#2: Heme & Lymphoid Neoplasms
Source 1: Heme & Lymph Manual & DB
Notes: May 2018
Histology--Heme & Lymphoid Neoplasms: How is histology coded when a lymph node excisional biopsy shows Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL), predominantly in diffuse T-cell histiocyte rich large B-cell lymphoma-like (THRLBCL) pattern. Comment states: The findings are that of nodular lymphocyte predominant Hodgkin lymphoma with diffuse T-cell rich pattern (T-cell/histiocyte-rich large B-cell lymphoma-like). This variant is regarded as clinically more advanced. See Discussion.
It appears an argument could be made for both NLPHL (9659/3) and THRLBCL (9688/3). We favor coding NLPHL (9659/3) because the pathologist did specifically call this a Hodgkin lymphoma, and also specified that it only has a T-cell/histiocyte-rich large B-cell lymphoma-like pattern.
Assign histology code 9659/3. According to the Hematopoietic database, this histology frequently has T-cells. The other description was not an actual histology, but noting that the appearance of the cells was similar to that histology.