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SEER Inquiry System - Report
Produced: 03/22/2025 6:34 PM
Question 20110109
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are to be abstracted when a patient is simultaneously diagnosed with multiple myeloma/plasma cell myeloma, plasmacytoma and plasma cell leukemia?
Discussion:
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This is accessioned as one primary and the histology is coded to 9732/3 [multiple myeloma].
To arrive at this answer, it is important to first try to determine how many different unique neoplasms there are to correctly identify the number of primaries to report. Per the Heme DB, plasma cell leukemia is an obsolete term. The current term and histology code for this diagnosis is 9732/3 [plasma cell myeloma]. Plasma cell myeloma and multiple myeloma are synonyms per the Heme DB. Therefore, per Rule M2 a single primary exists when there is a single histology. That takes care of the multiple myeloma/plasma cell myeloma and plasma cell leukemia, but not the plasmacytoma.
In checking the Heme DB, the terms plasma cell myeloma and multiple myeloma are not synonyms for plasmacytoma. Therefore, we are left to determine whether the multiple myeloma/plasma cell myeloma vs the plasmacytoma represents one or two primaries.
Under the Transformation section of the Heme DB, it indicates that plasmacytoma (a chronic disease process) transforms to multiple myeloma (an acute disease process). Per Rule M9, abstract a single primary and code the acute histology when both a chronic and an acute neoplasm are diagnosed simultaneously. The histology is coded to the acute neoplasm when there is no information on the biopsy regarding which is the "later" histology. This update will be added to the Heme Manual.
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 coded to multiple myeloma/plasma cell myeloma [9732/3]. The steps used to arrive at this decision are:
This answer assumes that the plasmacytoma is primary in bone.
Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Insure that the term "solitary plasmacytoma of the bone" [9731/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Scroll down to the TRANSFORMATIONS section information. It indicates that plasmacytoma (a chronic disease process) transforms to multiple myeloma (an acute disease process). When a cell type is listed in the transformation section for a given malignancy, the disease process in the transformation section is considered the acute process and the disease listed at the top of the screen display is considered the chronic process. In this case, both the chronic and acute disease processes were diagnosed simultaneously.
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. in this case because the chronic and acute phase of the disease was diagnosed within 21 days and there is one bone marrow biopsy. Code histology to multiple myeloma/plasma cell myeloma [9732/3], the acute disease process.
Now you need to determine whether plasma cell myeloma/multiple myeloma and plasma cell leukemia are multiple primaries.
Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Insure that the term "plasma cell leukemia" [9733/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Scroll down to the TRANSFORMATIONS section information. There are none.
Scroll to the ABSTRACTOR NOTE section which states that plasma cell leukemia is now listed as a variant of plasma cell myeloma [9732/3] rather than being a stand-alone neoplasm.
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. A single histology (e.g., two terms that are the variants of one another) is a single primary.
