# Presentation: 565036

## Other Sites

## Equivalent Terms, Definitions and Tables

- Acinar carcinoma of prostate
- Acini: Tiny sacs contain fluid for ejaculation
- Acinar: Adenocarcinoma originates in acini
- Acinar not histologic type
- Acinar refers to origin in acini

**Notes:**
Code adenocarcinoma when pathology says acinar.
Acinar carcinoma of the prostate is a misnomer. There is a histologic type called acinar carcinoma; however, in prostate acinar is used to mean a part of the prostate, rather than a histologic type. It refers to the structure of origin. You code that to adenocarcinoma, not to acinar.

## Table 1

- Paired organs and sites with laterality
***Note:  ***This table only includes anatomic sites covered by the Other Sites Rules.

**Notes:**
Use this table with multiple primary rule M8.

## Slide 4

| Site Code | Site or Subsite |
| --- | --- |
| C384 | Pleura |
| C400 | Long bones of upper limb, scapula, and associated joints |
| C401 | Short bones of upper limb and associated joints |
| C402 | Long bones of lower limb and associated joints |
| C403 | Short bones of lower limb and associated joints |
| C413 | Rib, clavicle (excluding sternum) |
| C414 | Pelvic bones (excluding sacrum, coccyx, symphysis pubis) |
| C441 | Skin of the eyelid |

## Slide 5

| Site Code | Site or Subsite |
| --- | --- |
| C442 | Skin of the external ear |
| C443 | Skin of other and unspecific parts of the face (if midline, assign code 9) |
| C445 | Skin of the trunk (if midline, assign code 9) |
| C446 | Skin of upper limb and shoulder |
| C447 | Skin of the lower limb and hip |
| C471 | Peripheral nerves and autonomic nervous system of upper limb and shoulder |
| C472 | Peripheral nerves and autonomic nervous system of the lower limb and hip |
| C491 | Connective, subcutaneous, and other
 soft tissues of upper limb and shoulder |

## Slide 6

| Site Code | Site or Subsite |
| --- | --- |
| C492 | Connective, subcutaneous, and other soft tissues of the lower limb and hip |
| C569 | Ovary |
| C570 | Fallopian tube |
| C620-C629 | Testis |
| C630 | Epididymis |
| C631 | Spermatic cord |
| C690-C699 | Eye and adnexa |
| C740-C749 | Adrenal gland |
| C754 | Carotid body |

## Table 2

**Mixed and Combination Codes**
**This table is used to determine mixed and combination codes ONLY**
- Apply the multiple primary rules FIRST. Combination codes are most often used when multiple histologies are present in a single tumor; they are rarely used for multiple tumors.  Use a combination code for multiple tumors ONLY when the tumors meet rules for a single primary

**Notes:**
Use this table to decide whether a combination code is appropriate.
Do not use the combination codes for separate tumors unless the multiple primary rules instruct you to do so.
Combination table should not be used to make something a single primary.  Teach that multiple primary rules must be applied first.

## Table 2 Continued

- Use this **two-page** table to select combination histology codes. Compare the terms in the diagnosis to the terms in Columns 1 and 2. If the terms match, code the case using the ICD-O-3 histology code in column 4. Use the combination codes listed in this table only when the histologies in the tumor match the histologies listed below

**Notes:**
Stress that the abstractor should not use a combination code if the terms on the pathology report do not match the terms on the table.

## Slide 9

| Column 1:
Required Histology | Column 2:
Combined With | Column 3:
Combination Term | Column 4:
Code |
| --- | --- | --- | --- |
| Small cell carcinoma | Large cell carcinoma | Combined small cell carcinoma | 8045 |
|  | Adeno-carcinoma |  |  |
|  | Squamous cell carcinoma |  |  |
| Squamous carcinoma | Basal cell carcinoma | Basosquamous carcinoma | 8094 |
| Islet cell | Exocrine | Mixed islet cell and exocrine adenocarcinoma (pancreas) | 8154 |
| Acinar  | Endocrine |  |  |

**Notes:**
For example -- To assign code 8045, the diagnosis must be “small cell carcinoma” AND one of the histologies in column 2: large cell carcinoma, adenocarcinoma or squamous cell carcinoma.

## Slide 10

| Column 1:
Required Histology | Column 2:
Combined With | Column 3:
Combination Term | Column 4:
Code |
| --- | --- | --- | --- |
| Hepatocellular carcinoma | Cholangio-carcinoma | Combined hepatocellular carcinoma and cholangiocarcinoma | 8180 |
| Adenocarcinoma | Carcinoid | Composite carcinoid | 8244 |
| Adenocarcinoma | Papillary | Adenocarcinoma with mixed subtypes
Adenocarcinoma combined with other types of carcinoma | 8255 |
|  | Clear cell |  |  |
|  | Mucinous (colloid) |  |  |
|  | Signet ring |  |  |
|  | Acinar |  |  |

**Notes:**
Assign code 8255 when the diagnosis is adenocarcinoma AND papillary carcinoma (for example)

## Slide 11

| Column 1:
Required Histology | Column 2:
Combined With | Column 3:
Combination Term | Column 4:
Code |
| --- | --- | --- | --- |
| Gyn malignancies with two or more of the histologies in column 2 | Clear cell
Endometroid
Mucinous
Papillary
Serous
Squamous
Transitional (Brenner) | Mixed cell adenocarcinoma | 8323 |
| Papillary and 
Follicular |  | Papillary carcinoma, follicular variant | 8340 |
| Medullary | Follicular  | Mixed medullary-follicular carcinoma | 8346 |

**Notes:**
For code 8323, case must be a gyn malignancy with at least two of the histologies in column 2. For example:
Assign code 8323 for a gyn malignancy with a diagnosis of clear cell AND endometroid carcinoma.

## Slide 12

| Column 1:
Required Histology | Column 2:
Combined With | Column 3:
Combination Term | Column 4:
Code |
| --- | --- | --- | --- |
| Medullary  | Papillary | Mixed medullary-papillary carcinoma | 8347 |
| Squamous carcinoma and 
Adenocarcinoma  |  | Adeno-squamous carcinoma | 8560 |
| Any combination of histologies in Column 2  | Myxoid
Round cell
Pleomorphic  | Mixed liposarcoma | 8855 |
| Embryonal rhabdomyo-sarcoma | Alveolar rhabdomyo-sarcoma | Mixed type rhabdomyo-sarcoma | 8902 |

## Slide 13

| Column 1:
Required Histology | Column 2:
Combined With | Column 3:
Combination Term | Column 4:
Code |
| --- | --- | --- | --- |
| Teratoma | Embryonal carcinoma | Teratocarcinoma | 9081 |
| Teratoma and one or more of the histologies in Column 2 | Seminoma
Yolk sac tumor | Mixed germ cell tumor | 9085 |
| Choriocarcinoma | Teratoma 
Seminoma
Embryonal | Choriocarcinoma combined with other germ cell elements | 9101 |

## Multiple Primary Rules

## Unknown if Single or Multiple Tumors

**Notes:**
Use this module when:

Central registry gets a pathology report of a biopsy followed by a hospital report of a resection. Central registry is not sure if there was a single tumor or multiple tumors

Hospital registry has an H&P documenting a biopsy in the physician’s office. Patient has another biopsy or resection. Registrar cannot confirm whether the patient had a single tumor or multiple tumors.

## Slide 16

| Rule |  |  |  |  | Notes/Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| UNKNOWN IF SINGLE OR MULTIPLE TUMORS |  |  |  |  | Tumor(s) not described as metastasis |  |
| M1 |  |  |  |  | Use this rule only after all information sources have been exhausted. | Single |

**Notes:**
Note:  The matrix version has been condensed to fit on the slides.
This is a default so everyone will handle the cases in a standardized manner. 

The note is a warning not to default to a single tumor until all sources of information have been exhausted.

## Single Tumor

## Slide 18

| Rule | Site |  |  |  | Notes/Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| SINGLE TUMOR |  |  |  |  | 1:  Tumor not described as metastasis
2:  Includes combinations of in situ and invasive |  |
| M2 | Single |  |  |  | The tumor may overlap onto or extend into adjacent/contiguous site or subsite. | Single |

**Notes:**
Single tumors are always a single primary no matter how large they become or how many regional sites they may involve.

## Multiple Tumors

## Slide 20

| Rule | Site | Histology |  |  | Notes/Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| MULTIPLE TUMORS
Multiple tumors may be a single primary or multiple primaries |  |  |  |  | 1:  Tumors not described as metastases
2:  Includes combinations of in situ and invasive |  |
| M3 | Prostate | Adeno-
carcinoma |  |  | 1:  Report only one adenocarcinoma of the prostate per patient per lifetime.
2: 95% of prostate malignancies are the common (acinar) adenocarcinoma histology (8140). See Equivalent Terms, Definitions and Tables for more information | Single |

**Notes:**
Same as previous rule. The patient has only one (acinar) adenocarcinoma of the prostate per lifetime.

## Slide 21

| Rule | Site | Histology |  |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M4 | Unilateral or bilateral | Retinoblastoma |  |  |  | Single |

**Notes:**
Retinoblastoma is always a single primary regardless of laterality or timing.

## Slide 22

| Rule | Site | Histology |  |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M5 | Any site or sites | Kaposi sarcoma |  |  |  | Single |

**Notes:**
Kaposi sarcoma in a patient with AIDS is usually diffuse. Regardless of how many organs are involved, Kaposi sarcoma is a single primary.

## Slide 23

| Rule | Site | Histology | Timing |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M6 | Thyroid | Follicular and papillary | Within 60 days of diagnosis |  |  | Single |

**Notes:**
Follicular and papillary carcinoma of the thyroid that occurs within 60 days is always a single primary even if they are separate tumors.

## Slide 24

| Rule | Site | Histology | Timing |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M7 | Bilateral ovary | Epithelial tumors (8000-8799) | Within 60 days of diagnosis |  |  | Single |

**Notes:**
The involvement of both ovaries with epithelial carcinoma within 60 days is a staging criteria rather than a multiple primary criteria.

## Slide 25

| Rule | Site |  |  |  | Notes/Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M8 | Both sides of a paired site (Table 1) |  |  |  | Table 1 – Paired Organs and Sites with Laterality | Multiple |

**Notes:**
Use table 1 to identify paired organs.
If both sides of a paired organ are involved, code as multiple primaries. The only exception to this rule is if the physician states unequivocally that one side is metastatic from the other.
A statement that the patient has bilateral carcinoma of the particular site is NOT sufficient to code as a single primary.

## Slide 26

| Rule |  | Histology |  |  | Notes/
Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M9 |  | Adenocarcinoma in adenomatous polyposis coli (familial polyposis) with one or more in situ or malignant polyps |  |  | Tumors may be present in a single or multiple segments of the colon, rectosigmoid, rectum. | Single |

**Notes:**
This rule is for rectosigmoid and rectal primaries.
Explain that rectum and rectosigmoid are in this set of rules rather than with colon.

## Slide 27

| Rule |  |  | Timing |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M10 |  |  | Diagnosed more than one (1) year apart |  |  | Multiple |

**Notes:**
For all sites covered by this rule, tumors diagnosed one year apart are multiple primaries.

## Slide 28

| Rule | Site |  |  |  | Notes/
Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M11 | Topography codes that are different at the second (Cxxx) and/or third (Cxxx) character |  |  |  | Next slide | Multiple |

**Notes:**
A  tumor in the rectum and a separate tumor in any other site are multiple primaries.

## Slide 29

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| M11
Continued |  |  |  |  | Example 1: A tumor in the penis C609 and a tumor in the rectum C209 have different second characters in their ICD-O-3 topography codes, so they are multiple primaries.
Example 2: A tumor in the cervix C539 and a tumor in the vulva C519 have different third characters in their ICD-O-3 topography codes, so they are multiple primaries |  |

## Slide 30

| Rule | Site |  |  |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M12 | Topography codes that differ only at the fourth (Cxxx) character in any one of the following primary sites:
Anus and anal canal C21_)
Bones, joints and articular cartilage (C40_-C41_)
Peripheral nerves and autonomic nervous system (C47_)
Connective tissue and other soft tissues (C49_)
Skin (C44_) |  |  |  |  | Multiple |

**Notes:**
As in the previous rules, there are certain primary sites where subsites (4th digit) are separate primaries.

## Slide 31

| Rule |  | Histology |  |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M13 |  | Frank in situ or malignant adenocarcinoma and an in situ or malignant tumor in a polyp |  |  |  | Single |

**Notes:**
Polyps occur in several sites such as uterus, stomach, rectosigmoid, etc. A malignancy in polyp and a frank malignancy are a single primary.
Because M11 has already excluded all cases with tumors in different sites, this rule would apply only to tumors in the same site.

## Slide 32

| Rule |  | Histology |  |  | Notes/Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M14 |  | Multiple in situ and/or malignant polyps |  |  | Note: Includes all combinations of adenomatous, tubular, villous, and tubulovillous adenomas or polyps. | Single |

**Notes:**
Malignant polyps with these different histologies in the same site are a single primary.

## Slide 33

| Rule |  |  | Timing | Behavior | Notes/
Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M15 |  |  | More than 60 days after diagnosis | An invasive tumor following an in situ tumor | Next slide | Multiple |

**Notes:**
First explain that if an invasive occurs less than 60 days after an in situ you would abstract as a single primary and code the invasive tumor.

This is new for everyone except SEER registries. Explain the rule thoroughly.

## Slide 34

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| M15
Continued |  |  |  |  | 1:  The purpose of this rule is to ensure that the case is counted as an incident (invasive) case when incidence data are analyzed.
2:  Abstract as multiple primaries even if the medical record/physician states it is recurrence or progression of disease. |  |

**Notes:**
Note 1 means that the incidence counts are for invasive cases only with a few exceptions. 

Explain that we do not want survival graphs showing people dying of in situ disease. We also don’t want the survival time affected by the time between an in situ and an invasive tumor

Note 2: IMPORTANT. You may have to explain to your physicians the reason behind the rule. The CoC physicians were all supportive when the rule and rationale were presented to them. 

## Slide 35

| Rule |  | Histology |  |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M16 |  | Cancer/malignant neoplasm, NOS (8000) and another is a specific histology; or
Carcinoma, NOS (8010) and another is a specific carcinoma; or 
Squamous cell carcinoma, NOS (8070) and another is a specific squamous cell carcinoma; or 
Adenocarcinoma, NOS (8140) and another is a specific adenocarcinoma; or
Melanoma, NOS (8720) and another is a specific melanoma; or
Sarcoma, NOS (8800) and another is a specific sarcoma |  |  |  | Single |

**Notes:**
Same as previous NOS rule with specific examples/instructions.

## Slide 36

| Rule |  | Histology |  |  |  | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M17 |  | Histology codes are different at the first (xxxx), second (xxxx), or third (xxxx) number |  |  |  | Multiple |

**Notes:**
All of the histologies that do not work with this three-digit rule were eliminated in previous rules. M17 will deal with all of the histologies that still work with the three-digit rule.

## Slide 37

| Rule |  |  |  |  | Notes/Examples | Primary |
| --- | --- | --- | --- | --- | --- | --- |
| M18 | Does not meet any of the above criteria |  |  |  | When an invasive lesion follows an in situ within 60 days, abstract as a single primary. | Single |

**Notes:**
This is a default rule. We do not have to write multiple rules saying that these conditions are single primaries. If the case did not meet the criteria for any of the previous rules, it is a single primary.

## Histology Coding Rules

## Single TumorIn Situ Only

**Notes:**
For Other Sites histology coding, the registrar must first decide if there is a single tumor or multiple tumors. If a single tumor, then decide if the tumor is in situ, in situ & invasive, or all invasive. After making those decisions, the registrar will proceed to the appropriate module in the Other Sites histology coding rules. 

## Slide 40

| Rule | Pathology
Cytology |  |  |  | Notes/ Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| SINGLE TUMOR: IN SITU ONLY
(Single Tumor; all parts are in situ) |  |  |  |  |  |  |
| H1 | The pathology/
cytology report is not available |  |  |  | Next Slide | The histology documented by the physician |

**Notes:**
Used when the abstractor does not have access to the pathology or cytology report.
You may notice that the wording here is slightly different from similar other sites histology rules (H8 and H18) and similar rules elsewhere. Since rule H1 is for an in situ tumor, there must be histologic confirmation to call it in situ.  Therefore, there is no reference here to the situation of not having a pathology or cytology specimen. 

Also note that there is no rule in the in situ module talking about the only specimen being from a metastatic site. By definition, in situ cancer cannot metastasize so the metastatic site rule is not appropriate for the in situ module.

## Slide 41

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| SINGLE TUMOR: IN SITU ONLY
(Single Tumor; all parts are in situ) |  |  |  |  |  |  |
| H1
Continued |  |  |  |  | 1:  Priority for using documents to code the histology
Documentation in the medical record that refers to pathologic or cytologic findings
Physician’s reference to type of cancer (histology) in the medical record
2:  Code the specific histology when documented.
3:  Code the histology to 8000 (cancer/malignant neoplasm, NOS) or 8010 (carcinoma, NOS) as stated by the physician when nothing more specific is documented |  |

**Notes:**
Note 1: Gives a priority for coding histology.
--If the medical record references a pathology or cytology report.  Example: Patient had a biopsy of the thyroid prior to arrival that was positive for follicular carcinoma in situ. 
--Use the physician’s documentation in the medical record giving the histology. Example: H&P with a diagnosis of adenocarcinoma in situ
Note 2: If any of the documentation sources mentions a specific histology, code as documented.
Note 3: If the only mention is that the patient has “carcinoma,” code 8010. If the only mention is that the patient has “cancer,” code 8000.

## Slide 42

| Rule |  |  | Histology |  | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H2 |  |  | One type |  | Do not code terms that do not appear in the histology description.
Example:  Do not code squamous cell carcinoma non-keratinizing unless the words “non-keratinizing” actually appear in the diagnosis. | The histology |

**Notes:**
Used when diagnosis is simply adenocarcinoma or squamous cell carcinoma.

Note: During Beta testing we saw that a lot of registrars would “expand” on the histology code or make assumptions about a code.

Example: if the diagnosis was squamous cell carcinoma, they would code non-keratinizing squamous cell carcinoma. The abstractors made the assumption that if the squamous cell carcinoma was not designated as keratinizing, it was non-keratinizing.  This is not true. When the diagnosis is squamous cell, it means that the pathologist could not designate it as either keratinizing or non-keratinizing. 

## Slide 43

| Rule |  |  | Histology |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H3 |  |  | Final diagnosis is:
Adenocarcinoma in a polyp 
Adenocarcinoma and a residual polyp or polyp architecture is recorded in other parts of the pathology report.
Adenocarcinoma and there is reference to a residual or pre-existing polyp or 
Mucinous/colloid or signet ring cell adenocarcinoma in a polyp or
There is documentation that the patient had a polypectomy  |  | It is important to know that the adeno-carcinoma originated in a polyp.  | 8210 (adeno-carcinoma in adenomatous polyp) or
8261 (adeno-carcinoma in villous adenoma) or 
8263 (adeno-carcinoma in tubulovillous adenoma)  |

## Slide 44

| Rule |  |  | Histology |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H4 |  |  | Carcinoma in situ, NOS (8010) and a specific in situ carcinoma or
Squamous cell carcinoma in situ, NOS (8070) and a specific in situ squamous cell carcinoma or 
Adenocarcinoma in situ, NOS (8140) and a specific in situ adenocarcinoma or
 Melanoma in situ, NOS (8720) and a specific in situ melanoma |  | Next Slide | The most specific histologic term |

**Notes:**
Same as previous NOS with specific histologies/instructions.
Rule H4 is not just about a NOS term with any other term; the terms must be related – adenocarcinoma, NOS and a more specific adenocarcinoma, for example.

## Slide 45

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H4
Continued |  |  |  |  | The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ____ differentiation, architecture or pattern.  The terms architecture and pattern are subtypes only for in situ cancer. |  |

**Notes:**
H4 continued.

Note that these instructions are for single tumor in situ only, so the terms architecture and pattern are valid.

## Slide 46

| Rule |  |  | Histology |  | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H5 |  |  | Multiple specific histologies or
A non-specific histology with multiple specific histologies |  | The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ____differentiation, architecture or pattern.  The terms architecture and pattern are subtypes only for in situ cancer. | The appropriate combination/ mixed code (Table 2) |

**Notes:**
Explain the non-specific and multiple specific histologies rule. 
On table 2, you must look up the combination, not adenocarcinoma, for example. You won’t find the original term on the table. Teach people how to look up the terms on table 2.

## Slide 47

| Rule |  |  |  |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H6 | None of the above conditions are met |  |  |  |  | The numerically higher ICD-O-3 code |

**Notes:**
This is a default code for any cases did not meet the criteria of the first 4 rules

## Single TumorInvasive and In Situ

## Slide 49

| Rule |  |  |  | Behavior | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| SINGLE TUMOR: INVASIVE AND IN SITU
(Single Tumor; in situ and invasive components) |  |  |  |  |  |  |
| H7 |  |  |  | Invasive and in situ | This is a change from the previous histology coding rules and is different from ICD-O-3 rules.  This change was made in collaboration with the ICD-O-3 editors.  The consensus was that coding the invasive component of the tumor better explains the likely disease course and survival category. | The single invasive histology.  Ignore the in situ terms. |

**Notes:**
This is a change from the previous rules. Be sure to emphasize.

The invasive histology is the one that will affect survival and govern treatment. By coding the invasive type, the case will be placed in the correct analysis group.

Even if the in situ portion is more specific, it will not be the histology that impacts survival and treatment. 

## Single TumorInvasive Only

## Slide 51

| Rule | Pathology
Cytology |  |  |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| SINGLE TUMOR: INVASIVE ONLY
(Single Tumor; all parts are invasive) |  |  |  |  |  |  |
| H8 | No pathology/cytology specimen or pathology/
cytology report is not available |  |  |  | Next Slide | The histology documented by the physician |

**Notes:**
Same as H1, except this one is for a single invasive tumor.

## Slide 52

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| SINGLE TUMOR: INVASIVE ONLY
(Single Tumor; all parts are invasive) |  |  |  |  |  |  |
| H8
Continued |  |  |  |  | 1:  Priority for using documents to code the histology
Documentation in the medical record that refers to pathologic or cytologic findings
Physician’s reference to type of cancer (histology) in the medical record
CT, PET or MRI scans
2:  Code the specific histology when documented.
3:  Code the histology to 8000 (cancer/malignant neoplasm, NOS) or 8010 (carcinoma, NOS) as stated by the physician when nothing more specific is documented |  |

## Slide 53

| Rule | Pathology/
Cytology | 
 |  |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H9 | None from primary site |  |  |  | Code the behavior /3 | The histology from a metastatic site |

**Notes:**
If there is no pathology or cytology specimen from the primary site, code the histology from a biopsy of a metastatic site. Example: Debulking with a final diagnosis that states: Cystadenocarcinoma of ovarian origin. Ovaries not identified in specimen. Code cystadenocarcinoma.

## Slide 54

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H10 |  | Prostate | Acinar
(adeno) carcinoma |  |  | 8140 (adenocarcinoma NOS) |

**Notes:**
When diagnosis is acinar adenocarcinoma of prostate, code to adenocarcinoma.

See the Equivalent Terms and Definitions: Acinar adenocarcinoma is not a histologic type; it confirms that the adenocarcinoma originates in the acini.

## Slide 55

| Rule |  |  | Histology |  | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H11 |  |  | One type |  | Do not code terms that do not appear in the histology description.
Example:  Do not code squamous cell carcinoma non-keratinizing unless the words “non-keratinizing” actually appear in the diagnosis. | The histology |

**Notes:**
Same as H2

## Slide 56

| Rule |  |  | Histology |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H12 |  |  | The final diagnosis is:
adenocarcinoma in a polyp or
adenocarcinoma and a residual polyp or polyp architecture is recorded in other parts of the pathology report or
adenocarcinoma and there is reference to a residual or pre-existing polyp or
adenocarcinoma mucinous/colloid or signet ring cell adenocarcinoma in a polyp or
There is documentation that the patient had a polypectomy  |  | It is important to know that the adeno-carcinoma originated in a polyp  | 8210 (adeno-carcinoma in adenomatous polyp) or
8261 (adeno-carcinoma in villous adenoma) or 
8263 (adeno-carcinoma in tubulovillous adenoma)  |

**Notes:**
Same as H3

## Slide 57

| Rule |  |  | Histology |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H13 |  |  | Cancer/Malignant neoplasm, NOS (8000) and a more specific histology
Carcinoma, NOS (8010) and a specific carcinoma or
Squamous cell carcinoma, NOS (8070) and a specific squamous cell carcinoma or 
Adenocarcinoma, NOS (8140) and a specific adenocarcinoma or
 Melanoma, NOS (8720) and a melanoma or
Sarcoma, NOS (8800) and a more specific sarcoma |  | Next Slide | The most specific histologic term |

**Notes:**
Similar to H4. H13 is for an invasive tumor.

## Slide 58

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H13
Continued |  |  |  |  | The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ____ differentiation.  The terms architecture and pattern are subtypes only for in situ cancer.
Example 1:  Adenocarcinoma, predominantly mucinous. Code mucinous adenocarcinoma (8480).
Example 2:  Non-small cell carcinoma, papillary squamous cell.  Code papillary squamous cell carcinoma (8052).  |  |

## Slide 59

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H14 |  | Thyroid | Papillary carcinoma |  |  | 8260 ( papillary adenocarcinoma, NOS) |

**Notes:**
This rule answers a common coding question

## Slide 60

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H15 |  | Thyroid | Follicular and papillary carcinoma |  |  | 8340 (Papillary carcinoma, follicular variant) |

**Notes:**
A thyroid tumor with both follicular and papillary carcinoma is coded 8340, papillary carcinoma, follicular variant.

## Slide 61

| Rule |  |  | Histology |  | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H16 |  |  | Multiple specific histologies or
A non-specific histology with multiple specific histologies |  | Next slide | The appropriate combination/ mixed code (Table 2) |

**Notes:**
Similar to H5.  H16 is for an invasive tumor.
Explain the non-specific and multiple specific histologies rule. 
On table 2, you must look up the combination, not adenocarcinoma, for example. You won’t find the original term on the table. Teach people how to look up the terms on table 2.

## Slide 62

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H16
Continued |  |  |  |  | The specific histologies may be identified as a type, subtype, predominantly, with features of, major, or with ____ differentiation.
Example 1 (multiple specific histologies):  Gyn malignancy with mucinous, serous and papillary adenocarcinoma.  Code 8323 (mixed cell adenocarcinoma) 
Example 2 (multiple specific histologies):  Combined small cell and squamous cell carcinoma.  Code 8045 (combined small cell carcinoma).
Example 3 (non-specific with multiple specific histologies): Adenocarcinoma with papillary and clear cell features. Code 8255 (adenocarcinoma with mixed subtypes)  |  |

## Slide 63

| Rule |  |  |  |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H17 | None of the above conditions are met |  |  |  |  | The numerically higher ICD-O-3 code |

**Notes:**
Same as H6

## Multiple Tumors Abstracted as a Single Primary

## Slide 65

| Rule | Pathology/
Cytology  |  |  |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY |  |  |  |  |  |  |
| H18 | No pathology/
cytology specimen or the pathology/ cytology report is not available |  |  |  | Next slide | The histology documented by the physician |

**Notes:**
Same as H1 and H8

## Slide 66

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| MULTIPLE TUMORS ABSTRACTED AS A SINGLE PRIMARY |  |  |  |  |  |  |
| H18
Continued |  |  |  |  | 1:  Priority for using documents to code the histology
Documentation in the medical record that refers to pathologic or cytologic findings
Physician’s reference to type of cancer (histology) in the medical record
CT, PET or MRI scans
2:  Code the specific histology when documented
3:  Code the histology to 8000 (cancer/malignant neoplasm, NOS) or 8010 (carcinoma, NOS) as stated by the physician when nothing more specific is documented |  |

## Slide 67

| Rule | Pathology/
Cytology | 
 |  |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H19 | None from primary site |  |  |  | Code the behavior /3 | The histology from a metastatic site |

**Notes:**
Same as H9

## Slide 68

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H20  |  | Prostate | Acinar
(adeno) carcinoma |  |  | 8140 (adenocarcinoma NOS) |

**Notes:**
Same as H10

## Slide 69

| Rule |  | Primary
Site | Histology | Behavior | Notes/ Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H21 |  | Sites such as:
Vulva
Vagina
Anus | Squamous intra-epithelial neoplasia grade III such as
Vulva (VIN III)
Vagina (VAIN III)
Anus (AIN III)  | In situ | Next Slide | 8077/2 (Squamous intra-epithelial neoplasia, grade III)  |

**Notes:**
Emphasize that the pathology report MUST say in situ carcinoma. 

These sites/histologies are squamous cell intraepithelial neoplasia and have a specific code in ICD-O-3.

## Slide 70

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H21
Continued |  |  |  |  | 1: VIN, VAIN, and AIN are squamous cell carcinomas. Code 8077 cannot be used for glandular intraepithelial neoplasia such as prostatic intraepithelial neoplasia (PIN) or pancreatic intraepithelial neoplasia (PAIN).
2: This code may be used for reportable-by-agreement cases  |  |

**Notes:**
Again, emphasize that the code 8077 is for squamous cell and cannot be used for other intraepithelial neoplasia that are designated as in situ carcinoma.
Warning: if you collect these non-reportables you must make another abstract if this becomes reportable. 

## Slide 71

| Rule |  | Primary
Site | Histology | Behavior | Notes/ Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H22 |  | Sites such as:
Pancreas  | Glandular intra-epithelial neoplasia grade III such as:
Pancreas (PAIN III)  | In situ | Next Slide | 8148/2 (Glandular intra-epithelial neoplasia grade III)  |

**Notes:**
Emphasize that the words “in situ” must be in the diagnosis.

In situ intraepithelial neoplasia of the pancreas and prostate are gladular or adenocarcinoma. They must be coded to 8148/2.

## Slide 72

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H22
Continued |  |  |  |  | This code may be used for reportable-by-agreement cases such as intraepithelial neoplasia of the prostate (PIN III)  |  |

**Notes:**
Warning: if you collect these non-reportables you must make another abstract if this becomes reportable. 

## Slide 73

| Rule |  |  | Histology |  | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H23 |  |  | One type |  | Do not code terms that do not appear in the histology description.
Example:  Do not code squamous cell carcinoma non-keratinizing unless the words “non-keratinizing” actually appear in the diagnosis. | The histology |

**Notes:**
Same as H2 and H11

## Slide 74

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H24 |  | Anus
Perianal region
Vulva | Extramammary Paget disease and an underlying tumor |  |  | The histology of the underlying tumor |

**Notes:**
Whenever there is a diagnosis of extramammary Paget disease of the anus, perianal region, or vulva there is usually an underlying tumor. Code the histology of the underlying tumor.

## Slide 75

| Rule |  |  | Histology |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H25 |  |  | The final diagnosis is:
adenocarcinoma in a polyp or
adenocarcinoma and a residual polyp or polyp architecture is recorded in other parts of the pathology report or
adenocarcinoma and there is reference to a residual or pre-existing polyp or
adenocarcinoma mucinous/colloid or signet ring cell adenocarcinoma in a polyp or
There is documentation that the patient had a polypectomy  |  | It is important to know that the adeno-carcinoma originated in a polyp  | 8210 (adeno-carcinoma in adenomatous polyp) or
8261 (adeno-carcinoma in villous adenoma) or 
8263 (adeno-carcinoma in tubulovillous adenoma)  |

**Notes:**
Same as H3 and H12

## Slide 76

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H26 |  | Thyroid | Papillary carcinoma |  |  | 8260 ( papillary adenocarcinoma, NOS) |

**Notes:**
Same as H14.  This rule answers a common coding question

## Slide 77

| Rule |  | Primary
Site | Histology |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H27 |  | Thyroid | Follicular and papillary carcinoma |  |  | 8340 (Papillary carcinoma, follicular variant) |

**Notes:**
The multiple primary rules tell you to code follicular and papillary carcinoma of the thyroid as a single primary when diagnosed within 60 days of each other. The histology is coded 8340, papillary carcinoma, follicular variant.

## Slide 78

| Rule |  |  |  | Behavior | Notes/Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H28 |  |  |  | Invasive and in situ | This is a change from the previous histology coding rules and is different from ICD-O-3 rules.  This change was made in collaboration with the ICD-O-3 editors.  The consensus was that coding the invasive component of the tumor better explains the likely disease course and survival category. | The single invasive histology.  Ignore the in situ terms. |

**Notes:**
Same as H7

## Slide 79

| Rule |  |  | Histology |  | Notes/
Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H29 |  |  | Cancer/Malignant neoplasm, NOS (8000) and a more specific histology
Carcinoma, NOS (8010) and a specific carcinoma or
Squamous cell carcinoma, NOS (8070) and a specific squamous cell carcinoma or 
Adenocarcinoma, NOS (8140) and a specific adenocarcinoma or
 Melanoma, NOS (8720) and a melanoma or
Sarcoma, NOS (8800) and a more specific sarcoma |  | Next Slide | The most specific histologic term |

**Notes:**
Same as H4 and H13.

## Slide 80

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H29
Continued |  |  |  |  | The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ____ differentiation.  The terms architecture and pattern are subtypes only for in situ cancer.
Example 1:  Adenocarcinoma, predominantly mucinous. Code mucinous adenocarcinoma (8480).
Example 2:  Non-small cell carcinoma, papillary squamous cell.  Code papillary squamous cell carcinoma (8052).  |  |

## Slide 81

| Rule |  |  | Histology |  | Notes/ Examples | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H30 |  |  | Multiple specific histologies or 
A non-specific histology with multiple specific histologies |  | Next slide | The appropriate combination/mixed code (Table 2) |

**Notes:**
Same ad H5 and H16

## Slide 82

| Rule |  |  |  |  | Notes/Examples |  |
| --- | --- | --- | --- | --- | --- | --- |
| H30
Continued |  |  |  |  | The specific histologies may be identified as a type, subtype, predominantly, with features of, major, or with ____ differentiation.
Example 1 (multiple specific histologies):  Gyn malignancy with mucinous, serous and papillary adenocarcinoma.  Code 8323 (mixed cell adenocarcinoma)
Example 2 (multiple specific histologies):  Combined small cell and squamous cell carcinoma.  Code 8045 (combined small cell carcinoma)
Example 3 (non-specific with multiple specific histologies): Adenocarcinoma with papillary and clear cell features. Code 8255 (adenocarcinoma with mixed subtypes) |  |

## Slide 83

| Rule |  |  |  |  |  | Code |
| --- | --- | --- | --- | --- | --- | --- |
| H31 | None of the above conditions are met |  |  |  |  | The numerically higher ICD-O-3 code |

**Notes:**
Same as H6 and H17

## MP/H Task Force