MP/H Rules/Histology--Sarcoma: What would be the morphology code for a low grade myofibroblastic sarcoma of the left distal forearm? I tried several different combinations but the closest I could come up with is myosarcoma.
Assign code 8825/3. Apply the ICD-O-3 Matrix Concept, Rule F, page 29 of the hardcover ICD-O-3. The WHO Classification of Soft tissue and Bone, page 85, lists low grade myofibroblastic sarcoma, also called myofibrosarcoma, 8825/3.
MP/H Rules/Histology--Sarcoma: What is the appropriate histology code for a final diagnosis of undifferentiated pleomorphic sarcoma and/or pleomorphic sarcoma, undifferentiated? See Discussion.
Does the Other Sites MP/H Rule H17 apply in this case, which results in coding the higher histology 8805/3 (undifferentiated sarcoma)? Or does the "undifferentiated" statement only refer to grade, which results in coding histology to 8802/3 (pleomorphic sarcoma)?
Assign 8802/34 to pleomorphic cell sarcoma/undifferentiated pleomorphic sarcoma. Pleomorphic is more important than undifferentiated when choosing the histology code in this case. Undifferentiated can be captured in the grade code.
MP/H Rules/Histology--Rectum: When not specifically mentioned as part of the histology, is the adenoma a second histologic type, or just a further physical description of the tumor? See Discussion.
Rectal tumor resection (APR) path report final dx: "mucinous carcinoma, see comment". The comment is the CAP-format tumor summary, which states "histologic type: adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma). Additional pathologic findings: adenomas - tumor arises in a tubulovillous adenoma".
If you follow the rules and only use the final dx, you would code a different histology than if you use the 'additional path findings.'
For cases diagnosed 2007 or later
Other Sites histology rule H12 applies in this case. Assign histology code 8263 [adenocarcinoma in tubulovillous adenoma].
Use information from the CAP protocol and from comments associated with the final diagnosis to code histology.
The fact that the malignancy arose in a polyp can be taken from anywhere in the medical record; not limited to the final diagnosis.
Based on the information provided for this case, the histology is adenocarcinoma with extensive mucin production (mucinous or colloid carcinoma) arising in a tubulovillous adenoma.
MP/H Rules/Histology--Prostate: What is the histology code for a prostate case whose histology reads “adenoca with mixed ductal and acinar variants?
Assign 8523/3.
The 2013 revision to ICD-O-3 has a new code for mixed acinar ductal carcinoma; however, this new code will not be implemented in the U.S. until 2018 or later. Page 7 of the Guidelines for ICD-O-3 Update Implementation document released by NAACCR 1/1/2014 instructs us to use 8523/3 in the meantime.
MP/H Rules/Histology--Pancreas: What is the histology code of invasive adenocarcinoma, non-mucinous with intraductal tubulopapillary features, moderately differentiated, from the pathology report final diagnosis of the pancreas? Does 'intraductal" refer to a non-invasive/in-situ component or describe the pattern of growth?
Assign 8503/3, intraductal papillary adenocarcinoma with invasion, to capture the more specific features of the adenocarcinoma. Histology Rule H13 for Other Sites states to code the most specific histologic term. Examples include Adenocarcinoma and a more specific adenocarcinoma. Note: The specific histology may be identified as type, subtype, predominantly, with features of, major, or with ___ differentiation.
MP/H Rules/Histology--Melanoma: Please clarify what we should code when we see the term 'spitz or spitzoid' in association with melanomas. See Discussion.
Path reports often diagnose "melanoma with spitzoid features." There is no code for this in ICD-O-3. Would it be melanoma NOS with a specific type for MP/H rule H9 (with features of...), or would we stop at H3? Could the matrix principle apply, changing 8770/0 (one of the synonyms is Spitz nevus) to 8770/3 (although no Spitz synonyms are specifically listed under this code)? What if the path report says "melanoma arising in a Spitz nevus"?
For cases diagnosed 2007 - 2020
Assign code 8720/3 [Malignant melanoma] for melanoma with Spitzoid features, Spitzoid variant of nevoid melanoma, melanoma arising in Spitz nevus, or Spitzoid melanoma. The WHO Classification of Tumors groups these with Nevoid melanomas and codes them to 8720/3.
According to WHO, "Nevoid melanoma is a subtype of malignant melanoma of the skin that is distinctive in that the primary lesion mimics many of the architectural features of a common compound or intradermal nevus ... or a Spitz nevus... These lesions are defined not as atypical nevi, but as melanomas because they involve the dermis and have the potential for metastasis."
MP/H Rules/Histology--Melanoma: How is the histology coded for an invasive melanoma stated to have a "superficial spreading growth pattern"? See Discussion.
Some facilities in our reporting region submit pathology reports that document invasive melanoma cases with a subtype stated to be a "growth pattern." The MP/H rules state that we are not to use the term "pattern" to code the histology of invasive tumors. However, applying this rule means the more specific histology will not be recorded for any of these cases. Can the term "growth pattern" be a more specific histologic type for invasive melanomas when no other information is available?
Code the histology as superficial spreading melanoma [8743/3]. For cases diagnosed 2007-2014, the steps used to arrive at this decision are:
Open the Multiple Primary and Histology Coding Rules manual. For a melanoma primary, use the Melanoma Histology rules to determine the histology code because there are site specific rules for cutaneous melanomas.
Start at Rule H1. The rules are intended to be reviewed in consecutive order within the applicable Module. Code the most specific histologic term when the diagnosis is melanoma, NOS [8720] with a single specific type, superficial spreading in this case. The subtype of this invasive melanoma is "superficial spreading."
A change will be made to Rule 9 in next update to indicate "growth pattern" can be used to describe an invasive histology.
MP/H Rules/Histology--Melanoma: How is histology coded for a "melanoma in situ, lentiginous type," arising in the skin of the lower leg? See Discussion.
In researching this, acral lentiginous melanoma is observed on the palms, soles and under the nails. To code to 8744, do we specifically have to see the word "acral" lentiginous melanoma?
For cases diagnosed 2007 to 2020
Assign 8742/2 [lentigo maligna] to "melanoma in situ, lentiginous type."
Acral lentiginous melanoma is not the same as melanoma, lentiginous type. "Acral lentiginous melanoma," 8744, should be used only if the report states acral lentiginous melanoma or malignant melanoma, acral lentiginous type.
Acral lentiginous melanoma most often occurs on the soles of the feet or the palms of the hands.
MP/H Rules/Histology--Lung: What is the histology of a lung tumor described as solid predominant with mucin production, 8230/3 (Multiple Primaries/Histology (MP/H) Rule 5) or 8255/3 (MP/H Rule 6)? See Discussion.
Pathology report: Left lower lobe lung, Tumor Size: Greatest dimension: 3.0 cm Additional dimensions: 2.5 x 2.0 cm; Tumor Focality: Unifocal; Histologic Type: Invasive adenocarcinoma Solid predominant with mucin production; Histologic Grade: G3: Poorly differentiated. Is the correct histology for this case 8230/3 (rule H5) or 8255/3 (rule H6)?
Code histology as 8230/3, solid adenocarcinoma with mucin formation, using MP/H Rule H3 as one histologic type is identified. All of the histologic terms (solid, mucin production) are covered by 8230/3. Therefore, rule H3 applies. Use the first rule that applies, and stop.
An official website of the United States government
Home