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SEER Inquiry System - Report
Produced: 12/19/2025 9:20 AM
Question 20110106
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Use Rule PH21 to code the primary site to C778 [lymph nodes of multiple regions]. The spleen is not listed under the Primary Site(s) section in the Heme DB for follicular lymphoma. Per Rule PH21 code the primary site to multiple lymph node regions, NOS (C778) when multiple lymph node regions, as defined by ICD-O-3, are involved and it is not possible to identify the lymph node region where the lymphoma originated. The spleen is a primary site for only a few lymphomas (noted in the Heme DB). Because the spleen filters blood, it is often reactive (splenomegaly) or frankly involved with the lymphoma. That reaction or involvement, however, does not affect the primary site coding. Only the involved nodes are used in coding primary site.
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.
Code the primary site to C778 [lymph nodes, NOS]. There are only a few lymphomas that originate in the spleen. In most cases, the spleen is a secondary site of involvement. The steps used to arrive at this decision are:
Enter in the Heme DB. Click on the SEARCH button. Insure that the term "follicular lymphoma" [9690/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Check the PRIMARY SITE(S) section. It indicates, "See Abstractor Notes and Module 7."
Scroll to the ABSTRACTOR NOTE section to find any information available about coding primary site. The notes state that follicular lymphoma predominantly involves lymph nodes. The spleen is listed as a secondary site.
Determine the primary site. 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 Primary Site Histology Rules. The rules are intended to be reviewed in consecutive order within the module.
Go to MODULE 7: Primary Site Rules for Lymphomas Only 9590/3-9729/3 PH25-PH37 as instructed in the PRIMARY SITE(S) section. Start at the first PH25. Stop at the first rule that applies to the case you are processing. In this case note that there are nodes above and below the diaphragm involved as well as the spleen. Code the primary site to lymph nodes, NOS [C779] when lymphoma is present in an organ and it is not known whether any of the involved lymph nodes are regional for the spleen.
PH30 does not apply because in addition to multiple regions of lymph nodes being involved in this case, there is also splenic involvement.
