SEER Inquiry System - View
Source 1: 2010 Heme & Lymph Manual & DB
Multiple primaries--Heme & Lymphoid Neoplasms: Plasmacytoma in the intervertebral disc diagnosed in 2010, had RT to pelvic bones and then in 2011 (more than 21 days) had a right hip biopsy that revealed immature plasma cell myeloma. There is clinical documentation that this is progression into myeloma; however, when I read rules PH6 and PH7 in the database it says to code C421/9732/3 when the clinical diagnosis is multiple myeloma and there is no documentation of bone marrow biopsy or results are unknown. There is a bone marrow biopsy but it states increased plasma cells, cells less than 10%. Skeletal survey and bone scan did not reveal any further lesions.
My question is would this be progression of disease of the plasmacytoma since there is only one lesion in the right hip 8 months later than the original diagnosis of plasmacytoma in the disc OR is this a second primary based on the right hip biopsy saying plasma cell myeloma and the physician documentation of progression? I know plasmacytomas are usually considered single lesions. Would this be considered multiple foci even if at different times?
Code the plasma cell myeloma as a second primary.
Per the Hematopoietic database, plasmacytoma transforms to multiple myeloma. Look at the multiple primary rules M10-M15 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 M12 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.