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