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

Changes Across All Site Modules

  • Priority Order for Using Documentation to Identify Histology: Guidance was clarified regarding coding histology when neoadjuvant therapy is given
  • "Majority; major; predominantly; greater than 50%" removed from equivalent terms and definitions in all sections (module-specific histology sections take precedence)
  • Bullet added to the note in all instances of the "same row rule" for site modules where histology tables contain nested subtypes/variants in column 3:
    • "A NOS histology in column 3 with an indented subtype/variant"

Changes to Site-Specific Modules

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Urinary

  • Table 1: ICD-O Primary Site Codes
    • "Urachal remnant" added as synonym for C677

Colon

  • GIST reportability updated for cases diagnosed 2021+
  • Colon wall illustrations added, which correspond with the anastomosis M Rules.
  • Table 1: Specific Histologies, NOS/ NST, and Subtypes/Variants
    • MANEC 8244 Row:
      • “Adenocarcinoma ex-goblet cell” added as a synonym
      • “Goblet cell adenocarcinoma” added to 8243 (updated terminology)
    • GIST 8936 Row:
      • “GIST, NOS” and “Gastrointestinal stromal sarcoma” added as synonyms
  • Multiple Primary Rules
    • Note added to anastomotic site rules: "A rectal stump is an anastomotic site"
  • Histology Coding Rules
    • H5 Invasive mucinous adenocarcinoma rule: Sub-bullet added
      • Mucinous carcinoma must meet a percentage requirement in order to be coded. Do not use majority of tumor, predominantly, or predominant part of the tumor to code mucinous 8480.
    • Rule H6 added: NEW RULE
      • Code invasive signet ring cell adenocarcinoma 8490 when the diagnosis is any of the following…
    • Rule H7 Code adenocarcinoma NOS when the final diagnosis is…
      • Percentage requirement clarified as less than or equal to 50%

Head and Neck

  • C442 removed from H&N module. C442 with reportable histologies other than melanoma fall into “Other Sites” rules.
  • Equivalent or Equal Terms:
    • "Hemangiosarcoma; angiosarcoma" added
    • “Malignant hemangioendothelioma; angiosarcoma” deleted
  • Terms that are NOT Equivalent or Equal:
    • “p16 negative is not equivalent to HPV negative” added
  • Table 1: Tumors of Nasal Cavity, Paranasal Sinuses and Skull base
    • Non-keratinizing squamous cell carcinoma 8072 row:
      • “Cylindrical cell carcinoma” and “Schneiderian carcinoma” moved from synonyms to subtype/variant column as histology code 8121
    • Sarcoma 8800 row:
      • “Malignant hemangioendothelioma 9130/3” added
  • Table 3: Tumors of Pyriform Sinus, Hypopharynx, Larynx, Trachea, and Parapharyngeal Space
    • Squamous cell carcinoma (SCC) 8070 row:
      • “Keratinizing squamous cell carcinoma 8071” added as a subtype/variant
      • “Non-keratinizing squamous cell carcinoma 8072” added as a subtype/variant
  • Table 4: Tumors of Oral Cavity and Mobile Tongue
    • Kaposi sarcoma 9140 row:
      • Deleted (Kaposi sarcoma is excluded from H&N module)
    • Squamous cell carcinoma 8070 row:
      • “Keratinizing squamous cell carcinoma 8071” added as a subtype/variant
      • “Non-keratinizing squamous cell carcinoma 8072” added as a subtype/variant
  • Table 5: Tumors of the Oropharynx, Base of Tongue, Tonsils, Adenoids
    • Squamous cell carcinoma (SCC) 8070 row:
      • Note added clarifying the use of p16 IHC to code 8086
  • Table 8: Tumors of Ear and External Auditory Canal
    • C442 removed from table and table name updated
    • Ceruminous adenocarcinoma 8420 row:
      • Deleted
  • Table 9: Paraganglioma of Carotid Body, Larynx, Middle Ear, Vagal Nerve
    • Paraganglioma codes separated into pre-2021 and 2021+

Malignant CNS

  • Table 1: WHO Grades for Select CNS Neoplasms
    • Section Added: WHO Grade II CNS Tumors
    • Instructions amended to included "and WHO Grade 2 neoplasms with malignant /3 behavior"
  • Table 2: Reportable Primary Sites and Histologies
    • “Conus medullaris/filum terminale” site code corrected to C720
    • “Nerves of Pelvis C475” added
  • Multiple Primary Rules
    • Clarified that a subsequent glioblastoma multiforme (GBM) in residual tumor is not a new primary (must be a separate GBM)

Non-Malignant CNS

  • Introduction
    • Note 5 regarding Pilocytic astrocytoma/optic nerve glioma clarified
  • Table 1: WHO Grades for Select CNS Neoplasms
    • Section Added: WHO Grade II CNS Tumors
  • Table 2: Reportable Primary Sites and Histologies
    • “Conus medullaris/filum terminale” site code corrected to C720
  • Table 4: Non-Reportable Neoplasms
    • Neurofibromatosis row added
  • Table 5: Histologic Types of Non-Malignant Intracranial (Brain and Glands) Tumors
    • Pilocytic astrocytoma/juvenile pilocytic astrocytoma 9421/1 row
      • Posterior fossa C719, cerebrum C710 removed;
      • Optic nerve C723 added
  • Table 6: Specific Histologies, NOS, and Subtypes/Variants
    • Neurocytoma 9506/1 row: Terminology changed from central neurocytoma to neurocytoma and the following terms were added as synonyms:
      • Central neurocytoma
      • Lipomatous medulloblastoma
      • Medullocytoma
      • Neurolipocytoma
    • Pituitary adenoma 8272 row: The following terms added as synonyms:
      • Gonadotroph adenoma
      • Somatotroph adenoma
      • Thyrotroph adenoma
      • Null cell adenoma
      • Plurihormonal and double adenomas

Breast

  • Table 2: Histology Combination Codes
    • Invasive carcinoma NST/duct carcinoma and invasive lobular carcinoma 8522 row
      • Note 2 added " This is the exception to the instruction features are not coded."
      • New row added for metaplastic carcinoma AND ductal or lobular
  • Table 3: Specific Histologies, NOS/ NST, and Subtypes/Variants
    • Medullary Carcinoma 8510 row:
      • “Medullary carcinoma with lymphoid stroma 8512” added as a subtype/variants
    • Metaplastic Carcinoma 8575 row:
      • Note 2 added
    • Periductal Stromal Tumor, low grade 9020 row:
      • Terminology updated to “Phyllodes tumor, malignant”
      • “Periductal stromal tumor, low grade” added as a synonym
      • “Cystosarcoma phyllodes, malignant” added as a synonym
    • Sarcoma 8800 row:
      • Histology code 9130/3 added to Malignant hemangioendothelioma
      • Note 2 added regarding Angiosarcoma subtypes
    • Ductal carcinoma 8500 row:
      • “Intraductal carcinoma 8500/2” added as a synonym
      • “Carcinoma, NOS” added as a synonym
    • Paget disease of the nipple with no underlying tumor 8540 row:
      • Behavior code removed
    • Papillary carcinoma 8503 row:
      • “Intraductal papilloma with ductal carcinoma in situ 8503/2” added as a synonym
  • Multiple Primary Rules
    • New notes before Multiple Tumors MP module:
      • “ER, PR, and/or HER2 are not used to determine multiple primaries.”
      • “A Subsequent tumor in the chest wall or surgical scar without evidence of residual breast tissue are regional metastasis.”
    • Rule M10 Abstract a single primary when multiple tumors of the same behavior are carcinoma NST/duct and lobular.
      • Same behavior requirement re-added.
  • Histology Coding Rules
    • New H rule: H6 Coding pleomorphic lobular carcinoma in situ
    • New H rule: H13 Coding metaplastic carcinoma when invasive carcinoma NST is present

Lung

  • Table 2: Combination/Mixed Histology Codes
    • Combined large cell neuroendocrine carcinoma 8013 row added
  • Table 3: Specific Histologies, NOS, and Subtype/Variants
    • Adenocarcinoma 8140 row:
      • “Minimally invasive adenocarcinoma” added as synonym
      • “Enteric adenocarcinoma/pulmonary intestinal-type adenocarcinoma 8144”: Terms swapped order
    • Large cell neuroendocrine carcinoma/combined large cell neuroendocrine carcinoma 8013/3
      • Histology removed from sarcoma row and added to its own row
  • Multiple Primary Rules
    • Rule M6 Subtype/variant rule: Note 2 added that tumors may be different behaviors
    • Rule M9 Simultaneous multiple tumors in…
      • Updated notes 1 and 2 to include examples for 8000 and 8010
  • Histology Coding Rules
    • Rule H3 Code the specific histology when the diagnosis is non-small cell lung carcinoma (NSCLC) consistent with (or any other ambiguous term) a specific carcinoma…
      • Rule reordered for readability (no changes to rule meaning)
    • Clarified histology coding for equal percentages of adenocarcinoma subtypes throughout histology rules and histology tables
    • Rule H10 Code mucinous adenocarcinoma (for lung only) when all tumors consist of…
      • Note 1 removed from H10 (does not apply to multiple tumors abstracted as a single primary)