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

See the December 2023 Revisions
See the May 2023 Revisions
See the December 2022 Revisions
See the September 2021 Revisions
See the November 2020 Revisions
See the July 2019 Revisions
See the April 2019 Revisions
See the January 2019 Revisions
See the 2018 Revisions

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)