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Source 1: Heme & Lymph Manual & DB
Multiple primaries--Heme & Lymphoid Neoplasms: Please refer to question: 20110152
I have a similar case where the patient had an excisional biopsy of a lymph node done 08-18-2011 with a diagnosis of follicular lymphoma grade 2-3A(60%) and 40% of the specimen with Diffuse Large B-Cell Lymphoma (DLBCL). On 08-25-2011 the patient had a bone marrow biopsy to complete his workup. The bone marrow biopsy was consistent with follicular lymphoma only, DLBCL was not seen. The physician has staged the case as DLBCL IVB.
I know that the rules have to be used in order. Nevertheless, why couldn't we use M14 instead of M13, since we know that patient was not treated in between and clearly it seems to have only one primary for the physician?
Stop at the first rule that applies. In this case, M13 applies. A chronic and acute diagnosed within 21 days, with documentation of tissue biopsies confirming both the chronic (follicular) and the acute (DLBCL) -- Abstract two primaries.
Our rules are standardized so that incidence rates are comparable accross the country. The physician is going to treat the DLBCL, which is the more aggressive of the two.