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Question: 20130081 Status

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

Multiple primaries--Heme & Lymphoid Neoplasms: How many primaries are accessioned when a patient is clinically stated to have Stage III follicular lymphoma following a diagnosis suspicious for B-cell lymphoma and is subsequently diagnosed with large B-cell lymphoma? See 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?

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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 greater than 21 days later by an acute neoplasm (DLBCL).

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 simultaneously. Rule M4 only applies when the two non-Hodgkin lymphomas are diagnosed simultaneously AND in the same location.

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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.

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