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This is a single primary, essential thrombocythemia [9962/3] diagnosed in 2007. The 2010 Heme DB and Manual should not have been used to determine the number of primaries in this case. The Heme DB applies only to cases diagnosed 2010 and later.

In order to determine the number of primaries, use the rules in place at the time of the subsequent 2009 diagnosis of primary myelofibrosis. Per the Single Versus Subsequent Primaries of Lymphatic and Hematopoietic Diseases table, a diagnosis of essential thrombocythemia [9962/3] followed by a diagnosis of primary myelofibrosis [9961/3] is a single primary.

Code as a single primary with histology Diffuse Large B-Cell Lymphoma.

In this case, there are two NHLs in the same location at the same time. Apply Rule M4, this is one primary. Per Note 5 under Rule M4, go to Rules PH11and PH15 to assign primary site and histology.

Rule PH11 states to code to the site of the origin (axillary mass) and to diffuse large b-cell lymphoma (9680/3) when DLBCL and any other non-Hodgkin lymphoma (follicular in this case) are present in the same location at the same time.

Using the multiple primaries calculator in this situation will give you two primaries, which is the wrong answer. Use the rules before using the calculator.

To get to the manual, go to the "Help me code for dx year." section. Choose 2010 or later and the most current manual will appear. We recommend that you save a copy of the PDF on your computer.

Abstract multiple primaries using the Heme and Lymphoid Rule M15. The Multiple Primaries Calculator shows that the plasmablastic lymphoma (9735/3) and extraosseus plasmacytoma (9734/3) are separate primaries. We also checked with our expert pathologist who concurs as the spinal lesion was not reviewed to prove that it is plasmablastic lymphoma, therefore, the diagnosis as per pathology remains plasmacytoma.

Abstract separate primaries using Rule M15 of the Hematopoietic and Lymphoid Neoplasms (Heme) Manual. The Heme Database states: Excluded from this category are progression of myeloproliferative neoplasms (MPNs) and evolution of primary MDS or primary MDS/MPN to acute myeloid leukemia (AML); in each of these latter cases evolution to AML is part of the natural history of the primary disease and it may be impossible to distinguish natural progression from therapy-related changes. There is no indication of transformation.

The leukemia cutis is secondary to leukemia that is already present. This is multiple disease processes going on at the same time. Look for more information on this case. Is there any previous diagnosis of MDS, leukemia, or some other disease that would result in a treatment related AML?

If no further information can be found, abstract one primary with 9920/3.

Code as one primary (9920/3). This case does not fit the rules very well, since it is a treatment-related neoplasm and involves a transformation of MDS to AML during the clinical workup. Per the abstractor notes for 9920/3, code 9920/3 when the physician comments that the neoplasm is treatment related. This can be for the MDS or the AML. Use text fields to document that it was first referred to as MDS and then transformed to AML. If you followed the rules strictly and coded this as two primaries (the MDS and AML), you would lose the information that this was treatment related, which is more important.

For cases diagnosed prior to 1/1/2010:It is important to note for this case that the two different types of NHL occurred in different lymph nodes; one type in one lymph node and the other type in another lymph node.

Use the fold-out table to determine single vs multiple primaries. According to the table, 9673/3 and 9680/3 would be two primaries no matter which of these was "first."

Assign the lower sequence number to the primary with the worse prognosis when two primaries are diagnosed simultaneously. Base the prognosis decision on the primary site, histology, and extent of disease for each of the primaries. If there is no difference in prognosis, the sequence numbers may be assigned in any order.

For cases diagnosed 1/1/10 and later, 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.

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.

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.