SEER Inquiry System - Question 20120009 Details

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 2012

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.

Code the histology as B-cell lymphoma, NOS [9591/3]. The steps used to arrive at this decision are as follows:

Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Several results will be returned. The first result is Malignant lymphoma, large B-cell, diffuse, immunoblastic, NOS which is an obsolete histology code, skip this histology. The second result is diffuse large B-cell lymphoma, this is a high grade lymphoma and the pathology states this is a low-grade lymphoma, skip this histology. The third result is Non-Hodgkin lymphoma, NOS. Ensure that the term "Non-Hodgkin lymphoma, NOS" [9591/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.

Scroll down to the ALTERNATIVE NAMES section. Note that B-cell lymphoma, NOS is an alternative name for this neoplasm. This is the NOS histology, as implied by the name.

Determine the codes for the other two histologies listed in the final diagnosis. First, Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Ensure that the term "Lymphoplasmacytic lymphoma" [9671/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.

Scroll down to the SAME PRIMARIES section. Note that histology code 9591/3 [B-cell lymphoma, NOS] is listed as the same primary for lymphoplasmacytic lymphoma.

Second, Enter in the Heme DB to search for the histology code. Click on the SEARCH button. Ensure that the term "Extranodal marginal zone lymphoma of mucosal-associated lymphoid tissue (MALT lymphoma)" [9699/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.

Scroll down to the ALTERNATIVE NAMES section. Note that marginal zone lymphoma, NOS, is listed as an alternative name. Next, scroll down to the SAME PRIMARIES information. Note that histology code 9591/3 [B-cell lymphoma, NOS] is listed as the same primary for marginal zone lymphoma.

Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) now that each histology code has been determined. Once in the manual, select the link to check the Primary Site and Histology Coding Rules. The rules are intended to be reviewed in consecutive order within the applicable Module. The first applicable Module in this case is Module 9, the NOS and More Specific Histology Module. Stop at the first rule that applies to the case you are processing. Code the histology as the non-specific (NOS) histology when the diagnosis is one non-specific histology two or more specific histologies the Heme DB multiple primaries calculator documents the specific histologies and NOS are the same primary no further information is available. Code the histology as 9591/3 [B-cell lymphoma, NOS].

Rule PH40 fits this case. There is one NOS histology code [9591/3] and two specific histology codes [9671/3 and 9699/3] in the same biopsy. The Heme DB states that B-cell lymphoma, NOS and lymphoplasmacytic lymphoma are the same primary and that B-cell lymphoma, NOS and marginal zone lymphoma are the same primary. There is no further information available. Use either the Multiple Primaries Calculator or the Same Primaries information from the Heme DB to determine whether the NOS and more specific histologies are the same primary.

Rule PH40 was written for these types of cases. The term "compatible with lymphoplasmacytic lymphoma (LPL) [9671/3] or marginal zone lymphoma (MZL) [9699/3]" means that the immunophenotype was not diagnostic of either LPL or MZL. Wait until there is a definitive diagnosis of either LPL or MZL and then change the histology code to the more specific diagnosis.

If the wrong PH Rule is chosen, for example, and the higher ICD-O-3 code is coded, the histology is incorrectly coded to 9699/3 [MZL]. If the patient is later confirmed to have LPL [9671/3], this subsequent diagnosis would be incorrectly accessioned as a second primary when this patient has only one disease process with a specific histology that was not clear at the time of the initial diagnosis.