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C340-C343, C348, C
(Excludes lymphoma and leukemia M9590 – M9992 and Kaposi sarcoma M9140)
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Introduction
Note 1 : 2007 MPH Rules and 2018 Solid Tumor Rules are used based on date of diagnosis.
- Tumors diagnosed 01/01/2007 through 12/31/2017: Use 2007 MPH Rules
- Tumors diagnosed 01/01/2018 and later: Use 2018 Solid Tumor Rules
- The original tumor diagnosed before 1/1/2018 and a subsequent tumor diagnosed 1/1/2018 or later in the same primary site : Use the 2018 Solid Tumor Rules. Note 2 : Cancers from many primary sites metastasize to the lung. It is important to rule out metastases from another organ/site before abstracting a lung primary. Note 3 : Tables and rules refer to ICD-O rather than ICD-O-3. The version is not specified to allow for updates. Use the currently approved version of ICD-O. Note 4 : Multifocal/multiple discrete foci tumors are often present in lepidic adenocarcinoma, minimally invasive adenocarcinoma, and adenocarcinoma in situ; these multiple foci may be referred to as ground-glass/lepidic. Note 5 : For those sites/histologies which have recognized biomarkers , the biomarkers are most frequently used to target treatment. Currently, there are clinical trials being conducted to determine whether these biomarkers can be used to identify multiple primaries and/or histologic type. Follow the Multiple Primary Rules; do not code multiple primaries based on biomarkers.
Changes from 2007 MPH Rules
These changes are effective with cases diagnosed 1/1/2018 and later.
Note 1 : Changes are implemented slowly over time, so it is not unusual for a pathology report to use an obsolete term. Obsolete terms and codes can be used when they are the only information available. Note 2 : WHO 4th^ Ed Tumors of Lung 2015 has a new classification of adenocarcinoma which is a significant change from the 2004 WHO classification. One of the major changes is discontinuing usage of the term bronchioloalveolar carcinoma (BAC) beginning with cases diagnosed 1/1/2018 and forward. The preferred term for BAC is now mucinous adenocarcinoma 8253.
- 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
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(two distinctly different histologies/different rows), code the histology from the most representative specimen (the greater amount of tumor).”
- New and changed ICD-O histology codes have been added to Table 3 and are identified by an asterisk. Some of those changes include: A. In situ and minimally invasive terms and codes B. Terms assigned a new histology code C. Histology codes assigned a different preferred term (18 codes with new preferred terms)
- The following new adenocarcinoma terms and codes have been added. The new terms and codes are for lung only. See notes in Table 3. A. Mucinous carcinoma/adenocarcinoma - 8253/3 when ο Behavior unknown/not documented (use staging form to determine behavior when available) ο Invasive - 8257/3 when ο Microinvasive ο Minimally invasive - 8253/2 when ο Preinvasive ο In situ Note : Previously, only invasive /3 codes were available for mucinous adenocarcinoma of the lung. It has been recognized tha t not all lung cancers are invasive /3 so new codes were implemented. B. Non-mucinous carcinoma/adenocarcinoma - 8256/3 when ο Microinvasive ο Minimally invasive - 8250/2 when ο Preinvasive ο In situ
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(Excludes lymphoma and leukemia M9590 – M9992 and Kaposi sarcoma M9140)
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Terms that are NOT Equivalent or Equal
This is a list of terms that are not equivalent. There are no casefinding implications.
- Bilateral is not equivalent to either single primary or multiple primaries. See Multiple Primary rules for instructions.
- Bronchus is not always equivalent to mainstem bronchus. The mainstem bronchus only extends a few centimeters into the lung. o Code to mainstem bronchus C340 when it is specifically stated in the operative report and/or documented by a physician o When only called bronchus, code to the lobe in which the bronchial tumor is located
- Component is not equivalent to type/subtype/variant Note : Component is only coded when the pathologist specifies the component as a second carcinoma.
- Lung only: Mucinous is not equivalent to colloid Note: The new codes for mucinous adenocarcinoma were implemented so mucinous carcinoma and colloid carcinoma could be analyzed separately.
- Mucin-producing/mucin-secreting carcinoma 8481 is not equivalent to mucinous carcinoma 8253 (new code for lung primaries only) o Mucin-producing/secreting tumors produce mucin, but not enough to be classified as mucinous carcinoma o The terms mucin-producing and mucin-secreting are still reportable. This bullet simply states they are not equivalent to mucinous carcinoma
- Multilocular is not equivalent to multinodular (see glossary for further information. The electronic glossary will be available in 2019)
- Phenotype is not equivalent to subtype/type/variant
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Table 1: Coding Primary Site
- The mainstem bronchus starts at the trachea and extends only a few centimeters into the lung where it connects with the secondary bronchus and divides into secondary bronchi. A. Each lobe of the lung has secondary bronchi i. The right lung has 3 secondary bronchi , one in each of the three lobes: upper; middle, and lower ii. The left lung has 2 secondary bronchi , one in each of the two lobes: upper and lower B. Code to mainstem bronchus C340 when it is specifically stated in the operative report and/or documented by a physician. C. When only called bronchus , code to the lobe in which the bronchial tumor is located
- See the graphic in this document with the endnote “End of Mainstem Bronchus; Start of Terminal/Secondary Bronchus”.
Table 1 contains terms used in physicians’ documentation and on scans to describe the location of a tumor.
This table has terms and anatomical descriptions which are not in the ICD-O.
Use this table to determine the correct site code. Do not use for other fields such as laterality. Column 1 contains the terminology used by physicians or on scans to describe lung “masses” (not lymph nodes). Column 2 indicates whether the term is used only for the right lung, or only for the left lung, or if it is used for both the right or left lung. Column 3 contains the ICD-O term and site code.
Table begins on next page
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Terminology Laterality Site Term and Code Bronchus NOS Bronchogenic Extending up to the hilum Extending down to the hilar region Lung NOS Pulmonary NOS Suprahilar NOS
Bilateral Lung NOS C Note : Includes
- Multiple tumors in different lobes of ipsilateral lung OR
- Multiple tumors in ipsilateral lung; unknown if same lobe or different lobe OR
- Tumor in bronchus, unknown if mainstem or lobar bronchus OR
- Tumor present, unknown which lobe
Lobar bronchi NOS Lobar bronchus NOS
Bilateral Code the lobe in which the lobar bronchus tumor is present C34__ Note : When lobe of origin is not documented/unknown , code to lung NOS C
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Table 2: Combination/Mixed Histology Codes
Instructions:
- Compare the terms in the diagnosis (pathology, cytology, radiographic, clinical) to the terms in Column 1.
- When the terms match , use the combination code listed in Column 2.
- The last row in the table is a “last resort” code: adenocarcinoma mixed subtypes 8255.
Note 1 : Do not use Table 2 in the following situations:
- For tumors with both invasive and in situ behavior. The Histology Rules instruct to code the invasive histology.
- When one of the histologies is described as differentiation or features. A histology with differentiation or features is a single histology.
- When the terms are a NOS and a subtype/variant of that NOS. See the Histology Rules for instructions on coding a NOS and a subtype/variant in a single tumor or multiple tumors abstracted as a single primary. Note 2 : Some combinations can be either in situ or invasive; others are limited to a /2 or /3 behavior code.
- When a code is limited to in situ, / 2 will be added to the code (both components are in situ)
- When a code is limited to invasive, /3 will be added to the code (both components are invasive) Note 3: This table is not a complete listing of histology combinations.
Column 1 lists the required terms for the combination code. Column 2 lists the combination term and code for histologies in Column 1.
Table begins on next page.
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Required Terms Combination Histologies and Code Small cell carcinoma/neuroendocrine tumor (NET) Note: Includes subtypes/variants of small cell/neuroendocrine tumor. See Table 3 for subtypes/variants.
AND
At least one of the following:
- Adenocarcinoma and any subtype/variant of adenocarcinoma
- Adenosquamous carcinoma
- Large cell carcinoma and any subtype/variant of large cell carcinoma (includes large cell neuroendocrine carcinoma)
- Squamous cell carcinoma and any subtype/variant of squamous cell carcinoma
- Non-small cell carcinoma
Combined small cell carcinoma 8045
Squamous cell carcinoma (epidermoid carcinoma)
AND
Large cell non-keratinizing squamous cell carcinoma
Note: Squamous cell carcinoma and epidermoid carcinoma are synonyms
Squamous cell carcinoma, large cell, nonkeratinizing 8072
Squamous cell carcinoma (epidermoid carcinoma)
AND
Small cell nonkeratinizing squamous cell carcinoma
Note: Squamous cell carcinoma and epidermoid carcinoma are synonyms
Squamous cell carcinoma, small cell, nonkeratinizing 8073
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Required Terms Combination Histologies and Code Squamous cell carcinoma, keratinizing
AND
Squamous cell carcinoma, non-keratinizing
Squamous cell carcinoma, NOS 8070
Squamous cell (epidermoid) carcinoma
AND
One or both of the following:
- Sarcomatoid carcinoma
- Spindle cell carcinoma
Note 1: Does not include subtypes/variants of squamous cell. See Table 3 for subtypes/variants. Note 2: Squamous cell carcinoma and epidermoid carcinoma are synonyms.
Squamous cell carcinoma, sarcomatoid 8074 Squamous cell carcinoma, spindle cell 8074
Table continues on next page
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Table 3: Specific Histologies, NOS, and Subtype/Variants
Use Table 3 as directed by the Histology Rules to assign the more common histology codes for lung tumors.
Note 1: Rare histologies may not be listed in the table. When a histology term is not found, reference ICD-O and all updates. Note 2: Submit a question to Ask a SEER Registrar when the histology code is not found in Table 3, ICD-O or ICD-O updates. Note 3: Behavior codes are listed when the term has only one possible behavior (either a /2 or /3). For histologies which may be either /2 or /3, a behavior code is not listed. Code behavior as documented in the pathology report. Note 4: Only use the histology code from the table when the diagnosis is EXACTLY the term listed. Note 5 : Sarcomatoid carcinoma is most frequently a tumor of the mediastinum, so it is not listed in this table.
IMPORTANT: Non-small cell lung carcinoma (NSCLC) is a broad group of cancers which includes all carcinoma types in Table 3 with the exception of:
- Small cell carcinoma/neuroendocrine tumors (NET Tumors) 8041 AND o All subtypes of small cell carcinoma AND
- Sarcoma NOS 8800 (not a carcinoma) AND o All subtypes of sarcoma NOS
NSCLC is usually adenocarcinoma, squamous cell carcinoma, or large-cell carcinoma. See the instructions for coding histology when NSCLC is the diagnosis.
Column 1 contains specific and NOS histology terms.
- Specific histology terms do not have subtypes/variants
- NOS histology terms do have subtypes/variants Column 2 contains synonyms for the specific or NOS term. Synonyms have the same histology code as the specific or NOS term. Column 3 contains subtypes/variants of the NOS histology. Subtypes/variants do not have the same histology code as the NOS term.
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Specific or NOS Histology Term and Code
Synonym of Specific or NOS
Subtype/variant of NOS and Code
Adenocarcinoma 8140
Note 1: Mucinous adenocarcinoma for lung only is coded as follows:
- 8253/3* when ο Behavior unknown/not documented (use staging form to determine behavior when available) ο Invasive
- 8257/3* when ο Microinvasive ο Minimally invasive
- 8253/2* when ο Preinvasive ο In situ
Note 2: Non-mucinous adenocarcinoma for lung only is coded as follows:
- 8256/3* when ο Microinvasive ο Minimally invasive
- 8250/2* when ο Preinvasive ο In situ
Adenocarcinoma NOS Adenocarcinoma in situ 8140/ Adenocarcinoma invasive 8140/ Adenocarcinoma, non- mucinous, NOS Minimally invasive adenocarcinoma 8140/
Acinar adenocarcinoma/adenocarcinoma, acinar predominant (for lung only) 8551* Adenoid cystic/adenocystic carcinoma 8200 Colloid adenocarcinoma 8480 Enteric adenocarcinoma/pulmonary intestinal-type adenocarcinoma 8144 Fetal adenocarcinoma 8333 Lepidic adenocarcinoma/adenocarcinoma, lepidic predominant 8250/3* Mucinous carcinoma/adenocarcinoma (for lung only) in situ 8253/2;* invasive 8253/3* minimally invasive 8257/3* microinvasive 8257/3* preinvasive 8253/2* Micropapillary adenocarcinoma/adenocarcinoma, micropapillary predominant 8265 Mixed invasive mucinous and non-mucinous adenocarcinoma 8254* Non-mucinous adenocarcinoma (for lung only) in situ 8250/2 * microinvasive 8256/3 * minimally invasive 8256/3* preinvasive 8250/2* Papillary adenocarcinoma/adenocarcinoma, papillary predominant 8260 Solid adenocarcinoma/adenocarcinoma, solid predominant 8230 Adenosquamous carcinoma 8560
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Specific or NOS Histology Term and Code
Synonym of Specific or NOS
Subtype/variant of NOS and Code
Large cell carcinoma 8012
Note 1: A diagnosis of large cell carcinoma is usually followed by further diagnostic testing to identify the subtype/variant. Note 2: The diagnosis of large cell carcinoma usually happens when there is a small amount of tissue (FNA), cytology, or when the tumor is highly differentiated. Large cell carcinoma lacks the features of small cell carcinoma, adenocarcinoma, or squamous carcinoma. Note 3: Large cell carcinoma with neuroendocrine (NE) differentiation lacks NE morphology and is coded as large cell carcinoma, not large cell neuroendocrine carcinoma.
Large cell anaplastic carcinoma Large cell carcinoma NOS Large cell carcinoma with no additional stains (subtype/variant – no ICD-O code) Large cell carcinoma with null immunohistochemical features (subtype/variant
- no ICD-O code) Large cell carcinoma with unclear immunohistochemical features (subtype/variant
- no ICD-O code) Large cell undifferentiated carcinoma Large cell neuroendocrine carcinoma 8013 Note: Per WHO, both large cell neuroendocrine carcinoma, NOS and combined large cell neuroendocrine carcinoma are coded 8013. See Table 2 for histologies included in combined large cell neuroendocrine carcinoma
Combined large cell neuroendocrine carcinoma
Lymphoepithelioma-like carcinoma 8082 Melanoma 8720
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Specific or NOS Histology Term and Code
Synonym of Specific or NOS
Subtype/variant of NOS and Code
Mucoepidermoid carcinoma 8430
Note: Mucoepidermoid tumor is listed as a synonym of mucoepidermoid carcinoma in WHO
Mucoepidermoid tumor
Myoepithelial carcinoma 8982 NUT carcinoma 8023/3 NUT: nuclear protein in tests NUT/M1 gene rearrangement*
Aggressive t(15:19) positive carcinoma BET-rearranged carcinoma Carcinoma with t(15:19) translocation Midline carcinoma of children and young adults with NUT rearrangement Midline lethal carcinoma NUT midline carcinoma PEComa malignant 8714/
Note: Tumor displays perivascular epithelioid (PEC) differentiation
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Specific or NOS Histology Term and Code
Synonym of Specific or NOS
Subtype/variant of NOS and Code
Squamous cell carcinoma 8070 Epidermoid carcinoma Epidermoid carcinoma NOS Squamous carcinoma Squamous cell carcinoma NOS Squamous cell epithelioma Squamous cell carcinoma in situ 8070/
Basaloid carcinoma/basaloid squamous cell carcinoma 8083 Keratinizing squamous cell carcinoma 8071 Non-keratinizing carcinoma 8072
*New codes/terms approved by IARC/WHO Committee for ICD-O.
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Illustrations
Used with permission
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