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Question: 20130035 Status

Source 1:   Heme & Lymph Neo Manual & DB
Source 2:  

Multiple primaries--Heme & Lymphoid Neoplasms: Should this be new primary based on the histology since per PH rules it states to code histology in this situation to diffuse large B-cell lymphoma? See discussion.

In 2011, patient presented with large mesenteric mass, numerous other smaller mesenteric lymph nodes, moderate retroperitoneal and extensive iliac chain adenopathy greather on right; small inguinal nodes are also present mostly on right side and splenomegaly per CT scan. Abdominal pelvic mass, needle biopsies: low grade CD-10 positive B-cell lymphoma, most consistent with low grade follicular lymphoma (FL). Pt was treated with R-CVP with unknown response. Then in June 2012, patient presents again for lap and lymph node biopsy for stated recurrence of lymphoma found on CT scan. Large mass seen in mesentery bowel. Abdominal mass biopsy: diffuse large B-cell lymphoma (DLBCL). Abdominal mass #2, excisional biopsy: diffuse large B-cell lymphoma, 95%, and follicular lymphoma grade 3, 5%. The majority of the tumor is now DLBCL.

The DLBCL is a new primary.

For this case, use the Hematopoietic Database since the second diagnosis is in 2012. First, go the database and look up follicular. In the transformations section, DLBCL is listed. This is a case with a chronic neoplasm (FL) and an acute neoplasm (DLBCL). Rules M8-M13 apply to these types of cases.

This scenario fits rule M10: chronic (follicular) followed by an acute (DLBCL) greater than 21 days.


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