Program Operations Manual System (POMS)
TN 53 (08-22)
COMPASSIONATE ALLOWANCES INFORMATION
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NUT CARCINOMA
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ALTERNATE
NAMES
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NUT Midline Carcinoma; Nuclear Protein Testis Carcinoma
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DESCRIPTION
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NUT Carcinoma, formerly known as NUT Midline Carcinoma, is a rare type of cancer that forms in
the respiratory tract and other places along the middle of the body, from the head
to the abdomen. This includes the thymus, the area between the lungs, and the pancreas,
liver, and bladder.
NUT Carcinoma occurs when a piece of chromosome 15 containing the NUT gene breaks
off and attaches to another chromosome. It is usually aggressive (fast-growing) and
cannot be cured. NUT Carcinoma is caused by a fusion of the BRD4, BRD3, NSD3, or other genes. This gene fusion causes the abnormal uncontrolled squamous cell
growth.
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DIAGNOSTIC TESTING, PHYSICAL FINDINGS, AND ICD-9/ICD-10-CM
CODING
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Diagnostic testing: The diagnosis of NUT Carcinoma is made by:
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Immunohistochemistry testing;
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Fluorescence in situ hybridization (FISH);
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Imaging scans such as CT, MRI, and PET;
Physical findings: The physical findings of NUT Carcinoma depend on where the cancer is growing in the
body. Some general symptoms are:
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Unintentional weight loss;
ICD-9: 186.9
ICD-10: C80.9
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PROGRESSION
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NUT Carcinoma is a rare and aggressive tumor that has primarily been reported in children
and young adults. NUT Carcinoma arises from many organs, mainly midline organs such
as the head, neck, and thorax, and usually has widespread metastases at the time of
diagnosis. Most patients have advanced stages of the disease and progress rapidly
to death. The average length of survival is approximately 10 months. The 2-year survival
rate is 30%.
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TREATMENT
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NUT Carcinoma is very resistant to standard chemotherapy treatments. The tumor may
initially respond to therapy, and then rapid recurrence is experienced. A multimodal
approach to treatment is utilized since most patients present with advanced disease.
If the cancer is localized and not yet metastasized, surgical resection may be curative.
Radiation and chemotherapy have limited effectiveness.
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SUGGESTED PROGRAMMATIC
ASSESSMENT*
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Suggested MER for Evaluation:
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Clinical history and examination that describes the diagnostic features of the impairment;
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Imaging reports such as CT scan or MRI scan;
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Pathology/biopsy reports.
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Suggested Listings for
Evaluation:
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DETERMINATION
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LISTING
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REMARKS
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Meets
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Equals
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13.02 D
13.14 B
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* Adjudicators may, at their discretion, use the Medical Evidence of Record or the
listings suggested to evaluate the claim. However, the decision to allow or deny the
claim rests with the adjudicator.
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