An official website of the United States government
Home
SEER Inquiry System - Report
Produced: 11/29/2024 7:49 AM
Question 20120042
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
CT guided core biopsy of pelvic mass is positive for B-cell non-Hodgkin lymphoma. Bone marrow biopsy is negative. Mediastinoscopy with mediastinal and pretracheal nodes biopsy is positive for follicular lymphoma grade 1 of 2. The patient has a PET demonstrating positive extensive metastatic disease with nodes in neck, chest, abdomen/pelvis and bone involvement. Should the histology be coded 9591/3 [NHL, NOS] or 9695/3 [FL, grade 1]? Which rule applies?
The table of contents for the Hematopoietic Manual indicates Module 8 for these histologies, however, Module 8 rules do not seem to apply. Continuing on to Module 9, the first rule that applies is PH30. PH30 states use the Heme DB to determine primary site/histology. The Heme DB indicates these are separate primaries, but both histologies are B-cell lymphomas.
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Code the histology to 9695/3 [follicular lymphoma, grade 1] per PH29.
Under the Alternate Names section of the Heme DB, B-cell non-Hodgkin lymphoma is synonym for non-Hodgkin lymphoma, NOS and B-cell lymphoma, NOS.
Per PH29, one codes the histology when there is one non-specific histology (NHL, NOS) and one specific histology (FL, grade 1). You are also required to confirm the specific and the non-specific (NOS) histology represent the same primary using the Multiple Primaries Calculator. The calculator indicates these are the same primary.
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 histology as follicular lymphoma, grade 1 [9695/3]. 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 "non-Hodgkin lymphoma, NOS" [9591/3] is highlighted on the screen.
Enter in the Heme DB to find the other histology in this case. Click on the SEARCH button. Ensure that the term "follicular lymphoma, grade 1" [9695/3] is highlighted on the screen.
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 and Histology Coding Rules. In this case, start with Module 8 (Histology Rules Only: All hematopoietic and lymphoid neoplasms 9590/3-9992/3) Rule PH 38. The rules are intended to be reviewed in consecutive order within the appropriate PH module. Stop at the first rule that applies to the case you are processing. Code the histology as 9695/3 [follicular lymphoma, grade 1], when there is one non-specific histology (NHL, NOS) and one specific histology (FL, grade 1).
Use the Multiple Primaries Calculator to confirm these are the same primary. In the 2010 Heme DB, click on the SHOW MULTIPLE PRIMARIES CALCULATOR button. Once the MP Calculator is displayed, Enter [NHL, NOS] in Histology Code 1, Enter [FL, grade 1] in Histology Code 2. Click on the CALCULATE button. The MP Calculator will indicate these are the same primary.
The first diagnosis is a "B-cell lymphoma." That is considered a generic, non-specific histology. It simply indicates this is a lymphoma and the lineage is B-cell. The next diagnosis is follicular lymphoma, grade 1. Follicular lymphoma is a B-cell lineage lymphoma. Therefore, the histology is coded to B-cell (lineage) follicular lymphoma, grade 1.
