An official website of the United States government
Home
SEER Inquiry System - Report
Produced: 06/04/2026 4:45 AM
Question 20120083
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
June 2006, the patient was diagnosed with follicular lymphoma, grade 3 by cervical lymph node biopsy and bone marrow biopsy. The patient refused treatment but was followed.
May 2007, the patient had another cervical LN biopsy with a diagnosis of follicular lymphoma, grade 2.
July, 2009, a neck mass excision was diagnosed as follicular lymphoma, grade 3.
June 2011, another neck lymph node was excised and diagnosed as follicular lymphoma, grade 2.
According to the MP calculator, FL grade 3 [9698/3] is a separate primary from FL grade 2 [9691/3]. Is the June 2011 diagnosis of FL grade 2 a new primary?
Answer:
Updated May 2026
This case should be accessioned as a single primary per Rule M15. The histology is coded to 9698/3 [follicular lymphoma, grade 3] diagnosed in 2006. The 2011 diagnosis of follicular lymphoma, grade 2 [9691/3] is not a new primary.
Follicular lymphoma, grade 2 [9691/3] is listed under the Same Primaries section of the Heme DB for 9698/3 [follicular lymphoma, grade 3]. To confirm this, Rule M15 indicates we are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries because none of the rules from 1-14 apply. Per the calculator, these histologies represent the same primary.
In addition, the following note was added to the Heme DB for all the Follicular Lymphomas (9690/3, 9691/3, 9695/3, 9698/3) in 2025.
Follicular lymphomas are always the same primary. When there are multiple diagnoses of Follicular lymphoma, update the histology (as needed) to always reflect the highest grade. Known grade always takes priority over the NOS histology. (See Rule M2 in the Hematopoietic manual).
Priority order:
1. 9698/3: Follicular lymphoma, Grade 3, 3A, 3B
2. 9691/3: Follicular lymphoma, Grade 2
3. 9695/3: Follicular lymphoma, Grade 1
4. 9690/3: Follicular lymphoma, NOS
History:
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.
This case should be accessioned as a single primary, follicular lymphoma, grade 3 [9698/3] diagnosed in 2006. The 2011 diagnosis of follicular lymphoma, grade 2 [9691/3] is not a new primary. The steps used to arrive at this decision are:
Enter in the Heme DB. Click on the SEARCH button. Ensure that the term, "follicular lymphoma, grade 2" [9691/3] is highlighted on the screen.
Scroll down to the TRANSFORMATIONS section. Follicular lymphoma, grade 2 does not transform to follicular lymphoma, grade 3. Therefore, this is not a case of transformation from a chronic to an acute neoplasm (or acute to chronic neoplasm).
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. Use the Hematopoietic calculator to determine the number of primaries in this case because Rules M1-M12 do not apply.
Click on the SHOW MULTIPLE PRIMARIES CALCULATOR button. Once the MP Calculator is displayed, Enter [FL, grade 3] in Histology Code 1 and Enter [FL, grade 2] in Histology Code 2. Click on the CALCULATE button. The MP Calculator will indicate these are the same primary.
There had been error in the 2010 MP Calculator that previously reported this combination of histologies as a multiple primary. This was corrected in the latest online version of the Heme DB.
