An official website of the United States government
Home
SEER Inquiry System - Report
Produced: 12/29/2025 12:43 PM
Question 20120058
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
The patient was diagnosed with an extranodal DLBCL on a biopsy of the stomach. A bone marrow biopsy performed 16 days later showed no DLBCL, but demonstrated an abnormal CD5-positive B-cell population that was subsequently referred to as CLL/SLL by the physician. The peripheral blood was negative and showed only moderate thrombocytopenia.
Does rule M10 apply in this case? Abstract the acute neoplasm as a single primary (DLBCL) as there was only one pathology specimen (stomach biopsy) proving DLBCL and the bone marrow did not definitively identify CLL/SLL.
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 M11. Code the histology of one primary to 9680/3 [diffuse large B-cell lymphoma], the acute neoplasm. Code the histology for the second primary to 9823/3 [chronic lymphocytic leukemia/small lymphocytic lymphoma], the chronic neoplasm.
Per Rule M11, abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach biopsy).
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) button will appear to indicate the correct version of the program is available now for query.
This case should be accessioned as two primaries, diffuse large B-cell lymphoma [9680/3] and chronic lymphocytic leukemia/small lymphocytic lymphoma [9823/3]. 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 "chronic lymphocytic leukemia/small lymphocytic lymphoma" [9823/3] is highlighted on the screen.
Scroll down to the TRANSFORMATIONS section. CLL/SLL (a chronic disease process) transforms to DLBCL (an acute disease process). When a cell type is listed under the transformations section for a given malignancy, the disease 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, the chronic and acute disease processes were diagnosed at the same time (within 21 days).
Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, go to the Multiple Primary Rules. The rules are intended to be reviewed in consecutive order from Rule M1 to Rule M16. Stop at the first rule that applies to the case you are processing. Abstract as multiple primaries when both a chronic and acute neoplasm are diagnosed simultaneously or less than or equal to 21 days apart AND there is documentation of two pathology specimens, one confirming the chronic neoplasm (bone marrow biopsy) and one confirming the acute neoplasm (stomach biopsy).
The physician used the bone marrow biopsy information to diagnose CLL/SLL.
