Revision History for the Solid Tumor Rules

Terms and Definitions (Breast)

• Table 2 Histology Combination Codes
  • 8522/3 Row, Note 2 clarified: Carcinoma NST includes all subtypes/variants of carcinoma NST.
• Table 3 Specific Histologies, NOS/ NST, and Subtypes/Variants
  • Metaplastic Carcinoma Row, Note added: Squamous cell carcinoma of the breast is extremely rare. Carefully check the pathology report to verify the squamous cell originated in the breast parenchyma, rather than the skin of the breast.
  • Myoepithelial carcinoma 8982 Row deleted (myoepithelial carcinoma is a subtype of metaplastic carcinoma)

Multiple Primary Rules (Breast)

Minor Changes

• Rule M8: Abstract a single primary when the diagnosis is Paget disease with synchronous/simultaneous underlying in situ or invasive carcinoma NST (duct/ductal) or subtypes of duct.
  • Clarified that Paget and underlying are synchronous
  • Note added: If the underlying tumor is any histology other than duct or subtypes of duct, continue through the rules.
• Rule M11: Abstract a single primary when a ductal carcinoma occurs after a combination code in the same breast.
  • Use of "Other in situ" code 8523/2 clarified for diagnosis year prior to 2018
• Rule M13: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row…
  • Note 1 deleted: The tumors must be the same behavior.

Major Changes

• NEW RULE:
  Rule M9: Abstract multiple primaries when the diagnosis is Paget disease with synchronous/simultaneous underlying tumor which is NOT duct.
• Rule M10: Abstract a single primary when synchronous/simultaneous multiple tumors are carcinoma NST/duct and lobular.
  • Note 1 deleted: Histologies must be the same behavior.
  • Note 2: List of ductal carcinoma subtypes updated

Histology Rules (Breast)

• Coding Multiple Histologies
  • #1A modified: Code the subtype/variant (specific histology) ONLY when documented to be greater than or equal to 90% of the tumor.
  • #1B: “Differentiation and features” instructions simplified and note added: A NOS with features or differentiation is a single histology. Go directly to the rules.
• Priority Order for Using Documentation to Identify Histology
  • Important Note #2 Modified: Code the histology assigned by the physician by using the following priority list and Histology Rules
  • #2: Tissue or pathology report from primary site
    • #2B: “Synoptic report as required by CAP” added to Final Diagnosis
  • #6: Code the histology documented by the physician when none of the above are available
    • #6A: “Treatment Plan” added

Terms and Definitions (Urinary)

• Equivalent Terms And Definitions
  • Added: Multifocal; multicentric
  • Added: Noninvasive may describe either in situ papillary carcinoma or flat urothelial cell carcinoma
• Terms that are Not Equivalent or Equal
  • Deleted: Component is not equivalent to subtype/variant
    Note: Component is only coded when the pathologist specifies the component as a second carcinoma.
  • Staging information removed from the note
• Priority for Coding Primary Site
  • Coding instructions clarified
• Table 2: Specific Histologies, NOS, and Subtypes/Variants
  • 8140 Row, Note added: Urachal carcinoma NOS is coded 8010/3. Urachal adenocarcinoma is coded 8140/3.

Multiple Primary Rules (Urinary)

Major Changes

• Rules have been renumbered
• Rule M6: Abstract multiple primaries when an invasive tumor occurs more than 60 days after an in situ tumor.
  • Moved up in hierarchy (formerly M17)
• Rule M7: Abstract a single primary when the patient has multiple occurrences of /2 urothelial carcinoma in the bladder.
  • Clarified that any combination of 8120/2 and 8130/2 in the bladder is a single primary
• Rule M8: Abstract multiple primaries when the patient has micropapillary urothelial carcinoma 8131/3 of the bladder AND a urothelial carcinoma 8120/3 (including papillary 8130/3) of the bladder.
  • Moved up in hierarchy (formerly Rule M12)
  • 8120/3 added to the rule
  • Removed non-synchronous tumors requirement
• Rule M9: Abstract a single primary when the patient has multiple invasive urothelial cell carcinomas in the bladder.
  • Clarified that an occurrence of micropapillary and an occurrence of urothelial carcinoma would be multiple primaries
• Rule M11: Abstract a single primary when there are urothelial carcinomas in multiple urinary organs.
  • "Synchronous" removed
• Rule M13 (Former): Abstract multiple primaries when the original tumor and subsequent tumor occur in different urinary sites.
  • Rule deleted
• NEW RULE
  Rule M14: Abstract multiple primaries when the ICD-O site code differs at the second (CXxx) and/or third (CxXx) character.
• Rule M15: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row in Table 2 in the Equivalent Terms and Definitions.
  • Behavior restriction removed; behavior is now irrelevant
  • Note 3 deleted (simplifying the text)

Minor Changes

• Multiple Tumors Module
  • Note 2 clarified: Non-synchronous tumors other than urothelial carcinoma and urothelial carcinoma subtypes in multiple urinary sites (see Rule M14)
• Rule M18: Abstract a single primary when tumors do not meet any of the above criteria.
  • Example removed; would be caught in earlier rule
• Rule M16: Abstract a single primary (the invasive) when an in situ tumor is diagnosed after an invasive tumor AND tumors occur in the same urinary site.
  • Bullets removed
• Rule M17: Abstract a single primary (the invasive) when an invasive tumor is diagnosed less than or equal to 60 days after an in situ tumor AND tumors occur in the same urinary site.
  • Bullets removed

Histology Rules

• Priority Order for Using Documentation to Identify Histology
  • Important Note #2 Modified: Code the histology assigned by the physician by using the following priority list and Histology Rules.
  • #2: Tissue or pathology report from primary site
    • #2B: "Synoptic report as required by CAP" added to Final Diagnosis
  • #5: Code the histology documented by the physician when none of the above are available
    • #5A: "Treatment Plan" added
• Coding Multiple Histologies
  • Instructions clarified
  • "Configuration" added to the "DO NOT CODE" section
• Rule H5: Code mixed urothelial carcinoma as follows…
  • Rule clarified

• Added to all sites except breast, non-malignant CNS and malignant CNS: "2007 Rules instruct 'Code the histology from the most representative specimen'. For all sites except breast and CNS, 2018 Rules instruct 'Code the most specific histology from biopsy or resection. When there is a discrepancy between the biopsy and resection (two distinctly different histologies/different rows), code the histology from the most representative specimen (the greater amount of tumor).'"

• Added: "Majority; major; predominantly; greater than 50%"
• Added: "Carcinoma; adenocarcinoma"

• Added: List of common metastatic sites

• Reorganized the terms and added clarity
• The term "component" added

• "From primary site" added to tissue/pathology to differentiate between metastatic site
• Added: Instructions to code histology prior to neoadjuvant therapy
• Added: Instructions to not change the histology in order make the case applicable for staging
• Added: "Note 2: The histology rules instruct to code the invasive histology when there are in situ and invasive components in a single tumor."
• Added: "Note 3: When there is a discrepancy between the biopsy and resection (two distinctly different histologies/different rows), code the histology from the most representative specimen (the greater amount of tumor)."

• Added: Instructions to all histology tables that include "nested" histologies; in other words, subtypes in column 3 that are also NOS histologies.

• Anticipated release date of Cutaneous Melanoma and Other Sites Rules has changed to 2020.

Terms and Definitions (Breast)

Major Changes

• Table 2, Duct + any histology row
  • Added: "DCIS mixed with other in situ carcinoma 8500/2"
  • Added: "Note: Prior to 2018, DCIS and other in situ was coded 8523/2"
  • Added: "Note 1: Both histologies must have the same behavior code"
• Table 2, Lobular carcinoma + Other Row
  • Added: "In situ lobular mixed with other types of in situ carcinoma 8524/2"
  • Deleted: "Note: Invasive carcinomas only. Do not use this code for in situ".
• Table 2, Paget disease + DCIS Row
  • Added: "Paget disease (specified as in situ) and DCIS/intraductal carcinoma 8543/2"
  • Modified: (Addressed behavior of Paget disease) "Paget disease (invasive or behavior not specified) and DCIS/intraductal carcinoma 8543/3"
  • Deleted: "Note: See Table 3 for subtypes/variants of DCIS".
• Table 3, Lobular carcinoma 8520 Row
  • Added to synonyms:
    • "Intraductal papilloma with lobular carcinoma in situ 8520/2"
    • "Lobular carcinoma in situ 8520/2"
    • "Lobular carcinoma with cribriform features"
• Table 3, Invasive Ductal Carcinoma 8500 Row
  • Moved: "Invasive mammary carcinoma with neuroendocrine features" removed from synonyms and added as a subtype of small cell carcinoma
  • Added: "Duct/Ductal carcinoma with mucin production" as a synonym
• Table 3, Metaplastic Carcinoma Row
  • Added: "Sarcomatoid Carcinoma 8033" to subtype/variants in column 3
  • Added: "Spindle cell carcinoma" as a synonym of the subtype 8032

Minor Changes

• Table 2 Histology Combination Codes
  • Note 1, Bullet 2: Statement in parentheses added: "When one of the histologies is described as differentiation or features (unless differentiation or features are part of the preferred term)"
  • Duct + Lobular 8522 Row: "8522 is used when:" (following bullets added)
    • "One tumor is mixed duct and lobular; the other tumor is either duct or lobular
    • All tumors may be mixed duct and lobular"
• Table 3 Specific Histologies
  • Carcinoma NST Row: Added "Note: Cribriform carcinoma may consist of up to 50% tubular formations. The term cribriform/tubular carcinoma is coded as cribriform carcinoma"
  • Table 3: Medullary Carcinoma Row: Added abbreviations "MC" and "AMC"

Multiple Primary Rules (Breast)

Major Changes

• Rule M12: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row in Table 3
  • Added: "Synchronous"
• NEW RULE:
  Rule M10: Abstract a single primary when any of the following conditions are met in the same breast:
  • DCIS subsequent to a diagnosis of mixed DCIS AND:
    • Lobular carcinoma in situ 8522/2 OR
    • In situ Paget 8543/2 OR
    • Invasive Paget 8543/3
    • Other in situ 8523/2 (prior to 2018, DCIS and other in situ was coded 8523/2)
  • Invasive carcinoma NST/duct subsequent to a diagnosis of mixed invasive carcinoma NST/duct AND:
    • Invasive lobular 8522/3 OR
    • Invasive Paget 8541/3 OR
    • Other invasive carcinoma 8523/3
• Rule M17: Last Resort Rule
  • Added: "Example:One tumor is invasive carcinoma NST/ductal 8500/3 and a separate non-contiguous tumor in the same breast is DCIS 8500/2. Abstract a single primary: invasive carcinoma NST/ductal 8500/3."
• ALL BREAST M RULES: Hierarchy was reordered. Please be sure you follow the rules in order.

Minor Changes

• Rule M9 Abstract a single primary when simultaneous multiple tumors are carcinoma NST/duct and lobular
  • Note 5 Added One or more tumors with combination duct and lobular histology 8522 AND a separate tumor with any other histology in Table 3 are multiple primaries.
  • Example added under Note 5
• Rule M13: Abstract multiple primaries when separate/non-contiguous tumors are on different rows in Table 3 in the Equivalent Terms and Definitions.
  • Example added: Paget disease of the nipple with underlying lobular are multiple primaries. Paget and lobular are on different rows in Table 3.

Histology Rules (Breast)

Major Changes

• NEW RULES
  • Rule H4: Code DCIS and in situ Paget 8543/2.
  • Rule H5: Code DCIS 8500/2 when there is a combination of DCIS and any other carcinoma in situ.
  • Rule H6: Code the histology using Table 2 when there are multiple in situ histologies (2 or more) within a single tumor.
    • Lobular and any histology other than DCIS 8524/2
    • Two or more histologies other than lobular and DCIS 8255/2
• Rule H10 (modified): Code mucinous carcinoma/adenocarcinoma 8480 ONLY when…
  • "greater than or equal to 90% of the tumor" changed to "greater than 90%"
• Rule H12 deleted and subsequent rules renumbered: "Code cribriform carcinoma 8201/3 when cribriform is mixed with any other carcinoma AND…"
  • Rule not needed; already covered in the "Coding Multiple Histologies" section
• Rule H24 (modified): Code the NOS/NST when there is a NOS/NST and a subtype/variant…
  • "greater than or equal to 90%" changed to "greater than 90%"

Minor Changes

• Rule H3 Code DCIS and in situ lobular carcinoma 8522/2 when DCIS and in situ lobular carcinoma are present.
  • Previous Note 1: Although the instructions in the "Coding Multiple Histologies in a Single Tumor" section state, "Code the histology that comprises the majority of tumor", 8522/2 identifies both DCIS and lobular carcinoma in situ.
  • Current Note 1: Although the notes preceding the in situ section say most tumors will be coded to DCIS, 8522/2 identifies both DCIS and lobular carcinoma in situ.
• Rule H15 Code the subtype/variant (specific histology) ONLY when there is a NOS/NST and a subtype/variant AND…
  • Examples changed from in situ to invasive
• Rule H16 Code the NOS/NST when there is a NOS/NST and a subtype/variant AND…
  • Examples changed from in situ to invasive
• Rule H23 Code the invasive histology when there are invasive and in situ histologies…
  • Examples added

Terms and Definitions (Colon)

Minor Changes

• Table 1 Specific Histologies, NOS, and Subtypes/Variants
  • Note 4 deleted: Typical colon, rectal, and appendiceal carcinomas may exhibit comedo features or differentiation. Comedo describes the tumor appearance rather than a true histologic subtype/variant of adenocarcinoma. Code to adenocarcinoma 8140.
  • "Adenoma" deleted from adenocarcinoma synonyms (adenoma is not reportable)

Multiple Primary Rules (Colon)

Major Changes

• Rule M11 Modified: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row in Table 1 in the Equivalent Terms and Definitions.
  • Added: "Synchronous"
• Rule M15: Abstract a single primary when tumors do not meet any of the above criteria.
  • Example added for invasive and in situ tumors of same histology.

Histology Rules (Colon)

Minor Changes

• Priority Order for Using Documentation to Code Histology
  • Note deleted: Ignore the terms "cribriform" and "comedo" when they are used to describe the histology or are mentioned in the microscopic portion of the path report.

Terms and Definitions (Head and Neck)

Major Changes

• Table 10 Paired Sites: Tonsillar fossa C090 and tonsillar pilla C091 removed from sites where laterality must be coded

Minor Changes

• Notes regarding salivary duct and salivary gland tumors moved to Table 6
• Table 1 removed and all tables renumbered
• Equivalent and Equal Terms Angiosarcoma Added: "Malignant hemangioendothelioma; angiosarcoma"
• Table 2 Tumors of Nasopharynx:
  • Instructions: C118 "hypopharynx" corrected to "nasopharynx"
• Table 8 Tumors of Ear and External Auditory Canal
  • Note Modified: (SCC added) "External ear/skin excludes basal cell carcinoma, squamous cell carcinoma, and all non-malignant neoplasms"

Multiple Primary Rules (Head and Neck)

Major Changes

• Rule M3: Abstract multiple primaries when there are separate/non-contiguous tumors in any two of the following sites:
  Site codes added:
  • Hard palate C050 AND/OR soft palate C051 AND/OR uvula C052
  • Maxillary sinus C310 AND/OR ethmoid sinus C311 AND/OR frontal sinus C312 AND/OR sphenoid sinus C313
  • Submandibular gland C080 AND sublingual gland C081
• Rule M9 Abstract a single primary (the invasive) when an in situ tumor is diagnosed after an invasive tumor in the same primary site.
  • Added: "In the same primary site"
• Rule M10: Abstract a single primary (the invasive) when an invasive tumor is diagnosed less than or equal to 60 days after an in situ tumor in the same primary site.
  • Added: "In the same primary site"
• Rule M12: Abstract a single primaryi when separate/non-contiguous tumors in the same primary site are on the same row in the appropriate site table (Tables 1-9) in the Equivalent Terms and Definitions. Timing is irrelevant.
  • Added: "In the same primary site"

Histology Rules (Head and Neck)

Minor Changes

• Priority Order for Using Documentation to Code Histology:
  • #3 Tissue Pathology from a Metastatic Site: Note 3 Added: "This includes cytology from a regional lymph node"

Terms and Definitions (Kidney)

Major Changes

• Table 1, NET row:
  • "Small cell neuroendocrine tumor" in column 1 renamed "Neuroendocrine tumor"
  • "Small cell neuroendocrine tumor/carcinoma" added as a synonyms in column 2.

Minor Changes

• Table 1, Sarcoma row: Subtypes of rhabdomyosarcoma reorganized (indented under rhabdomyosarcoma)

Multiple Primary Rules (Kidney)

Major Changes

• Rule M7 Modified: Abstract multiple primaries when separate/non-contiguous tumors are two or more different subtypes/variants in Column 3, Table 1 in the Equivalent Terms and Definitions. Tumors must be in same kidney
  • Deleted: "Timing is irrelevant"
• Rule M8 Modified: Abstract a single primary when synchronous, separate/non-contiguous tumors are on the same row in Table 1 in the Equivalent Terms and Definitions. Tumors must be in the same kidney
  • Deleted: "Timing is irrelevant"
  • Added: "Synchronous"
• Former M11 deleted: Abstract multiple primaries when the patient has a subsequent tumor after being clinically disease-free for greater than three years after the original diagnosis or last recurrence.
• NEW RULE: M11 Abstract a single primary (the invasive) when an invasive tumor is diagnosed less than or equal to 60 days after an in situ tumor in the same kidney.
• NEW RULE: M12 Abstract multiple primaries when an invasive tumor occurs more than 60 days after an in situ tumor in the same kidney.

Terms and Definitions (Lung)

• Coding Multiple Histologies:
  • #1C Note 2: "Adenocarcinoma, lepidic predominant" added

Multiple Primary Rules (Lung)

• Rule M7 Modified: Abstract a single primary when synchronous, separate/non-contiguous tumors in the same lung are on the same row.
  • Added: "Synchronous"
  • Deleted: "Timing is irrelevant"

Terms and Definitions (Malignant CNS)

Major Changes

• Table 3 Specific Histologies
  • Astrocytoma 9400 Row: Subtype variant added: "Pleomorphic xanthroastrocytoma/anaplastic pleomorphic xanthroastrocytoma 9424"
  • Oligodendroglioma 9450 row: "Anaplastic Oligodendroglioma NOS" deleted as a synonym

Minor Changes

• Changes from 2007 Rules:
  • Examples added to #1A and #1B (not recommended terms).

Multiple Primary Rules (Malignant CNS)

Major Changes

• Rule M7: Abstract a single primary when there are separate, non-contiguous tumors in the brain (multicentric/multifocal) with the same histology XXXX.
  • Added: "with the same histology XXXX"
• Rule M8: Abstract multiple primaries when multiple tumors are present in any of the following sites or subsites (the following bullets were added)
  • Cauda equina C721 AND any other part of CNS
  • Any two or more of the cranial nerves: C722 Olfactory, C723 Optic, C724 Acoustic, C725 Cranial nerves NOS

Minor Changes

• Rule M6: Abstract multiple primaries when a patient has a glial tumor and is subsequently diagnosed with a glioblastoma multiforme 9440 (GBM).
  • Note 1 added List of glial tumor histologies

Histology Rules

Major Changes

• NEW RULE: Rule H1 Code the reportable CNS tumor when a patient has…NF1, NF2, Schwannomatosis
  • Subsequent Histology Rules renumbered

Peripheral nerve roots (C470, C473, C475, and C476) were removed from the document; at this time, they are non-reportable to the standard setters.

Terms and Definitions (Non-malignant CNS)

Major Changes

• Section 2: Reportable Primary Sites and Histologies
  • Note added: "Cavernous sinus hemangiomas are reportable. Code primary site cerebral meninges C700".
• Table 6: Specific Histologies, NOS, and Subtypes/Variants
  • Meningioma Row: "Psammomatous meningioma 9533/0" added as a subtype
  • Lipoma Row: Code for Lipoma corrected from "8850" to "8860"
  • Added: "Prolactinoma 8271/0" added as a new row

Minor Changes

• Table 5: Histologic Types of Non-Malignant Intracranial (Brain and Glands) Tumors
  • Added: "IMPORTANT: This table does not list ALL PRIMARY SITES that are possible for a histology. It only includes sites where the histology can occur INTRACRANIALLY."
  • Craniopharyngioma 9350/1 row: "Craniopharyngeal duct C752" added in column 2
  • Added: "Prolactinoma 8271/0"

Multiple Primary Rules (Non-malignant CNS)

Major Changes

• M Rule: Abstract multiple primaries when multiple tumors are present in any of the following sites:
  • Rule moved from M12 to M7. All subsequent rules renumbered.

Minor Changes

• Rule M4 Abstract a single primary when a single benign tumor /0 transforms to an uncertain/borderline tumor
  • Deleted: Example 2 A neurofibroma NOS 9540/0 transforms to neurofibromatosis NOS 9540/1.

Terms and Definitions (Urinary)

Major Changes

• Table 2: Specific Histologies, NOS, and Subtypes/Variants
  • Adenocarcinoma 8140 and Carcinoma 8010 rows combined into one row
  • Micropapillary urothelial carcinoma 8131 moved to be a subtype of papillary urothelial 8130

Minor Changes

• Equivalent Terms Added: "Flat transitional cell carcinoma; flat urothelial carcinoma; urothelial carcinoma in situ; noninvasive flat carcinoma; in situ transitional cell carcinoma"
• Equivalent Terms Modified: "Papillary transitional cell carcinoma; papillary urothelial carcinoma" changed to "Noninvasive papillary carcinoma; papillary transitional cell carcinoma; intramucosal papillary urothelial carcinoma"
• Non-Equivalent Terms: Noninvasive; papillary urothelial carcinoma
  • "flat urothelial carcinoma" added to note
  • "T0" corrected to "Ta"
  • "…tumor which does not invade the subepithelial connective tissue" changed to "…tumor which does not invade beyond the subepithelial connective tissue"
• Priority for Coding Primary Site
  • #1A Modified: "The histology is non-invasive or in situ /2 urothelial carcinoma or any subtype/variant (may be called flat carcinoma, noninvasive flat carcinoma)"
  • #1B Note Added: "Overlapping non-invasive tumors of the bladder and ureter almost always originate in the bladder. They extend/overlap into the ureter by spreading along the mucosa. It is important to code these primaries to bladder C678 NOT to overlapping lesion of urinary organs C688."
  • #2C Added: "Code overlapping lesion of urinary organs C688 when a single tumor overlaps two urinary sites and the origin is unknown/not documented. Use for overlapping tumor involving any of the following sites:
    • Renal pelvis and ureter
    • Bladder and urethra"
• Table 2: Specific Histologies, NOS, and Subtypes/Variants
  • 8140 Row: "Urachal adenocarcinoma/carcinoma" added as a synonym

Multiple Primary Rules (Urinary)

Major Changes

• Rule M3 ("separate/non-contiguous tumors" added to bullet 2) "Abstract multiple primaries when there are:
  • Separate/non-contiguous tumors in both the right AND left renal pelvis AND
  • No other urinary sites are involved with separate/non-contiguous tumors"
• Rule M4 ("separate/non-contiguous tumors" added to bullet 2) "Abstract multiple primaries when there are:
  • Separate/non-contiguous tumors in both the right AND left ureter AND
  • No other urinary sites are involved with separate/non-contiguous tumors"
• Rule M5 Modified: "Abstract a single primary when synchronous or simultaneous tumors are noninvasive in situ /2 urothelial carcinoma (flat tumor) 8120/2 in the following sites"
  • Added: "synchronous or simultaneous"
• Rule M7 Modified: Abstract a single primary when the patient has multiple occurrences of invasive tumors in the bladder
  • Clarified that both tumors must be 8130 or both tumors must be 8120. Not mix and match.
  • Note 1 added: "Timing is irrelevant"
• New Rules
  • Rule M8: Abstract a single primary when there are synchronous urothelial carcinomas in multiple urinary organs.
  • Rule M12: Abstract multiple primaries when the patient has non-synchronous tumors which are 8130/3 and 8131/3.
  • Rule M13: Abstract multiple primaries when the original tumor and subsequent tumor occur in different urinary sites.

Histology Rules (Urinary)

• Rule H5 Modified: Code as follows when there is a mixture of urothelial carcinoma OR one urothelial carcinoma subtype/variant AND or WITH…
  • Clarification: Urothelial subtypes included
  • Deletion: Sarcomas removed from the list
  • Change: Clear cell carcinoma and endometrioid carcinoma moved under the adenocarcinoma category and coding instruction changed to "code 8120 or subtype of 8120".