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The MP/H Equivalent Terms and Definitions for Colon indicate that type, subtype, predominantly, with features of, major, or with ___ differentiation are all equivalent in terms of coding histology. However, this is not indicated in the General Instructions (e.g., Histologic Type ICD-O-3 or General Instructions Histology Coding Rules). It also is not included as a Note under the Rules where one would expect to use these terms, for example, Rule H7. Is this an oversight or error in the Manual?

In this case, Rule H7 seems to be the first (and most appropriate) rule that applies to this mixed histology tumor. However, the specific histology terms that an invasive tumor may be identified as, are only listed under Rule H13. Can these same terms be used when applying rules for which they are not specifically noted? It would seem logical to use the equivalent histology terms to code a mixed histology tumor identified as a subtype or with features, etc., despite the fact that the specific terms are not listed under Rule H7.

This diagnosis is not listed in the ICD-O-3 though it is listed as code 9509/1 for this specific tumor in the 2007 WHO classification of Tumours of Central Nervous System. (See link:  http://link.springer.com/article/10.1007/s00401-007-0243-4/fulltext.html.)

Under the hematopoietic data base, treatment for polycythemia vera shows chemotherapy, immunotherapy, and phlebotomy. Essential thrombocytopenia shows blood thinners, anti-clotting medications, aspirin, chemotherapy, immunotherapy, and other therapy (Anagrelide) (for essential thrombocythemia only) and watchful waiting (for asymptomatic patients). Myelodysplastic syndrome shows bone marrow transplant, chemotherapy, immunotherapy, and stem cell transplant.

SEER*RX under warfarin says: Per the 2012 Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual (page 10), blood thinners and/or anti-clotting agents are to be coded as treatment (Other Therapy) for the following histologies: 9740/4 Mast cell sarcoma 9741/3 Systemic mastocytosis 9742/3 Mast cell leukemia 9875/3 Chronic myelogenous leukemia BCR/ABL 1 positive 9950/3 Polycythemia vera 9961/3 Primary myelofibrosis 9962/3 Essential thrombocythemia 9963/3 Chronic neutrophilic leukemia 9975/3 Myelodysplastic/myeloproliferative neoplasm, unclassifiable.

Patient has a perihilar bile duct primary with a microscopic focus of invasive moderately differentiated adenocarcinoma arising in a large papilloma. The MP/H Rules do not address adenocarcinomas arising in a papilloma, only adenocarcinomas arising in an adenoma (or polyp). Should the histology be coded as 8140 for the invasive adenocarcinoma component? Or should the matrix principle be applied and the histology coded as a malignant glandular papilloma (8260/3)?

The pathologist completed a CAP protocol using soft tissue. Pathology revealed a 2.5 cm tumor with invasion of skeletal muscle with deep margins positive for tumor.

8/1/15 CT Exam showed enlarged prostate and left seminal vesicle with multiple enlarged pelvic LNs. Findings: suspicious for prostate cancer with invasion of seminal vesicle. Bone scan findings: positive bone mets in multiple sites. PSA 169.0 (elevated). Patient was started on casodex 8/12/15. A prostate biopsy was performed on 9/16/15 to confirm diagnosis, adenocarcinoma Gleason 4+5. Patient's treatment continued with radiation to bone.