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SEER Inquiry System - Report
Produced: 11/16/2024 2:26 AM
Question 20120021
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Multiple primaries--Heme & Lymphoid Neoplasms: How are the terms "chronic" and "acute" used to help determine the number of primaries to be abstracted and what rule applies when a diagnosis of diffuse large B-cell lymphoma is followed two years later by a diagnosis of follicular lymphoma, grade 3A of 3? See Discussion.
Discussion:
7/31/08 Biopsy of the left supraclavicular lymph node diagnosed Stage IIIB DLBCL [9680/3]
10/14/10 Biopsy of a right supraclavicular lymph node diagnosed follicular lymphoma, grade 3A or 3 [9698/3].
Which multiple primary rule applies to determine the number of primaries to report? Is Rule M4 ignored? Does Rule M13 apply because follicular lymphoma normally transforms to DLBCL? Is this still a transformation because the follicular lymphoma came AFTER the DLBCL (the "acute" reverted to "chronic")? Or does Rule M15 apply, and the Multiple Primaries Calculator should be used to determine the number of primaries to report?
Are "transformations" the acute phases of the more chronic disease? The Heme Manual and previous training sessions do not make this apparent.
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
This case should be accessioned as two primaries per Rule M13. Code the histology for the 7/31/08 diagnosis to 9680/3 [diffuse large B-cell lymphoma] and the code the histology for the 10/14/2010 diagnosis to 9698/3 [follicular lymphoma, grade 3A of 3]. Rule M13 applies to this case because the neoplasm was originally diagnosed in the blast or acute phase (DLBCL) and reverted to a less aggressive or chronic phase (follicular lymphoma) after treatment.
Per the "Transformations to" section in the Heme DB for follicular lymphoma, grade 3 transforms to diffuse large B-cell lymphoma [9680/3]. This means that the follicular lymphoma is the chronic neoplasm and that DLBCL is the acute neoplasm. In this case, the chronic neoplasm was diagnosed after the acute neoplasm was diagnosed and treated (with chemotherapy).
Do not Stop at Rule M4 because diffuse large B-cell lymphoma and follicular lymphoma (both NHL's) were not present in the same node(s) AT THE SAME TIME.
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) will appear which indicates the correct version of the program is available now for query.
This case should be accessioned as two primaries, the 7/31/2008 diagnosis of diffuse large B-cell lymphoma [9680/3] and the 10/14/2010 diagnosis of follicular lymphoma, grade 3A of 3 [9698/3]. The steps used to arrive at this decision are:
Enter in the Heme DB to find the histology. Click on the SEARCH button. Ensure that the term "Follicular lymphoma, grade 3" [9698/3] is highlighted on the screen under the RESULTS FOR ALL TERMS area.
Scroll down to the TRANSFORMATIONS section information. Follicular lymphoma, grade 3 transforms to diffuse large B-cell lymphoma [9680/3]. This means that the follicular lymphoma is considered the chronic neoplasm and that DLBCL is considered the acute neoplasm. In this case, the chronic neoplasm was diagnosed after the acute neoplasm was diagnosed and treated (with chemotherapy).
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 neoplasm was originally diagnosed in the blast or acute phase (DLBCL) and reverted to a less aggressive or chronic phase (follicular lymphoma) after treatment. Abstract as multiple primaries, DLBCL [9680/3] followed by follicular lymphoma, grade 3 [9698/3].
Do not Stop at Rule M3 because diffuse large B-cell lymphoma and follicular lymphoma were not present in the same node(s) AT THE SAME TIME (a clarification will be added to Rule M3).
