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SEER Inquiry System - Report
Produced: 09/19/2026 6:03 PM
Question 20110047
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a patient is diagnosed with NHL, large B-cell lymphoma in 3/2010 followed by a "recurrence of previously diagnosed" NHL per a 12/2010 liver biopsy? See Discussion.
Discussion:
Are there timing rules related to the comparison of slides from a subsequent hematopoietic primary diagnosis to the slides from the original hematopoietic primary diagnosis that impact the number or primaries reported?
For example, how many primaries are reported for a patient was diagnosed in 3/2010 with large B-cell lymphoma who underwent 7 rounds of chemo. Per 10/2010 PET scan, there was no evidence of disease. In 12/2010 a liver biopsy revealed, "features consistent with recurrence of previously diagnosed non-Hodgkin lymphoma." The pathologist did not compare slides to the original, but several immunoperoxidase stains were done to obtain the final diagnosis in 12/2010.
Does timing or comparison to the original slides matter for Heme & Lymphoid Neoplasms? Is a comparison of slides needed as required for solid tumor "recurrences"?
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as one primary per Rule M15, 9680/3 [diffuse large B-cell lymphoma]. Per Rule M15 one is to use the Heme DB Multiple Primaries Calculator to determine the number of primaries for all cases that do not meet the criteria of M1-M14. The 12/2010 liver diagnosis of NHL, NOS [9591/3] is the same primary per the Multiple Primaries Calculator.
There are no timing rules for lymphoma other than rules M8-M13 which deal with the timing of chronic and acute diagnoses.
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:
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
For cases diagnosed 2010-2011, access the 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.
This case should be accessioned as one primary, 9680/3 [diffuse large B-cell lymphoma]. The steps used to arrive at this decision are:
Enter in the Heme DB to find the histology. Click on the SEARCH button. Insure that the term "diffuse large-B-cell lymphoma (DLBCL)" [9680/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Note that according to the pathology reports available, there is only a single histology for this case. There are no timing rules for lymphoma other than rules M7-M12 which deal with the timing of chronic and acute diagnoses. The same disease recurred in this case.
Click on the 2010 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, locate one of the three formats (i.e., flowchart, matrix or text) to check the Multiple Primary Rules. The rules are intended to be reviewed in consecutive order from Rule M1 to Rule M13. Stop at the first rule that applies to the case you are processing.
. Abstract a single primary when there is a single histology. It is the same primary regardless of the time interval between the two diagnoses.
