SEER Inquiry System - View

Question: 20130031 Status
Final

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


Question
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a plasmacytoma of the intervertebral disc is diagnosed in 2010 followed by a diagnosis of immature plasma cell myeloma by a right hip biopsy in 2011? See Discussion.

Discussion
The patient was diagnosed with intervertebral disc plasmacytoma and had radiation therapy to the pelvic bones in 2010. In 2011 (more than 21 days later) a right hip biopsy revealed immature plasma cell myeloma. There is clinical documentation that this is progression into myeloma. Per the Heme DB (Primary Site(s) and Definition sections) and Rule PH30, in the Heme Manual, the primary site is coded to C421 [bone marrow] and the histology is coded 9732/3 [plasma cell myeloma] when there is a clinical diagnosis of multiple myeloma and/or there is no documentation of a bone marrow biopsy or the results are unknown. This patient did have a bone marrow biopsy that indicates there are an increased plasma cells present; plasma cells represent less than 10%. The skeletal survey and bone scan did not reveal any further lesions.

Is this progression of disease because there is only one lesion in the right hip 8 months after the diagnosis of plasmacytoma? Or is this a second primary based on the right hip biopsy that showed plasma cell myeloma and the physician’s documentation of disease progression? Plasmacytomas are usually considered single lesions. Would this disease process be considered to have multiple lesions if they are diagnosed at different times?

Answer
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

This case is accessioned as two primaries: Plasmacytoma diagnosed in 2010 and plasma cell myeloma diagnosed in 2011 per Rule M10. The patient has a diagnosis of a solitary plasmacytoma (chronic neoplasm) followed by a diagnosis of plasma cell myeloma (acute neoplasm) diagnosed greater than 21 days later.

The physician is calling this a progression to plasma cell myeloma even though the bone marrow has less than 10% plasma cells, take this statement as progression or a clinical diagnosis of plasma cell myeloma.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

History
Code the plasma cell myeloma as a second primary.

Per the Hematopoietic database, plasmacytoma transforms to multiple myeloma. Look at the multiple primary rules M8-M13 to determine if this is a multiple primary.

Since the physician is calling this a progression to plasma cell myeloma even though the bone marrow has cells less than 10%, take this statement as progression.

The first diagnosis was a chronic disease (plasmacytoma). The second diagnosis is the acute disease (plasma cell myeloma) and these diagnoses are greater than 21 days apart. Rule M10 states to abstract as multiple primaries when a neoplasm is originally diagnosed as chronic and there is a second diagnosis of an acute neoplasm and there are more than 21 days between diagnoses.



Last Updated
07/01/2014

Date Finalized
07/10/2013