Solid Tumor Rules Changes for 2022 - Kidney, Lung, Malignant CNS, Urinary, Melanoma and Other Sites

Patricia Hines, CTR Solid Tumor Rules Leave a Comment

Solid Tumor Rules Changes for 2022 - Kidney, Lung, Malignant CNS, Urinary, Melanoma and Other Sites

Effective September 1, 2021, for all cases diagnosed January 1, 2022, and forward.

This week we wrap up the remaining changes made to the Solid Tumor Rules. As with the previous sites, changes have been made to both the multiple primary and histology sections, as well as different tables within each section. Several of these changes also reflect several changes made to the ICD-0-3 manual and other manuals this year as well.   

Per the “September 2021 Revision History for Solid Tumor Rules,” the following new changes have been revised for the kidney, lung, malignant CNS, urinary, melanoma, and other sites sections." 


Table 1: Specific Histologies, NOS/ NST, and Subtypes/Variants  
  • Renal cell carcinoma row:  
    • Note 3 added: "Continue coding sarcomatoid renal cell carcinoma as 8312 until otherwise indicated."  
    • "Succinate dehydrogenase-deficient renal cell carcinoma (SDHS) 8311* (reportable beginning 1/1/2022)" added as a subtype/variant  
  • Sarcoma row:  
    • Spindle cell/sclerosing rhabdomyosarcoma 8912/3 moved to be indented under Rhabdomyosarcoma 8900/3 (error fix)  
Multiple Primary Rules  
  • Rule M7: 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  
    • Note 2 added regarding combinations of 8311  


Table 2: Combination/Mixed Histology Codes  
  • Combined small cell carcinoma row 8045:  
    • "(includes large cell neuroendocrine carcinoma)" added to third bullet  
Multiple Primary Rules  
  • M Rule: Abstract a single primary when there are simultaneous multiple tumors…  
    • Note added to emphasize that the tumors must be diagnosed simultaneously  
  • M Rule: Abstract multiple primaries when there is a single tumor in each lung…  
    • Note 6 added: "Tumors do not need to be diagnosed at the same time (simultaneous or synchronous)."  

Malignant CNS:  

  • Clarification added: "See the Non-malignant CNS Rules when the primary site is optic nerve and the diagnosis is either optic glioma or pilocytic astrocytoma. The behavior for these tumors is non-malignant and coded 9421/1."  
Table 3: Specific Histologies, NOS, and Subtypes/Variants  
  • Malignant peripheral nerve sheath tumor 9540 row:  
    • Added as a subtype/variant: "Epithelioid malignant peripheral nerve sheath tumor 9542"  


Terms that are Not Equivalent or Equal  
  • Added: Papillary growth pattern is not equivalent to papillary urothelial carcinoma  
Coding Histology  
  • Instruction #4: DO NOT CODE histology when described as:  
    • "Configuration" removed from list  
    • "Growth pattern" added to list  


Multiple Primary Rules  
  • Same row rule:  
    • Removed text "Tumors must have the same laterality" (was unnecessary)  
  • Last resort rule:  
    • Note removed: "When an invasive melanoma follows an in situ melanoma within 60 days, abstract as a single primary." (note was unnecessary and misleading)  
Histology Rules 
  • Rule H1: Code the histology when only one histologic type is identified. 
    • Note added: "When the histology includes the term regressing or regression, continue through the rules."  
    • Note added: "When the histology includes the term lentigo malignant melanoma, continue through the rules."  

Other Sites:  

Table 2: Mixed and Combination Codes  
  • Gyn malignancies with two or more of the histologies in column 2 row:  
    • Note added: "First refer to ICD-O-3.2 and ICD-O updates to confirm if the mixed histology has a specific code. Example: papillary serous adenocarcinoma is coded 8460 per ICD-O." 
Histology Rules 
  • H Rule: Rule H4 Code the most specific histologic term when the diagnosis is…
    • Bullet added: "Sarcoma, NOS (8800) and a specific sarcoma" 

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