An official website of the United States government
Home
SEER Inquiry System - Report
Produced: 05/24/2026 8:12 PM
Question 20130081
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Discussion:
01/27/2012 R neck mass FNA: Suspicious for B-cell non-Hodgkin lymphoma.
02/17/2012 Cervical node bx: In situ involvement by follicular-like B-cells of uncertain significance +CD10. Two other cervical biopsies show infarcted, extensively necrotic lymphoid tissue highly suspicious for B-cell lymphoma.
03/20/2012 Bone marrow: Low grade B-cell lymphoproliferative disorder with plasmacytic differential.
04/18/2012 Medical Oncology treats patient for Stage III follicular lymphoma.
10/16/2012 Cervical LN core bx: CD10+ large B-cell lymphoma.
Should Rule M4 (single primary) and Module 6, Rule PH11 apply to this case?
Answer:
Updated May 2026
This case should be accessioned as two primaries: follicular lymphoma [9690/3] diagnosed 02/17/2012 and diffuse large B-cell lymphoma [9680/3] diagnosed 10/16/2012 per Rule M10. This patient was diagnosed with a chronic neoplasm (follicular lymphoma) followed later by an acute neoplasm (DLBCL) after the completion of the initial clinical workup for the chronic neoplasm.
The follicular lymphoma was initially diagnosed on 02/17/2012. The cervical node biopsies were "highly suspicious for B-cell lymphoma" [9591/3]. While "suspicious" is a reportable ambiguous term used to accession cases, suspicious cytologies are not SEER reportable and, therefore, the diagnosis date cannot be 01/27/2012. The histology of the first primary would be updated to 9690/3 [follicular lymphoma] based on the Medical Oncology note on 04/18/2012 that confirmed the histology was follicular lymphoma and the patient was being treated for such.
The diagnosis of DLBCL was made 8 months later. Rule M4 cannot apply to this case because the follicular lymphoma and DLBCL were not diagnosed in the same biopsy specimen. Rule M4 only applies when the two non-Hodgkin lymphomas are diagnosed in the same biopsy specimen.
History:
There are two primaries, first is follicular lymphoma and the second is Diffuse Large B Cell Lymphoma.
The first primary is follicular lymphoma. Date of diagnosis is 1/27/12 because "suspicious" is an ambiguous term we use to collect cases. When the physician confirms FL on 4/12, change the histology from B-cell lymphoma (NOS) to follicular lymphoma. Not only is this case one that would be put into the registry DB based on ambiguous terminology, that DX was followed by a physician DX and treatment for FL. All of these (ambiguous terminology, physician diagnosis, and treatment for the disease) make this case reportable.
The diagnosis of DLBCL was made 9 months after the DX of FL. Do not use M4 to make this a single primary - M4 specifically says that two NHL's are SIMULTANEOUSLY present AND in the same location. These were not simultaneous diagnoses, there were 9 months between them.
Use Rule M10, Abstract multiple primaries when a neoplasm is originally diagnosed as a chronic (FL) and there is a second diagnosis of an acute neoplasm (DLBCL) MORE THAN 21 DAYS AFTER THE CHRONIC DIAGNOSIS.
