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SEER Inquiry System - Report
Produced: 09/07/2024 9:12 PM
Question 20120004
Inquiry Details
References:
Heme & Lymph Manual & DB. Grade rules
Question:
Discussion:
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code grade to 6 [B-cell] for the histology malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant [9680/3]. Under the Definition section for histology code 9680/3 it states there are morphologic variants of the disease: centroblastic, immunoblastic, plasmablastic, T-cell/histiocyte-rich, anaplastic.
Rule G3 in the Heme Manual confirms the grade listed in the Heme DB under its Grade section for the histology 9680/3. While the patient presented with a variant of DLBCL that is T-cell/histiocyte rich, it is still a B-cell phenotype. The grade is coded accordingly.
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:
For cases diagnosed 2012 and later, access the Hematopoietic Database at
http://seer.cancer.gov/tools/heme/.
Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. The 2012 Hematopoietic Coding Manual (PDF) will appear which indicates the correct version of the program is available now for query.
Assign grade code 6 [B-cell]. The steps used to arrive at this decision are:
Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Ensure that the term "Diffuse large B-cell lymphoma (DLBCL)" [9680/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area. Note the GRADE is specified as "6 - B-cell."
Scroll down to the DEFINITION section. DLBCL has several morphologic variants including T-cell rich DLBCL.
Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, locate the Grade of Tumor Rules. The rules are intended to be reviewed in consecutive order starting with Rule G1 and ending with Rule G9. Stop at the first rule that applies to the case you are processing. Code the grade to 6 [B-cell] because DLBCL [histology 9680/3] is listed among the B-cell precursor lymphoid neoplasms and the mature B-cell neoplasms.
Rule G3 confirms the Grade listed in the Heme DB for DLBCL. Although this is a variant that is T-cell/histiocyte rich, it is still a B-cell phenotype.
