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Question: 20120083 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 accessioned if a patient is diagnosed with follicular lymphoma, grade 3 in 2006 and is subsequently diagnosed with follicular lymphoma, grade 2 in 2011?



Discussion
In June 2006 the patient was diagnosed with follicular lymphoma, grade 3 by cervical lymph node biopsy and bone marrow biopsy. The patient refused treatment but was followed. In May 2007, the patient had another cervical LN biopsy with a diagnosis of follicular lymphoma, grade 2. In July, 2009, a neck mass excision was diagnosed as follicular lymphoma, grade 3. In June 2011 another neck lymph node was excised and diagnosed as follicular lymphoma, grade 2. According to the MP calculator, FL grade 3 [9698/3] is a separate primary from FL grade 2 [9691/3]. Is the June 2011 diagnosis of FL grade 2 a new primary?



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 a single primary, follicular lymphoma, grade 3 [9698/3] diagnosed in 2006. The 2011 diagnosis of follicular lymphoma, grade 2 [9691/3] is not a new primary. The steps used to arrive at this decision are:

Step 1: Enter follicular lymphoma, grade 3 in the Heme DB. Click on the SEARCH button. "Follicular lymphoma, grade 3” [9698/3] appears on the screen below the NAME column.

Step 2: Scroll down to the SAME primaries section. Follicular lymphoma, grade 2 is listed as a same primary.

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 M15. Use the Hematopoietic calculator to determine the number of primaries in this case because Rules M1-M14 do not apply.

Step 4: Click on the SHOW MULTIPLE PRIMARIES CALCULATOR button. Once the MP Calculator is displayed, Enter 9698/3 [FL, grade 3] in Histology Code 1 and Enter 9691/3 [FL, grade 2] in Histology Code 2. Click on the CALCULATE button. The MP Calculator will indicate these are the same primary.



History
For cases diagnosed 2010-2011, access the Hematopoietic Database at

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

Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. For 2010-2011 diagnoses, click on the "use the 2010 database" label in the upper right corner of the screen. The 2010 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 a single primary, follicular lymphoma, grade 3 [9698/3] diagnosed in 2006. The 2011 diagnosis of follicular lymphoma, grade 2 [9691/3] is not a new primary. The steps used to arrive at this decision are:

Step 1: Enter follicular lymphoma, grade 2 in the Heme DB. Click on the SEARCH button. Ensure that the term, “follicular lymphoma, grade 2” [9691/3] is highlighted on the screen.

Step 2: Scroll down to the TRANSFORMATIONS section. Follicular lymphoma, grade 2 does not transform to follicular lymphoma, grade 3. Therefore, this is not a case of transformation from a chronic to an acute neoplasm (or acute to chronic neoplasm).

Step 3: Click on the 2010 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, locate one of the three formats (i.e., flowchart, matrix or text) to check the Multiple Primary Rules. The rules are intended to be reviewed in consecutive order from Rule M1 to Rule M13. Stop at the first rule that applies to the case you are processing. Stop at Rule M13. Use the Hematopoietic calculator to determine the number of primaries in this case because Rules M1-M12 do not apply.

Step 4: Click on the SHOW MULTIPLE PRIMARIES CALCULATOR button. Once the MP Calculator is displayed, Enter 9698 [FL, grade 3] in Histology Code 1 and Enter 9691 [FL, grade 2] in Histology Code 2. Click on the CALCULATE button. The MP Calculator will indicate these are the same primary.

NOTE: There had been error in the 2010 MP Calculator that previously reported this combination of histologies as a multiple primary. This was corrected in the latest online version of the Heme DB.



Last Updated
02/25/2014

Date Finalized
12/14/2012