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Hematopoietic neoplasms that transform generally don't have 'chronic' or 'acute' as part of their preferred name. The 'chronic' and 'acute' designations are determined by the usual course of the neoplasm. Chronic neoplasms are generally slow growing while acute neoplasms grow fast and are more widespread. Not all Hematopoietic neoplasms transform. Each neoplasm that has the ability to transform has the transformations listed under the 'Transformations to' and/or 'Transformation from' sections in the Hematopoietic database.

For example, Diffuse large B-cell lymphoma (histology code 9680/3) has no histologies/neoplasms listed under 'transformations to.' This means that this neoplasm does not transform to any other neoplasm. There are multiple histologies/neoplasms listed under 'Transformations from' indicating the neoplasms listed under the Transformations from are the chronic neoplasms, and DLBCL is the acute neoplasm. If DLBCL (9680/3) occurs at the same time, within 21 days, or greater than 21 days of any of the histologies listed under 'Transformations From,' rules M8-M13 apply. If DLBCL (9680/3) occurred at the same time as a neoplasm not listed in the Transformations sections, the acute and chronic rules do not apply.

Abstract two primaries and assign

Primary 1: C772, 9699/3

Primary 2: C162, 9699/3

Per Rule M7, you would change the first case to histology 9699/3 based on Note 4 under Rule M7, Note 4: Change the histology code on the original abstract to the more specific histology when the original diagnosis is in your registry database. Use previous editions of ICD-O (i.e., ICD-O-1, ICD-O-2) or the Hematopoietic Database to assign the code applicable to the year of diagnosis for the more specific histology.

Per Rule M2 this would be the same primary based on both being the same histology; however, there is an exception for MALT lymphomas (9699/3), which states: Abstract multiple primaries when a nodal MALT (C770-779, 9699/3) occurs before or after an extranodal MALT (all other sites, 9699/3).

For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

Accession a single primary, diffuse large B-cell lymphoma [9680/3] diagnosed in 2003 per Rule M2. Abstract a single primary when there is a single histology. Per Rule M2, Note 2, a recurrence of the same histology is always a single primary (timing is not relevant).

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.

We consulted with our expert hematopathologist who advised this is a single primary, Hodgkin lymphoma (9659/3).

The diagnosis from 5/14/2021 states NLPHL. It also states there is T-cell histiocyte rich large B-cell lymphoma-like transformation. The WHO Classification of Hematopoietic and Lymphoid Tissues demonstrates six different patterns to NLPHL, which are: A) 'classical' nodular, B) serpiginous/interconnected nodular, C) nodular with prominent extra-nodular LP cells, D) T-cell-rich nodular, E) diffuse with a T-cell-rich background, and F) diffuse, B-cell-rich pattern.

In this case, they are describing a NLPHL type E (diffuse with a T-cell rich background). The term used is "T-cell histiocyte rich large B-cell lymphoma-LIKE transformation. "Like" as used here means that it is like a transformation; if it was NLPHL transforming to T-cell histiocyte rich large B-cell lymphoma, it would not have the word "like" in the diagnosis. This is a variant of NLPHL and not an actual transformation to another lymphoma. Even though NLPHL can transform to T-cell histiocyte rich large B-cell lymphoma, it is not the case here since the word "like" appears in the diagnosis.

We will update the histology in the Hematopoietic and Lymphoid Neoplasm Database to include these additional patterns.

Rule H7 applies. Assign code 8255. H13 does not apply as mucinous/colloid/signet are not NOS histologies. They are specific histologies. This will be addressed in the upcoming revisions to the rules.

Rule M7 applies. Abstract the bladder diagnosis and the renal pelvis diagnosis as separate primaries.

The lung diagnosis is metastatic. The MP/H rules do not apply to metastatic tumors.

For tumors diagnosed prior to 2007:

Code as one primary. Code the Histology field to 8263/3 [Adenocarcinoma in tubulovillous adenoma].

Count as a single primary and code the more specific term when simultaneous lesions are present and one lesion is an "NOS" term and the other is a more specific term. "Polyp" is an NOS term. Adenoma is an associated term, but is more specific (Tubulovillous adenoma is more specific than "polyp").

For tumors diagnosed 2007 or later, refer to the MP/H rules. If there are still questions about how this type of tumor should be coded, submit a new question to SINQ and include the difficulties you are encountering in applying the MP/H rules.

Most often when the invasive tumor and the in situ component are in the same lung and are the same histology, rule M12 (example 3) applies and this is a single primary. If the first wedge resection included part of the tumor and the in situ was not separate from the tumor, it is a single primary. We suspect that the margins were positive on the first wedge specimen which prompted the second wedge resection where the in situ was found. In addition, terminology for lung malignancies is undergoing change: what was called BAC (invasive) is now called adenocarcinoma in situ.

For cases diagnosed prior to 1/1/2010:

Report this case as one primary according to the physician's opinion. Code the histology as 9699/3 [marginal zone B-Cell lymphoma, NOS] and code the date of diagnosis as 2000.

Code the physicians opinion regardless of whether or not it agrees with the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table. Use the table when the physician does not state whether or not there is a new primary.

For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.

For cases diagnosed prior to 1/1/2010:Report as two primaries if that reflects the medical opinion for this case. The table is a guide, but does not overrule the clinician's opinion. These extranodal lymphomas are diagnosed in two different sites more than 2 months apart. They are listed as the same primary in the folding table because 9591/3 is generally a non-specific term and 9698/3 is a more specific cell type. If both histologies were diagnosed in the same organ or tissue, this is the same primary. However, the primary sites in this example are distinctly different.

For cases diagnosed 2010 forward, refer to the Hematopoietic and Lymphoid Neoplasm Case Reportability and Coding Manual and the Hematopoietic Database (Hematopoietic DB) provided by SEER on its website to research your question. If those resources do not adequately address your issue, submit a new question to SINQ.