtype/variant when there is a NOS and a single subtype/variant of that NOS such as the following…
  • Bullet removed: "Small cell neuroendocrine carcinoma"
  • Bullets added: "Neuroendocrine carcinoma" and "Neuroendocrine tumor"
• H Rule: Code mixed small cell carcinoma 8045 when the final diagnosis small cell neuroendocrine mixed with any other type of carcinoma (does not apply to sarcoma): References to subtype/variants of small cell carcinoma removed
• NEW H Rule added to both Single Tumor and Multiple Tumors Abstracted as a Single Primary modules: Code combined large cell carcinoma 8013 when the final diagnosis is large cell neuroendocrine carcinoma and any other type of carcinoma (does not apply to sarcoma).