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
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
- MANEC 8244 Row:
- 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%
- H5 Invasive mucinous adenocarcinoma rule: Sub-bullet added
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
- Non-keratinizing squamous cell carcinoma 8072 row:
- 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
- Squamous cell carcinoma (SCC) 8070 row:
- 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
- Kaposi sarcoma 9140 row:
- 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
- Squamous cell carcinoma (SCC) 8070 row:
- 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
- Pilocytic astrocytoma/juvenile pilocytic astrocytoma 9421/1 row
- 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
- Neurocytoma 9506/1 row: Terminology changed from central neurocytoma to neurocytoma and the following terms were added as synonyms:
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
- Invasive carcinoma NST/duct carcinoma and invasive lobular carcinoma 8522 row
- 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
- Medullary Carcinoma 8510 row:
- 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.
- New notes before Multiple Tumors MP module:
- 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
- Adenocarcinoma 8140 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)
- 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…