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SNOMED CT codes for gynaecological

Authors: Brian Rous1 and Naveena Singh2

1Cambridge University Hospitals NHS Trust and 2Barts Health NHS Trusts

Background (summarised from NHS Digital):

• SNOMED CT is a structured clinical vocabulary for use in an electronic health record. It forms an integral part of the electronic care record, and serves to represent care information in a clear, consistent, and comprehensive manner. • The move to a single terminology, SNOMED CT, for the direct management of care of an individual, across all care settings in England, is recommended by the National Information Board (NIB), in “Personalised Health and Care 2020: A Framework for Action”. • SNOMED CT is owned, managed and licensed by SNOMED International. NHS Digital is the UK Member's National Release Centre for the creation of, and delegated authority to licence the SNOMED CT Edition and derivatives. • The benefits of using SNOMED CT in electronic care records are that it: • enables sharing of vital information consistently within and across health and care settings • allows comprehensive coverage and greater depth of details and content for all clinical specialities and professionals • includes diagnosis and procedures, symptoms, family history, allergies, assessment tools, observations, devices • supports clinical decision making • facilitates analysis to support clinical audit and research • reduces risk of misinterpretations of the record in different care settings • Implementation plans for England: • SNOMED CT must be implemented across primary care and deployed to GP practices in a phased approach from April 2018. • Secondary care, acute care, mental health, community systems, dentistry and other systems used in direct patient care must use SNOMED CT as the clinical terminology, before 1 April 2020. This includes pathological disease coding. • The list below provides topography and morphology codes for Tumours of the Female Genital Tract as listed in the WHO blue book (2014). • The purpose of this list is to promote the use of uniform codes within our specialty and avoid duplication of work in searching for these via NHS Digital or TRUD (Technology Reference data Update Distribution), as the system is complex and several codes may be applicable for the same

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 1 version 1.0, dated January 2019

. These may be incorporated within laboratory informations systems/reports at local and individual discretion.

1. Topography codes: Female genital tract (Table 1)

Table 1. Topography codes for tumours of the female genital tract

Topography codes Anatomical SNOMED 2/3 SNOMED CT term SNOMED CT site code T-87000/T- Entire ovary (body 181464007 87000 structure) Fallopian T-86000/ T- Entire fallopian tube 181463001 tube 88000 (body structure) OvaryT- and86920 Fallopian tube and ovary 110642008 Fallopian (combined site) (body tube structure) Peritoneum T-Y4400/ T- Peritoneum (serous 15425007 D4400 membrane) structure (body structure) Broad T-86300/ T- Entire broad ligament 362723009 ligament D6500 (body structure) Round T-86700/ T- Entire round ligment of 245495009 ligament D6507 (body structure) Uterine T-82600/ T- Entire uterine ligament 272668006 ligament D6400 (body structure) Ovarian T-87430/ Entire ovarian ligament 279916003 ligament T_D6501 (body structure) Uterus T-82000 / T- Uterine structure (body 35039007 83000 structure) Uterine T-83000 / T- Cervix uteri structure 71252005 cervix 83200 (body structure) Myometrium T-85000 / T- Myometrial structure 27232003 83600 (body structure) Endometrium T-84000 / T- Endometrial structure 2739003 83400 (body structure) T-80000/T- Entire vulva (body 265796001 81000 structure) Clitoris T-80400/ T- Entire clitoris (body 181442003 81400 structure) Vagina T-81000/ T- Entire vagina (body 181441005 82000 structure) T-88000/ T- Entire placenta (body 181455002 F1100 structure) Product of No specific Entire product of 280706002 conception code (use T- conception (body

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 2 version 1.0, dated January 2019

88000)/ T- structure) F0000

2. Morphology Codes: Tumours of the Ovary (Table 2)

Table 2: Morphology codes for tumours of the ovary

Morphology codes: Ovary WHO 2014 ICD-O SNOMED CT Term SNOMED CT code Category code Epithelial Tumours: Serous Benign serous M-84410 Serous 51608009 cystadenoma Benign serous M-90140 Serous adenofibroma 2026006 adenofibroma Serous surface M-84610 Serous surface 67073007 papilloma Serous borderline M-84421 Serous cystadenoma, 128849004 tumour borderline malignancy Serous adenofibroma 128885004 of borderline malignancy Serous borderline M-84602 Serous borderline 703559005 tumour - tumor, micropapillary micropapillary variant High-grade serous M-84613 High grade serous 703563003 carcinoma Low-grade serous M-84603 Low grade serous 703561001 carcinoma carcinoma Benign mucinous M-84700 Mucinous 67182003 cystadenoma cystadenoma Epithelial Tumours: Mucinous Mucinous M-90150 Mucinous 10705005 adenofibroma adenofibroma Mucinous M-84721 Mucinous cystic tumor 128852007 borderline tumour of borderline malignancy Mucinous 128887007 adenofibroma of borderline malignancy Mucinous M-84803 Mucinous 2495009 carcinoma Epithelial Tumours: Endometrioid Benign M-83800 Endometrioid 71106006 Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 3 version 1.0, dated January 2019

endometrioid cystadenoma Benign M-83810 Endometrioid 20829008 endometrioid adenofibroma adenofibroma Endometrioid M-83801 Endometrioid 75987005 borderline tumour adenoma, borderline malignancy Endometrioid 25874003 adenofibroma, borderline malignancy Endometrioid M-83803 Endometrioid 30289006 carcinoma carcinoma Epithelial Tumours: Clear Cell Clear cell M-84430 Clear cell cystadenoma 128687009 cystadenoma Clear cell M-83130 Clear cell 58161009 adenofibroma adenofibroma Clear cell M-83131 Clear cell cystic tumor 128688004 borderline tumour of borderline malignancy Clear cell 128890001 adenofibroma of borderline malignancy Clear cell M-83103 Clear cell 30546008 carcinoma adenocarcinoma Epithelial Tumours: Brenner Benign Brenner M- Benign Brenner tumor 253051001 tumour 90000 Borderline M-90001 Brenner tumor, 89996007 borderline malignancy Malignant Brenner M-90003 Brenner tumor, 42194009 tumour malignant Epithelial Tumours: Seromucinous Benign M-84740 Seromucinous 703564009 seromucinous cystadenoma cystadenoma Benign M-90140 Seromucinous 703652007 seromucinous adenofibroma adenofibroma Seromucinous M-84741 Seromucinous 703565005 borderline tumour borderline tumor Seromucinous M-84743 Seromucinous 703568007 carcinoma carcinoma Epithelial Tumours: Undifferentiated Undifferentiated M-80203 Undifferentiated 38549000

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 4 version 1.0, dated January 2019

carcinoma carcinoma Mesenchymal tumours Low-grade M-89313 Endometrial stromal 128726006 endometrioid , low grade stromal sarcoma (morphologic abnormality) High-grade M-89303 Endometrial stromal 70555003 endometrioid sarcoma, high grade stromal sarcoma (morphologic abnormality) Mixed Epithelial and Mesenchymal Tumours Adenosarcoma M-89333 Adenosarcoma 31470003 M-89803 Carcinosarcoma 623264007 Sex cord-stromal tumours Pure stromal tumours M-88100 Fibroma, no 112682009 International Classification of Diseases for subtype (morphologic abnormality) Cellular fibroma M-88101 Cellular fibroma 128882001 (morphologic abnormality) M-86000 Thecoma, no 52490000 International Classification of Diseases for Oncology subtype (morphologic abnormality) Luteinized Thecoma, luteinized thecoma M-86010 (morphologic 54482004 associated abnormality) with sclerosing peritonitis M-88103 Fibrosarcoma 53654007 (morphologic abnormality) Sclerosing stromal M-86020 Sclerosing stromal 64512009 tumour tumor (morphologic abnormality) Signetring stromal M-85900 Signet-ring stromal 703598000 tumour tumor (morphologic abnormality) Microcystic M-85900 Microcystic stromal 703599008 stromal tumour tumor (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 5 version 1.0, dated January 2019

Leydig cell tumour M-86500 Leydig cell tumor, 5014008 benign (morphologic abnormality) Steroid cell M-87600 Compound nevus 49409001 tumour (morphologic abnormality) Steroid cell M-87603 Steroid cell tumor, 128907008 tumour, malignant malignant, (morphologic abnormality) Pure sex cord tumours Adult granulosa M-86203 Granulosa cell tumor, 18861007 cell tumour malignant (morphologic abnormality) Juvenile granulosa M-86221 Juvenile granulosa cell 77029009 cell tumour tumor (morphologic abnormality) M-86401 Sertoli cell tumor, no 128857001 International Classification of Diseases for Oncology subtype (morphologic abnormality) Sex cord tumour M-86231 Sex cord tumor with 72457004 with annular annular tubules tubules (morphologic abnormality) Mixed sex cord-stromal tumours Sertoli-Leydig cell tumours Well differentiated M-86310 Sertoli-Leydig cell 34110004 tumor, well differentiated (morphologic abnormality) Moderately M-86311 Sertoli-Leydig cell 128905000 differentiated tumor of intermediate differentiation (morphologic abnormality) With heterologous M-86341 Sertoli-Leydig cell 128725005 elements tumor, intermediate differentiation, with heterologous elements (morphologic abnormality) Poorly M-86313 Sertoli-Leydig cell 128906004 Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 6 version 1.0, dated January 2019

differentiated tumor, poorly differentiated (morphologic abnormality) With heterologous M-86343 Sertoli-Leydig cell 128727002 elements tumor, poorly differentiated, with heterologous elements (morphologic abnormality) Retiform M-86331 Sertoli-Leydig cell 128724009 tumor, retiform (morphologic abnormality) With heterologous M-86341 Sertoli-Leydig cell 128725005 elements tumor, intermediate differentiation, with heterologous elements (morphologic abnormality) Sex cord-stromal M-85901 Sex cord-stromal 71440001 tumours, NOS tumor, no International Classification of Diseases for Oncology subtype (morphologic abnormality) Germ cell tumours M-90603 Dysgerminoma 60718004 (morphologic abnormality) Yolk sac tumour M-90713 Endodermal sinus 74409009 tumor (morphologic abnormality) Embryonal M-90703 28047004 carcinoma (morphologic abnormality) Nongestational M-91003 , no 44769000 choriocarcinoma International Classification of Diseases for Oncology subtype (morphologic abnormality) Mature M-90800 Teratoma, benign 42717009 (morphologic abnormality) Immature M-90803 Teratoma, malignant, 19467007

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 7 version 1.0, dated January 2019

teratoma no International Classification of Diseases for Oncology subtype (morphologic abnormality) Mixed germ cell M-90853 Mixed 32844007 tumour (morphologic abnormality) Monodermal teratoma and somatic-type tumours arising from a dermoid , M-90900 Struma ovarii 24327009 benign (morphologic abnormality) Struma ovarii, M-90903 Struma ovarii, 18854008 malignant malignant (morphologic abnormality) M-82403 Carcinoid tumor no 81622000 International Classification of Diseases for Oncology subtype (morphologic abnormality) Strumal carcinoid M-90911 Strumal carcinoid 32071008 (morphologic abnormality) Mucinous M-82433 Goblet cell carcinoid 31396002 carcinoid (morphologic abnormality) Neuroectodermal type tumours Sebaceous tumours Sebaceous M-84100 78424008 adenoma (morphologic abnormality) Sebaceous M-84103 Sebaceous 54734006 carcinoma adenocarcinoma (morphologic abnormality) Squamous cell M-80703 Squamous cell 28899001 carcinoma carcinoma, no International Classification of Diseases for Oncology subtype (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 8 version 1.0, dated January 2019

Germ cell - sex cord-stromal tumours Gonadoblastoma including M-90731 Gonadoblastoma 74751003 gonadoblastoma (morphologic with malignant abnormality) germ cell tumour Mixed germ cell- M-85941 Mixed germ cell-sex 406096006 sex cordstromal cord-stromal tumor tumour, (morphologic unclassified abnormality) Miscellaneous tumours Tumours of rete ovarii Wolffian tumour M-91101 Mesonephric tumor (morphologic 13071008 abnormality) Small cell M-80443 Small cell carcinoma, intermediate 5958006 carcinoma, cell (morphologic abnormality) hypercalcaemic type Small cell M-80413 Small cell carcinoma (morphologic 74364000 carcinoma, abnormality) pulmonary type Wilms tumour M-89603 Nephroblastoma (morphologic 25081006 abnormality) Paraganglioma M-86931 Extra-adrenal paraganglioma 51747000 (morphologic abnormality) Solid M-84521 Papillary cystic tumor 27078002 pseudopapillary (morphologic abnormality) neoplasm Mesothelial tumours Adenomatoid M-90540 2348006 tumour (morphologic abnormality) M-90503 Mesothelioma, 62064005 malignant (morphologic abnormality) tumours M-88400 Myxoma (morphologic 39143003 abnormality) Others Plasmacytoma M-97343 Plasmacytoma, 128921005 extramedullary (not occurring in bone) (morphologic abnormality) Adenoma of rete M-91100 Mesonephroma, 72889001 ovarii benign (morphologic Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 9 version 1.0, dated January 2019

abnormality) Adenocarcinoma M-91103 Mesonephroma, 2221008 of rete ovarii malignant (morphologic abnormality)

3. Morphology Codes: Tumours of the Peritoneum (Table 3)

Table 3: Morphology codes for tumours of the peritoneum

Morphology codes: Peritoneum WHO 2014 ICD-O SNOMED CT Term SNOMED Category code CT code Mesothelial tumours Well-differentiated M-90520 Epithelioid 84919003 papillary mesothelioma, benign mesothelioma (morphologic abnormality) Malignant M-90503 Mesothelioma, 62064005 mesothelioma malignant (morphologic abnormality) Epithelial tumours of Müllerian type Serous borderline M-84421 Serous cystadenoma, 128849004 tumour/Atypical borderline malignancy proliferative serous (morphologic tumour abnormality) Low-grade serous M-84603 Papillary serous 90282004 carcinoma (morphologic abnormality) High-grade serous M-84613 Serous surface papillary 15674004 carcinoma carcinoma (morphologic abnormality) Others tumours Leiomyomatosis M-88901 Leiomyomatosis, no 75210008 peritonealis International disseminata Classification of Diseases for Oncology subtype (morphologic abnormality) Tumours of uncertain origin Desmoplastic small M-88063 Desmoplastic small 128735004 round cell tumour round cell tumor

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 10 version 1.0, dated January 2019

(morphologic abnormality) Miscellaneous primary tumours Solitary fibrous M-88151 128736003 tumour (morphologic abnormality) Solitary fibrous M-88153 Solitary fibrous tumor, 128737007 tumour, malignant, malignant (morphologic abnormality) Pelvic M-88221 Abdominal fibromatosis 45187003 (morphologic abnormality) Inflammatory M-88251 Myofibroblastic tumor 116064009 myofibroblastic (morphologic tumour abnormality) Calcifying fibrous M-88170 Calcifying fibrous tumor 703613000 tumour (morphologic abnormality) Extra- M-89363 Gastrointestinal stromal 128756002 gastrointestinal sarcoma (morphologic stromal tumour abnormality) Endometrioid stromal tumours Low-grade M-89313 Endometrial stromal 128726006 endometrioid sarcoma, low grade stromal sarcoma (morphologic abnormality) High-grade M-89303 Endometrial stromal 70555003 endometrioid sarcoma, high grade stromal sarcoma (morphologic abnormality) Tumour-like lesions Peritoneal M-90550 Multicystic 128901009 inclusion mesothelioma, benign (morphologic abnormality)

4. Morphology Codes: Tumours of the Fallopian tube (Table 4)

Table 4: Morphology codes for tumours of the fallopian tube

Morphology codes: Fallopian Tube WHO 2014 Category ICD-O SNOMED CT Term SNOMED code CT code

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 11 version 1.0, dated January 2019

Benign epithelial tumours Papilloma Serous M-90140 Serous adenofibroma 2026006 adenofibroma (morphologic abnormality) Epithelial precursor lesion Serous tubal M-84412 Serous intraepithelial 703558002 intraepithelial carcinoma (morphologic carcinoma abnormality) Epithelial borderline tumour Serous borderline M-84421 Serous cystadenoma, 128849004 tumour / Atypical borderline malignancy proliferative serous (morphologic tumour abnormality) Malignant epithelial tumours Low-grade serous M- Papillary serous 90282004 carcinoma 84603 cystadenocarcinoma (morphologic abnormality) High-grade serous M-84613 Serous surface papillary 15674004 carcinoma carcinoma (morphologic abnormality) Endometrioid M- Endometrioid 30289006 carcinoma 83803 carcinoma (morphologic abnormality) Undifferentiated M- Carcinoma, 38549000 carcinoma 80203 undifferentiated (morphologic abnormality) Mucinous M- Mucinous 72495009 carcinoma 84803 adenocarcinoma (morphologic abnormality) Transitional cell M-81203 Transitional cell 27090000 carcinoma carcinoma (morphologic abnormality) Clear cell carcinoma M-81303 Papillary transitional 12400006 cell carcinoma (morphologic abnormality) Mixed epithelial-mesenchymal tumours Adenosarcoma M-89333 Adenosarcoma 31470003 (morphologic abnormality) Carcinosarcoma M- Carcinosarcoma 63264007 89803 (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 12 version 1.0, dated January 2019

Mesenchymal tumours M- Leiomyoma, no 44598004 88900 International Classification of Diseases for Oncology subtype (morphologic abnormality) M- Leiomyosarcoma, no 51549004 88903 subtype (morphologic abnormality) Others Mesothelial tumours Adenomatoid M-90540 Adenomatoid tumor 2348006 tumour (morphologic abnormality) Germ cell tumours Mature teratoma M- Teratoma, benign 42717009 90800 (morphologic abnormality) Immature teratoma M- Teratoma, malignant, no 19467007 90803 International Classification of Diseases for Oncology subtype (morphologic abnormality)

5. Morphology Codes: Tumours of the Broad Ligament and Other Uterine Ligaments (Table 5)

Table 5: Morphology codes for tumours of the broad ligament and other uterine ligaments

Morphology codes: Broad Ligament and Other Uterine Ligaments

ICD-O code ICD-O ICD-O code ICD-O code code Epithelial tumours of Müllerian type Serous cystadenoma M-84400 Cystadenoma (morphologic 47620003 abnormality) Serous M-90130 Adenofibroma, no 2962009 cystadenofibroma / International Classification of adenofibroma Diseases for Oncology subtype (morphologic abnormality) Serous borderline M-84421 Serous cystadenoma, 128849004 tumour / Atypical borderline malignancy proliferative serous (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 13 version 1.0, dated January 2019

tumour

Low-grade serous M-84603 Papillary serous 90282004 carcinoma cystadenocarcinoma (morphologic abnormality) High-grade serous M-84613 Serous surface papillary 15674004 carcinoma carcinoma (morphologic abnormality) Endometrioid M-83803 Endometrioid carcinoma 30289006 carcinoma (morphologic abnormality) Mucinous carcinoma M-84803 Mucinous adenocarcinoma 72495009 (morphologic abnormality) Clear cell carcinoma M-83103 Clear cell adenocarcinoma 30546008 (morphologic abnormality) Mesenchymal and mixed tumours Leiomyoma M-88900 Leiomyoma, no International 44598004 Classification of Diseases for Oncology subtype (morphologic abnormality) M-89320 Adenomyoma (morphologic 40293003 abnormality) Adenosarcoma M-89333 Adenosarcoma (morphologic 31470003 abnormality) Leiomyosarcoma M-88903 Leiomyosarcoma, no subtype 51549004 (morphologic abnormality) Miscellaneous tumours Wolffian tumour M-91101 Mesonephric tumor 13071008 (morphologic abnormality) Papillary cystadenoma (with M-84500 Papillary cystadenoma 32140001 von Hippel (morphologic abnormality) Lindau disease) Ependymoma M-93913 Ependymoma, no 57706008 International Classification of Diseases for Oncology subtype (morphologic abnormality)

6. Morphology Codes: Tumours of the Uterine Corpus (Table 6)

Table 6: Morphology codes for tumours of the uterine corpus

Morphology codes: Uterine Corpus

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 14 version 1.0, dated January 2019

ICD-O code ICD-O ICD-O code ICD-O code code Epithelial tumours and precursors

Atypical hyperplasia / M-83802 Endometrioid 703548001 Endometrioid intraepithelial neoplasia intraepithelial (morphologic abnormality) neoplasia Endometrioid M-83803 Endometrioid carcinoma 30289006 carcinoma (morphologic abnormality) Endometrioid M-85703 Adenocarcinoma with 15176003 carcinoma with squamous metaplasia squamous (morphologic abnormality) differentiation Endometrioid M-82633 Adenocarcinoma in 5658009 carcinoma, tubulovillous adenoma villoglandular variant (morphologic abnormality) Endometrioid M-83823 Endometrioid 128680006 carcinoma, secretory adenocarcinoma, secretory variant variant (morphologic abnormality) Mucinous carcinoma M-84803 Mucinous adenocarcinoma 72495009 (morphologic abnormality) Serous endometrial M-84412 Serous intraepithelial 703558002 intraepithelial carcinoma (morphologic carcinoma abnormality) Serous carcinoma M-84413 Serous 90725004 cystadenocarcinoma (morphologic abnormality) Clear cell carcinoma M-83103 Clear cell adenocarcinoma 30546008 (morphologic abnormality) Low-grade Carcinoid tumor no neuroendocrine M-82403 International Classification 81622000 tumour of Diseases for Oncology Carcinoid tumour subtype (morphologic abnormality) High-grade M-80413 Small cell carcinoma 74364000 neuroendocrine (morphologic abnormality) carcinoma - Small cell neuroendocrine carcinoma High-grade M-80133 Large cell neuroendocrine 128628002 neuroendocrine carcinoma (morphologic carcinoma - Large abnormality) cell neuroendocrine carcinoma

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 15 version 1.0, dated January 2019

Mixed cell M-83233 Mixed cell adenocarcinoma 38958001 adenocarcinoma (morphologic abnormality) Undifferentiated M-80203 Carcinoma, 38549000 carcinoma undifferentiated (morphologic abnormality) Dedifferentiated carcinoma Code as per differentiated component

Mesenchymal tumours Leiomyoma M-88900 Leiomyoma, no 44598004 International Classification of Diseases for Oncology subtype (morphologic abnormality) Cellular leiomyoma M-88920 Cellular leiomyoma 90955001 (morphologic abnormality) Leiomyoma with M-88930 Bizarre leiomyoma 48897006 bizarre nuclei (morphologic abnormality) Mitotically active M-88900 Leiomyoma, no 44598004 leiomyoma International Classification of Diseases for Oncology subtype (morphologic abnormality) Hydropic leiomyoma M-88900 Leiomyoma, no 44598004 International Classification of Diseases for Oncology subtype (morphologic abnormality) Apoplectic leiomyoma M-88900 Leiomyoma, no 44598004 International Classification of Diseases for Oncology subtype (morphologic abnormality) Lipomatous M-88900 Leiomyoma, no 44598004 leiomyoma International Classification (lipoleiomyoma) of Diseases for Oncology subtype (morphologic abnormality) Epithelioid M-88910 Epithelioid leiomyoma 19071004 leiomyoma (morphologic abnormality) Myxoid leiomyoma M-88960 Myxoid leiomyoma 703635008 (morphologic abnormality) Dissecting M-88900 Leiomyoma, no 44598004 (cotyledonoid) International Classification leiomyoma of Diseases for Oncology subtype (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 16 version 1.0, dated January 2019

Diffuse M-88901 Leiomyomatosis, no 75210008 leiomyomatosis International Classification of Diseases for Oncology subtype (morphologic abnormality) Intravenous M-88901 Leiomyomatosis, no 75210008 leiomyomatosis International Classification of Diseases for Oncology subtype (morphologic abnormality) Metastasizing M-88981 Metastasizing leiomyoma 128747005 leiomyoma (morphologic abnormality) Smooth muscle tumour of uncertain M-88971 Smooth muscle tumor 75109009 malignant (morphologic abnormality) potential Leiomyosarcoma M-88903 Leiomyosarcoma, no 51549004 subtype (morphologic abnormality) Epithelioid M-88913 Epithelioid 42392001 leiomyosarcoma leiomyosarcoma (morphologic abnormality) Myxoid M-88963 Myxoid leiomyosarcoma 16090008 leiomyosarcoma (morphologic abnormality) Endometrial stromal and related tumours Endometrial stromal M-89300 Endometrial stromal 70971005 nodule (morphologic abnormality) Low-grade M-89313 Endometrial stromal 128726006 endometrial stromal sarcoma, low grade sarcoma (morphologic abnormality) High-grade M-89303 Endometrial stromal 70555003 endometrial stromal sarcoma, high grade sarcoma (morphologic abnormality) Undifferentiated M-88053 Undifferentiated sarcoma 128734000 (morphologic abnormality) Uterine tumour M-85901 Sex cord-stromal tumor, no 71440001 resembling ovarian International Classification sex cord tumour of Diseases for Oncology subtype (morphologic abnormality) Miscellaneous mesenchymal tumours M-89003 Rhabdomyosarcoma, no 30924005 subtype (morphologic abnormality)

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 17 version 1.0, dated January 2019

Perivascular M-87140 Perivascular epithelioid 703604002 epithelioid cell tumor, benign tumour, Benign (morphologic abnormality) Perivascular M-87143 Perivascular epithelioid 703605001 epithelioid cell tumor, malignant tumour , Malignant (morphologic abnormality) Mixed epithelial and mesenchymal tumours Adenomyoma M-89320 Adenomyoma 40293003 (morphologic abnormality) Atypical polypoid M-89320 Adenomyoma 40293003 adenomyoma (morphologic abnormality) Adenofibroma M-90130 Adenofibroma, no 2962009 International Classification of Diseases for Oncology subtype (morphologic abnormality) Adenosarcoma M-89333 Adenosarcoma 31470003 (morphologic abnormality) Carcinosarcoma M-89803 Carcinosarcoma 63264007 (morphologic abnormality) Miscellaneous tumours Adenomatoid tumour M-90540 Adenomatoid tumor 2348006 (morphologic abnormality)

7. Morphology Codes: Gestational Trophoblastic Disease (Table 7)

Table 7: Morphology codes for Gestational Trophoblastic Disease

Morphology codes: Gestational Trophoblastic Disease ICD-O code ICD-O ICD-O code ICD-O code code Neoplasms Choriocarcinoma M-91003 Choriocarcinoma, no 44769000 International Classification of Diseases for Oncology subtype (morphologic abnormality) Placental site M-91041 Placental site trophoblastic 75320001 trophoblastic tumour tumor (morphologic abnormality) Epithelioid M-91053 Trophoblastic tumor, 128767001 trophoblastic tumour epithelioid (morphologic abnormality) Molar pregnancies

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 18 version 1.0, dated January 2019

Hydatidiform mole, M-91000 Hydatidiform mole, no 48430004 NOS International Classification of Diseases for Oncology subtype (morphologic abnormality) Complete mole M-91000 Hydatidiform mole, no 48430004 International Classification of Diseases for Oncology subtype (morphologic abnormality) Partial mole M-91030 Partial hydatidiform mole 51793002 (morphologic abnormality) Invasive mole M-91001 Invasive hydatidiform mole 18799007 (morphologic abnormality)

8. Morphology Codes: Tumours of the Uterine Cervix (Table 8)

Table 8: Morphology codes for Tumours of the uterine cervix

Morphology codes: Uterine Cervix ICD-O code ICD-O ICD-O code ICD-O code code Epithelial tumours Squamous cell tumours and precursors Low-grade squamous M-80770 Squamous intraepithelial 450595003 intraepithelial lesion neoplasia, low grade (morphologic abnormality) High-grade squamous M-80772 Squamous intraepithelial 20365006 intraepithelial lesion neoplasia, grade III (morphologic abnormality) Squamous cell M-80703 , 28899001 carcinoma, NOS, no International Classification of Diseases for Oncology subtype (morphologic abnormality) SCC, Keratinizing M-80713 Squamous cell carcinoma, 18048008 keratinizing (morphologic abnormality) SCC, Nonkeratinizing M-80723 Squamous cell carcinoma, 45490001 large cell, nonkeratinizing (morphologic abnormality) SCC, Papillary M-80523 Papillary squamous cell 39056008 carcinoma (morphologic abnormality)

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 19 version 1.0, dated January 2019

SCC, Basaloid M-80833 Basaloid squamous cell 128634009 carcinoma (morphologic abnormality) SCC, Warty M-80543 Warty (condylomatous) 399408005 carcinoma (morphologic abnormality) SCC, Verrucous M-80513 89906000 (morphologic abnormality) SCC, M-81203 Transitional cell carcinoma 27090000 Squamotransitional (morphologic abnormality) SCC, M-80823 Lymphoepithelial 7300000 - carcinoma (morphologic like abnormality) Squamous papilloma M-80520 Squamous cell papilloma 63451008 (morphologic abnormality) Glandular tumours and precursors Adenocarcinoma in M-81402 Adenocarcinoma in situ 51642000 situ (morphologic abnormality) Adenocarcinoma, M-81403 Adenocarcinoma, no 35917007 NOS subtype (morphologic abnormality) Endocervical M-81403 Adenocarcinoma, no 35917007 adenocarcinoma, subtype (morphologic usual type abnormality) Mucinous carcinoma, M-84803 Mucinous adenocarcinoma 72495009 NOS, (morphologic abnormality) Mucinous carcinoma, M-84823 Mucinous adenocarcinoma, 128695008 Gastric type endocervical type (morphologic abnormality) Mucinous carcinoma, M-81443 Adenocarcinoma, intestinal 25190001 Intestinal type type (morphologic abnormality) Mucinous carcinoma, M-84903 Signet ring cell carcinoma 87737001 Signet ring cell type (morphologic abnormality) Villoglandular M-82633 Adenocarcinoma in 5658009 carcinoma tubulovillous adenoma (morphologic abnormality) Endometrioid M-83803 Endometrioid carcinoma 30289006 carcinoma (morphologic abnormality) Clear cell carcinoma M-83103 Clear cell adenocarcinoma 30546008 (morphologic abnormality) Serous carcinoma M-84413 Serous 90725004 cystadenocarcinoma (morphologic abnormality) Mesonephric M-91103 Mesonephroma, malignant 2221008 carcinoma (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 20 version 1.0, dated January 2019

Adenocarcinoma Adenocarcinoma with admixed with M-85743 neuroendocrine 128704005 neuroendocrine differentiation carcinoma (morphologic abnormality) Other epithelial tumours Adenosquamous M-85603 Adenosquamous carcinoma 59367005 carcinoma (morphologic abnormality) Glassy cell carcinoma M-80153 Glassy cell carcinoma 128630000 (morphologic abnormality) Adenoid basal M-80983 Adenoid basal carcinoma 128637002 carcinoma (morphologic abnormality) Adenoid cystic M-82003 11671000 carcinoma (morphologic abnormality) Undifferentiated M-80203 Carcinoma, 38549000 carcinoma undifferentiated (morphologic abnormality) Neuroendocrine tumours Low-grade Carcinoid tumor no neuroendocrine M-82403 International Classification 81622000 tumour of Diseases for Oncology Carcinoid tumour subtype (morphologic abnormality) Atypical carcinoid M-82493 Atypical carcinoid tumor 128658008 tumour (morphologic abnormality) High-grade M-80413 Small cell carcinoma 74364000 neuroendocrine (morphologic abnormality) carcinoma - Small cell neuroendocrine carcinoma High-grade M-80133 Large cell neuroendocrine 128628002 neuroendocrine carcinoma (morphologic carcinoma - Large abnormality) cell neuroendocrine carcinoma Mesenchymal tumours and tumour-like lesions Benign Leiomyoma M-88900 Leiomyoma, no 44598004 International Classification of Diseases for Oncology subtype (morphologic abnormality) M-89050 Genital rhabdomyoma 128748000 (morphologic abnormality) Malignant Leiomyosarcoma M-88903 Leiomyosarcoma, no 51549004 subtype (morphologic Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 21 version 1.0, dated January 2019

abnormality)

Rhabdomyosarcoma M-89103 Embryonal 14269005 rhabdomyosarcoma (morphologic abnormality) Alveolar soft part M-95813 Alveolar soft part sarcoma 88195001 sarcoma (morphologic abnormality) Angiosarcoma M-91203 Hemangiosarcoma 39000009 (morphologic abnormality) Malignant peripheral M-95403 Malignant peripheral nerve 19897006 nerve sheath tumour sheath tumor (morphologic abnormality) M-88503 Liposarcoma, no 49430005 International Classification of Diseases for Oncology subtype (morphologic abnormality) Undifferentiated M-88053 Undifferentiated sarcoma 128734000 endocervical sarcoma (morphologic abnormality) Ewing sarcoma M-93643 Peripheral 73676002 neuroectodermal tumor (morphologic abnormality) Mixed epithelial and mesenchymal tumours Adenomyoma M-89320 Adenomyoma 40293003 (morphologic abnormality) Adenosarcoma M-89333 Adenosarcoma 31470003 (morphologic abnormality) Carcinosarcoma M-89803 Carcinosarcoma 63264007 (morphologic abnormality) Melanocytic tumours Blue naevus M-87800 Blue nevus (morphologic 63166000 abnormality) Malignant M-87203 Malignant melanoma, no 2092003 International Classification of Diseases for Oncology subtype (morphologic abnormality) Germ cell tumour Yolk sac tumour M-90713 Endodermal sinus tumor 74409009 (morphologic abnormality)

9. Morphology Codes: Tumours of the Vagina (Table 9)

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 22 version 1.0, dated January 2019

Table 9: Morphology codes for tumours of the vagina

Morphology codes: Vagina WHO 2014 Category ICD-O SNOMED CT Term SNOMED code CT code Epithelial tumours Low-grade squamous M-80770 Squamous 450595003 intraepithelial lesion intraepithelial neoplasia, low grade (morphologic abnormality) High-grade squamous M-80772 Squamous 20365006 intraepithelial lesion intraepithelial neoplasia, grade III (morphologic abnormality) Squamous cell M-80703 Squamous cell 28899001 carcinoma, NOS, carcinoma, no International Classification of Diseases for Oncology subtype (morphologic abnormality) SCC, Keratinizing M-80713 Squamous cell 18048008 carcinoma, keratinizing (morphologic abnormality) SCC, Nonkeratinizing M-80723 Squamous cell 45490001 carcinoma, large cell, nonkeratinizing (morphologic abnormality) SCC, Papillary M-80523 Papillary squamous cell 39056008 carcinoma (morphologic abnormality) SCC, Basaloid M-80833 Basaloid squamous cell 128634009 carcinoma (morphologic abnormality) SCC, Warty M-80543 Warty (condylomatous) 399408005 carcinoma (morphologic abnormality) SCC, Verrucous M-80513 Verrucous carcinoma 89906000 (morphologic abnormality) Squamous papilloma M-80520 Squamous cell 63451008 papilloma (morphologic Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 23 version 1.0, dated January 2019

abnormality) Tubulosquamous polyp M-85600 Mixed squamous cell 107692003 and glandular papilloma (morphologic abnormality) Endometrioid M-83803 Endometrioid 30289006 carcinoma carcinoma (morphologic abnormality) Clear cell carcinoma M-83103 Clear cell 30546008 adenocarcinoma (morphologic abnormality) Mucinous carcinoma M-84803 Mucinous 72495009 adenocarcinoma (morphologic abnormality) Mesonephric carcinoma M-91103 Mesonephroma, 2221008 malignant (morphologic abnormality) Tubulovillous adenoma M-82630 Tubulovillous adenoma 61722000 (morphologic abnormality) Villous adenoma M-82610 Villous adenoma 128859003 (morphologic abnormality) Mixed tumour M-89400 8360001 (morphologic abnormality) Adenosquamous M-85603 Adenosquamous 59367005 carcinoma carcinoma (morphologic abnormality) Adenoid basal M-80983 Adenoid basal 128637002 carcinoma carcinoma (morphologic abnormality) Small cell M-80413 Small cell carcinoma 74364000 neuroendocrine (morphologic carcinoma abnormality) Large cell M-80133 Large cell 128628002 neuroendocrine neuroendocrine carcinoma carcinoma (morphologic abnormality) Mesenchymal tumours Leiomyoma M-88900 Leiomyoma, no 44598004 International Classification of Diseases for Oncology subtype (morphologic Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 24 version 1.0, dated January 2019

abnormality) Rhabdomyoma M-89050 Genital rhabdomyoma 128748000 (morphologic abnormality) Leiomyosarcoma M-88903 Leiomyosarcoma, no 51549004 subtype (morphologic abnormality) Rhabdomyosarcoma, M-89003 Rhabdomyosarcoma, no 30924005 NOS, subtype (morphologic abnormality) Embryonal M-89103 Embryonal 14269005 rhabdomyosarcoma rhabdomyosarcoma (morphologic abnormality) Undifferentiated M-88053 Undifferentiated 128734000 sarcoma sarcoma (morphologic abnormality) Angiomyofibroblastoma M-88260 Angiomyofibroblastoma 128739005 (morphologic abnormality) Aggressive M-88410 Angiomyxoma 57723004 angiomyxoma (morphologic abnormality) Myofibroblastoma M-88250 Myofibroblastoma 128738002 (morphologic abnormality) Mixed epithelial and mesenchymal tumours Adenosarcoma M-89333 Adenosarcoma 31470003 (morphologic abnormality) Carcinosarcoma M-89803 Carcinosarcoma 63264007 (morphologic abnormality) Melanocytic tumours Melanocytic naevus M-87200 Pigmented nevus, no 21119008 International Classification of Diseases for Oncology subtype (morphologic abnormality) Blue naevus M-87800 Blue nevus 63166000 (morphologic abnormality) Malignant melanoma M-87203 Malignant melanoma, 2092003 no International Classification of Diseases for Oncology Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 25 version 1.0, dated January 2019

subtype (morphologic abnormality) Germ cell tumours Mature teratoma M-90840 Mature cystic teratoma 72277008 (morphologic abnormality) Yolk sac tumour M-90713 Endodermal sinus 74409009 tumor (morphologic abnormality) Others Ewing sarcoma M-93643 Peripheral 73676002 neuroectodermal tumor (morphologic abnormality)

10. Morphology Codes: Tumours of the Vulva (Table)

Table 10: Morphology codes for tumours of the vulva

Morphology codes: Vulva WHO 2014 Category ICD-O SNOMED CT Term SNOMED code CT code Epithelial tumours Squamous cell tumours and precursors Low-grade squamous M-80770 Squamous intraepithelial 450595003 intraepithelial lesion neoplasia, low grade (morphologic abnormality) High-grade squamous M-80772 Squamous intraepithelial 20365006 intraepithelial lesion neoplasia, grade III (morphologic abnormality) Differentiated-type M-80712 Lichen sclerosus- 403475002 vulvar intraepithelial associated vulval neoplasia intraepithelial neoplasia Squamous cell M-80703 Squamous cell carcinoma, 28899001 carcinoma no International Classification of Diseases for Oncology subtype (morphologic abnormality) SCC, Keratinizing M-80713 Squamous cell carcinoma, 18048008 keratinizing (morphologic abnormality)

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 26 version 1.0, dated January 2019

SCC, Nonkeratinizing M-80723 Squamous cell carcinoma, 45490001 large cell, nonkeratinizing (morphologic abnormality) SCC, Basaloid M-80833 Basaloid squamous cell 128634009 carcinoma (morphologic abnormality) SCC, Warty M-80543 Warty (condylomatous) 399408005 carcinoma (morphologic abnormality) SCC, Verrucous M-80513 Verrucous carcinoma 89906000 (morphologic abnormality) Basal cell carcinoma M-80903 Basal cell carcinoma 1338007 (morphologic abnormality) Benign squamous lesions Vestibular papilloma M-80520 Squamous cell papilloma 63451008 (morphologic abnormality) Glandular tumours Paget disease M-85423 Paget's disease, 71447003 extramammary (except Paget's disease of bone) (morphologic abnormality) Tumours arising from Bartholin and other specialized anogenital glands Bartholin gland carcinomas Adenocarcinoma M-81403 Adenocarcinoma, no 35917007 subtype (morphologic abnormality) Squamous cell M-80703 Squamous cell carcinoma, 28899001 carcinoma no International Classification of Diseases for Oncology subtype (morphologic abnormality) Adenosquamous M-85603 Adenosquamous 59367005 carcinoma carcinoma (morphologic abnormality) Adenoid cystic M-82003 Adenoid cystic carcinoma 11671000 carcinoma (morphologic abnormality) Transitional cell M-81203 Transitional cell 27090000 carcinoma carcinoma (morphologic abnormality)

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 27 version 1.0, dated January 2019

Adenocarcinoma of M-85003 Infiltrating duct 82711006 mammary gland type carcinoma (morphologic abnormality) Adenocarcinoma of M-81403 Adenocarcinoma, no 35917007 Skene gland origin subtype (morphologic abnormality) Phyllodes tumour, M-90203 , 87913009 malignant, malignant (morphologic abnormality) of other type Adenocarcinoma of M- Adenocarcinoma, no 35917007 sweat gland type 81403 subtype (morphologic abnormality) Adenocarcinoma of M- Adenocarcinoma, no 35917007 intestinal type 81403 subtype (morphologic abnormality) Benign tumours and cysts Papillary M- 89791006 84050 (morphologic abnormality) Mixed tumour M- Pleomorphic adenoma 8360001 89400 (morphologic abnormality) M- Fibroadenoma, no 65877006 90100 International Classification of Diseases for Oncology subtype (morphologic abnormality) Adenoma M- Adenoma, no subtype 32048006 81400 (morphologic abnormality) Adenomyoma M- Adenomyoma 40293003 89320 (morphologic abnormality) Neuroendocrine tumours High-grade M- Small cell carcinoma 74364000 neuroendocrine 80413 (morphologic carcinoma - Small cell abnormality) neuroendocrine carcinoma High-grade M- Large cell neuroendocrine 128628002 neuroendocrine 80133 carcinoma (morphologic carcinoma - Large cell abnormality) neuroendocrine carcinoma

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 28 version 1.0, dated January 2019

Merkel cell tumour M- Merkel cell carcinoma 5052009 82473 (morphologic abnormality) Neuroectodermal tumour Ewing sarcoma M- Peripheral 73676002 93643 neuroectodermal tumor (morphologic abnormality) Soft tissue tumours Benign tumours M- Lipoma, no International 46720004 88500 Classification of Diseases for Oncology subtype (morphologic abnormality) Superficial M- Angiomyxoma 57723004 angiomyxoma 88410 (morphologic abnormality) Superficial M- Myofibroblastoma 128738002 myofibroblastoma 88250 (morphologic abnormality) Cellular angiofibroma M- Angiofibroma, no 60392001 91600 International Classification of Diseases for Oncology subtype (morphologic abnormality) Angiomyofibroblastoma M- Angiomyofibroblastoma 128739005 88260 (morphologic abnormality) Aggressive M- Angiomyxoma 57723004 angiomyxoma 88410 (morphologic abnormality) Leiomyoma M- Leiomyoma, no 44598004 88900 International Classification of Diseases for Oncology subtype (morphologic abnormality) Granular cell tumour M- Granular cell tumor 12169001 95800 (morphologic abnormality) Malignant tumours Embryonal M- Embryonal 14269005 Rhabdomyosarcoma 89103 rhabdomyosarcoma (morphologic abnormality) Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 29 version 1.0, dated January 2019

Alveolar M- Alveolar 63449009 Rhabdomyosarcoma 89203 rhabdomyosarcoma (morphologic abnormality) Leiomyosarcoma M- Leiomyosarcoma, no 51549004 88903 subtype (morphologic abnormality) Epithelioid sarcoma M- Epithelioid sarcoma 59238007 88043 (morphologic abnormality) Alveolar soft part M- Alveolar soft part sarcoma 88195001 sarcoma 95813 (morphologic abnormality) Liposarcoma M- Liposarcoma, no 49430005 88503 International Classification of Diseases for Oncology subtype (morphologic abnormality) Malignant peripheral M- Malignant peripheral 19897006 nerve sheath tumour 95403 nerve sheath tumor (morphologic abnormality) Kaposi sarcoma M- Kaposi's sarcoma, 49937004 91403 morphology (morphologic abnormality) Fibrosarcoma M- Fibrosarcoma 53654007 88103 (morphologic abnormality) Dermatofibrosarcoma M- Dermatofibrosarcoma 76594008 protuberans 88321 (morphologic abnormality) Melanocytic tumours Congenital melanocytic M- Small congenital nevus 128881008 naevus 87610 (morphologic abnormality) Acquired melanocytic M- Pigmented nevus, no 21119008 naevus 87200 International Classification of Diseases for Oncology subtype (morphologic abnormality) Blue naevus M- Blue nevus (morphologic 63166000 87800 abnormality)

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 30 version 1.0, dated January 2019

Atypical melanocytic M- Pigmented nevus, no 21119008 naevus of genital type 87200 International Classification of Diseases for Oncology subtype (morphologic abnormality) Dysplastic melanocytic M- Dysplastic nevus 61814002 naevus 87270 (morphologic abnormality) Malignant melanoma M- Malignant melanoma, no 2092003 87203 International Classification of Diseases for Oncology subtype (morphologic abnormality) Germ cell tumour Yolk sac tumour M- Endodermal sinus tumor 74409009 90713 (morphologic abnormality)

Reference:

NHS Digital Terminology and classifications: https://digital.nhs.uk/services/terminology-and-classifications/snomed-ct

Guidance document: List of SNOMED CT codes for gynaecological neoplasms, 31 version 1.0, dated January 2019