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SEER Inquiry System - Report
Produced: 12/25/2025 9:20 AM
Question 20130142
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are reported if a 2010 inguinal lymph node biopsy diagnosis of follicular lymphoma, grade 1 is subsequently diagnosed in 2012 with a 50% follicular, grade 3 and 50% diffuse large B-cell via a biopsy of an axillary mass?
Discussion:
In 2010 a left inguinal lymph node biopsy revealed follicular lymphoma, grade 1. There were no other suspicious lymph nodes in the body.
In 2012 a biopsy of a large axillary mass revealed a a 50% follicular, grade 3 and 50% diffuse large B-cell.
According to the rules, the transformation to a B-cell is new primary. Is the mixed cell neoplasm a single primary?
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
There are two reportable primaries for this case -- follicular lymphoma in 2010 and DLBCL in 2012.
First determine the histologies needed to to determine the number of primaries to report. We determined the histologies are follicular lymphoma, grade 1 for 2010 and DLBCL for 2012 as follows:
- Rule M4, a mix of DBLCL and follicular lymphoma, grade 3 is a single primary when two or more types of non-Hodgkin lymphoma are simultaneously present in the same anatomic location(s), such as the same lymph node or lymph node region(s), the same organ(s), and/or the same tissue(s). Additionally, the instruction per Rule PH11 indicates one is to code the histology to diffuse large B-cell lymphoma (DLBCL) (9680/3) when DLBCL and any other non-Hodgkin lymphoma (i.e., follicular lymphoma, grade 3) are present in the same lymph node(s), lymph node region(s), organ(s), tissue(s) or bone marrow.
Per the Hematopoietic database, follicular lymphoma (all types are chronic) transforms to DLBCL (acute). Per Rule M 10 instructions, "Abstract as multiple primaries when a neoplasm is as a neoplasm there is a of an neoplasm after the chronic diagnosis." Therefore, abstract the DLBCL as a second 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.
