1/2/11 Skin biopsy was positive. IMMUNOSTAIN for Human Herpesviruses 8 is positive confirming a diagnosis of Kaposi's sarcoma.

1/4/11 Groin lymph node biopsy was positive: Kaposi's sarcoma. (There are multiple positive nodes on PET) Bone marrow biopsy was negative.

Patient was treated with neoadjuvant chemotherapy and radiation for Stage IV rectal cancer in 2004 followed by an abdominoperineal resection, then FOLFOX. Lung metastasis resected March 06. Pelvic recurrence Dec 06, treated with Temodar, capcitabine, Thalidomide for approximately 2 years until remission June 08. Maintained on Thalidomide in 2008; stopped Dec 08 for cytopenia. MDS diagnosed Nov 09. Progressed to acute myeloid leukemia (AML) Jan 10.

Bone marrow biopsy states lymphoplasmacytic lymphoma. Oncologist "Bone marrow showing 50% marrow involvement with IgM kappa restricted B-cell lymphoma consistent with lymphoplasmacytic lymphoma. Lab revealed normal quantitative immunoglobulin save for slightly elevated IgM and very small IgM kappa serum protein spike. PET revealed no abnormal liver or lymph nodes, asplenic, slight uptake throughout skeleton consistent with marrow involvement but being somewhat nonspecific. Asymptomatic Stage 4A lymphoplasmacytic lymphoma with early incidentally discovered bone marrow involvement."

The answers to questions 20110026 and 20110036 appear to conflict with each other. Question 20110026 (see discussion) states that monomorphic is an alternate name for polymorphic and should be coded to 9971/3. Question 20110036 states the monomorphic post transplant lymphoproliferative disorder itself is not reportable, code the lymphoma.

See discussion.

Malignant non-Hodgkin lymphoma, large B-cell type, with features consistent with T-cell rich variant.

Plasma cell leukemia is a variant of multiple myeloma and when these two histologies are found simultaneously in bone marrow, it should be abstracted as multiple myeloma (single primary). Why code the histology to multiple myeloma 9732/3 rather than to plasma cell leukemia 9733/3 which has the higher code, as instructed in Rule PH41? Why does the multiple primaries calculator show these histologies to be multiple primaries?

According to Hemato Manual Module 1, PH2, I am supposed to code the histology diagnosed by the definitive diagnostic method, which for lymphoma, NOS (9590/3) is histologic confirmation, but if I use that it will be 8000/3 and will no longer be a lymphoma. If there is no histologic confirmation of lymphoma, would I go to PH3 and code to 9590/3 and use diagnostic confirmation code 7?

See discussion.

A patient was diagnosed with diffuse large B-cell NHL in 2001. Patient presents in 2011 with a biopsy of the pharynx showing diffuse large B-cell lymphoma after an interval of being disease free for 8-9 years. The medical oncologist states that this is almost certainly a second malignancy rather than recurrence since recurrence almost always does so within the first 2-3 years.

Does stromal invasion mean invasive, behavior /3?

The breast biopsy shows DCIS with focal and very early stromal invasion and microcalcifications. The following lumpectomy and sentinel node biopsy shows DCIS and no invasive malignancy.

Should macrocytic anemia be collected?