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Question: 20120074 Status

Source 1:   Heme & Lymph Manual & DB
Source 2:  

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned if a patient is diagnosed in 2004 with extranodal diffuse large B-cell lymphoma (DLBCL) of the stomach followed by a 2011 diagnosis of DLBCL involving abdominal lymph nodes? See Discussion.

In 2004 a patient’s extranodal DLBCL was treated with a partial gastrectomy at another facility. A recurrence of DLBCL was diagnosed in 2011 by a fine needle aspiration of abdominal lymph nodes. The patient presented to this facility for chemotherapy.

For cases diagnosed 2010 and forward, access the Hematopoietic Database at

This case is accessioned as a single primary. Code the histology to 9680/3 [diffuse large B-cell lymphoma] and diagnosis date to 2004. Per Rule M2, abstract as a single primary when there is a single histology.

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.

This SINQ question has been updated to the Hematopoietic & Lymphoid Neoplasm Manual & Database published January 2014. The original answer below was written based on the rules in 2010 For cases diagnosed 2010-2011, access the Hematopoietic Database at

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, diffuse large B-cell lymphoma [9680/3] diagnosed in 2004. The steps used to arrive at this decision are:

Step 1: Enter diffuse large B-cell lymphoma in the Heme DB to find the histology. Click on the SEARCH button. Ensure that the term “Diffuse large B-cell lymphoma (DLBCL)” [9680/3] is highlighted on the screen. There was only one type of lymphoma diagnosed in this case; DLBCL was diagnosed in 2004 and 2011.

Step 2: 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. Stop at Rule M2. Abstract as a single primary when there is a single histology.

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