An official website of the United States government
Home
SEER Inquiry System - Report
Produced: 01/17/2026 12:33 AM
Question 20100077
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
Does Rule M5 only apply if both diseases are present at the original diagnosis, or does it also take into account a recurrence of an old disease? The answer to this question makes a difference between stopping at rule M5 and abstracting as one disease, or going on to rule M15 to query the Hematopoietic Database to determine whether the patient has two separate primaries.
Example: Patient had Stage II Hodgkin disease in 2005 (all lymph nodes above diaphragm, supraclavicular LN biopsied at diagnosis), treated and patient achieved complete remission. In 2010, the patient is admitted for suspected recurrence. A supraclavicular lymph node biopsy showed, "Recurrent Hodgkin" AND "EBV+ Diffuse Large B-cell Lymphoma," both in the same lymph node. Applying rule M5, this is a single primary and states not to query the DB. However, this doesn't seem correct as it does not account for the new DLBCL.
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
You must first determine the histology codes for each occurrence of lymphoma. The 2005 diagnosis was stated to be Hodgkin disease (NOS) [9650/3]. The 2010 diagnosis was Hodgkin and EBV + diffuse large B-cell lymphoma (two histologies). Per Rule M5 the 2010 diagnosis is a single primary because the Hodgkin and the non-Hodgkin (DLBCL) were simultaneously present in the same lymph node. Per Rule PH14, a Hodgkin and non-Hodgkin simultaneously present in the same location should be coded to 9596/3 [B-cell lymphoma, unclassifiable].
Ultimately, there is a diagnosis of 9596/3 in 2010 that followed a diagnosis of 9650/3 in 2005. Per Rule M15, use the Multiple Primary Calculator to determine the number of primaries, which indicates the 9596/3 is a new primary.
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. https://educate.fhcrc.org/LandingPage.aspx.
History:
This SINQ question has been updated to the Hematopoietic & Lymphoid Neoplasm Manual & Database published January 2014.
The original answer below was written based on the rules in 2010
You actually have two "diseases" to consider. The first is the 2005 occurrence of Hodgkin only. After a remission, the patient appeared with a different "disease" because there was both Hodgkin and EBV+ DLBCL present. That does not match the original diagnosis.
For cases diagnosed 2010-2011, start by classifying the "new" disease, then compare it to the original. You correctly identified M4 as the multiple primary rule. When this rule says "same primary" it is referring ONLY to the new diagnosis that you are researching. In other words, you would not code Hodgkin and DLBCL in the same node(s) as separate primaries. Next go to the PH rules. The first module that applies to this case is Module 6, PH21 which says to code combinations of Hodgkin and non-Hodgkin in the same node(s) to 9596/3 [composite lymphoma]. Enter 9596/3 in the search mechanism of the 2010 Hematopoietic Database and you will see the preferred term: B-cell lymphoma, unclassifiable with features intermediate between DLBCL and classical Hodgkin lymphoma. This is the new WHO classification for this disease. I have noted that the older term "composite lymphoma" from the ICD-O-3 is not listed. We will add in the next revision.
Now you have an ICD-O-3 code that fits the new diagnosis, 9596/3 and an ICD-O-3 code for the previous diagnosis of Hodgkin disease, NOS (now called classical Hodgkin) [9650/3].
Enter those codes into the Multiple Primaries calculator. The result is that this is a new primary. Create a new abstract for the 2010 diagnosis with a primary site of lymph nodes and histology 9596/3 [B-cell lymphoma, unclassifiable with features intermediate between DLBCL and classical Hodgkin lymphoma].
Rule M4 cautioned you not to consult the DB at that point because you would have entered Hodgkin [9650/3] and DLBCL [9680/3] in the Multiple Primaries calculator. When you got the reply "new primary" you would have abstracted the second occurrence as DLBCL [9680/3] which would not have been correct.
The answers for SINQ questions with 2010 ID numbers were written using the 2010 Heme & Lymph Manual & DB. The instructions for using the 2010 Hematopoietic Database were written for the version of the software in use as of 5/24/2011. The user interface of the web-based 2010 Hematopoietic Database available from the SEER website varies slightly from the 5/24/2011 version in that the web-based version provides all the disease information in one scrollable window.
For cases diagnosed 2010-2011, access the 2010 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.
