This is a document containing changes only. Do not use in place of the Solid Tumor Rules.

Expand All Collapse All

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”

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”
  • 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"
  • 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”
  • 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
  • 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
  • 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

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

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

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

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
  • 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”
  • 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”
    • “Papillary thyroid carcinoma, NOS 8260”
      • Synonyms added:
        • “Clear cell papillary thyroid carcinoma”
        • “Spindle cell papillary thyroid carcinoma”
        • “Warthin-like papillary thyroid carcinoma”
    • “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
  • Table 15: Fallopian Tube Histologies
    • “Carcinosarcoma 8980/3” row:
      • Note added
  • 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
  • Table 17: Uterine Cervix Histologies
    • “Carcinosarcoma 8980/3” row:
      • Note added
    • Endometrioid adenocarcinoma, NOS 8380” row:
      • Synonym added: “Endometrial adenocarcinoma/carcinoma”
  • Table 18: Vagina Histologies
    • “Carcinosarcoma 8980/3” row:
      • Note added
    • Endometrioid adenocarcinoma, NOS 8380” row:
      • Synonym added: “Endometrial adenocarcinoma/carcinoma”
  • Table 20: Soft Tissue Histologies
    • “Liposarcoma, NOS 8850/3” row:
      • Histology code for Myxoid pleomorphic liposarcoma corrected to 8859/3
  • 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”