SEER Inquiry System - View

Question: 20120058 Status
Final

References
Source 1:   Heme & Lymph Neo Manual & DB
pgs:  
Notes:  
Source 2:  
pgs:  
Notes:  


Question
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be accessioned when the patient is diagnosed with an acute neoplasm (diffuse large B-cell lymphoma) per a pathology report and is subsequently diagnosed clinically with a chronic neoplasm (chronic lymphocytic leukemia/small lymphocytic lymphoma) less than 21 days later?



Discussion
The patient was diagnosed with an extranodal DLBCL on a biopsy of the stomach. A bone marrow biopsy performed 16 days later showed no DLBCL, but demonstrated an abnormal CD5-positive B-cell population that was subsequently referred to as CLL/SLL by the physician. The peripheral blood was negative and showed only moderate thrombocytopenia.

Does rule M10 apply in this case? Abstract the acute neoplasm as a single primary (DLBCL) as there was only one pathology specimen (stomach biopsy) proving DLBCL and the bone marrow did not definitively identify CLL/SLL.



Answer
For cases diagnosed 2010 and forward, access the Hematopoietic Database at Click on Hematopoietic and Lymphoid Database. In the search box, enter your histology or the ICD-O-3 code. Click on the link to that disease. In the "Help me code for dx year" field, enter the year of diagnosis. The Hematopoietic Coding Manual (PDF) button will appear.

This case should be accessioned as two primaries, diffuse large B-cell lymphoma [9680/3] and chronic lymphocytic leukemia/small lymphocytic lymphoma [9823/3]. The steps used to arrive at this decision are:

Step 1: Enter CLL in the Heme DB to find the histology. Click on the SEARCH button. “Chronic lymphocytic leukemia/small lymphocytic lymphoma” [9823/3] appears on the screen under the NAME column.

Step 2: Scroll down to the "TRANSFORMATIONS from" section. CLL/SLL (a chronic disease process) is listed as a disease that "transforms to DLBCL (an acute disease process)." When a cell type is listed under the "transformations from" section for a given malignancy, the disease in the transformation section is considered the chronic process and the disease listed at the top of the screen display is considered the acute process. In this case, the chronic and acute disease processes were diagnosed at the same time (within 21 days).

Step 3: Click on the HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, locate the Multiple Primary rules. The rules are intended to be reviewed in consecutive order from Rule M1-M15. Stop at the first rule that applies to the case you are processing. Stop at Rule M11. Abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach biopsy).

NOTE: The physician used the bone marrow biopsy information to diagnose CLL/SLL.



History
For cases diagnosed 2012 and later, access the Hematopoietic Database at

http://seer.cancer.gov/tools/heme/.

Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. The 2012 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.

This case should be accessioned as two primaries, diffuse large B-cell lymphoma [9680/3] and chronic lymphocytic leukemia/small lymphocytic lymphoma [9823/3]. The steps used to arrive at this decision are:

Step 1: Enter CLL in the Heme DB to find the histology. Click on the SEARCH button. Ensure that the term “chronic lymphocytic leukemia/small lymphocytic lymphoma” [9823/3] is highlighted on the screen.

Step 2: Scroll down to the TRANSFORMATIONS section. CLL/SLL (a chronic disease process) transforms to DLBCL (an acute disease process). When a cell type is listed under the transformations section for a given malignancy, the disease in the transformation section is considered the acute process and the disease listed at the top of the screen display is considered the chronic process. In this case, the chronic and acute disease processes were diagnosed at the same time (within 21 days).

Step 3: Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, go to the Multiple Primary Rules. The rules are intended to be reviewed in consecutive order from Rule M1 to Rule M16. Stop at the first rule that applies to the case you are processing. Stop at Rule M13. Abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach biopsy).

NOTE: The physician used the bone marrow biopsy information to diagnose CLL/SLL.



Last Updated
02/25/2014

Date Finalized
09/11/2012