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Question: 20120071 Status
Final

References
Source 1:   Heme & Lymph Neo Manual & DB
pgs:  
Notes:  
Source 2:  
pgs:  
Notes:  


Question
Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded and what rule applies if the patient has involvement of multiple organs and one lymph node chain with diffuse large B-cell lymphoma?



Discussion
In 2011 the patient was diagnosed with a 15 cm mass involving the terminal ileum, cecum and adjacent mesentery. The pathology was positive for diffuse large B-cell lymphoma. A staging PET/CT revealed a mass at the base of tongue and a left cervical lymph node. The biopsy of the base of tongue also showed DLBCL.



Answer
For cases diagnosed 2010 and forward, access the Hematopoietic Database at Click on Hematopoietic and Lymphoid Database. In the search box, enter your histology or the ICD-O-3 code. Click on the link to that disease. In the "Help me code for dx year" field, enter the year of diagnosis. The Hematopoietic Coding Manual (PDF) button will appear.

Apply rule PH22 and code the primary site to lymph nodes, NOS [C77.9]. 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. Click on the term “diffuse large B-cell lymphoma (DLBCL)” [9680/3] on the screen under the NAME area.

Step 2: Check the PRIMARY SITE(S) section. No specific primary site is stated. There is a reference to the Abstractor Notes and Module 7.

Step 3: Scroll down to the ABSTRACTOR NOTE section. While the pathology does not indicate that this is the B-cell lymphoma, unclassifiable with features intermediate between DLBCL and Burkitt variant, the ABSTRACTOR NOTE does indicate that diffuse large B-cell lymphoma, “may have lesions in ileocecal region or jaws. Bone marrow and peripheral blood may be involved. Patients present with lymphadenopathy or mass lesions in extranodal site.” This patient has involvement of two extranodal sites and involvement of regional lymph nodes for only one of those sites.

Step 4: Click on the HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, locate the Primary Site and Histology Coding Rules. The Heme DB PRIMARY SITE(S) information states Module 7 applies to DLBCL. The rules within the Module are intended to be reviewed in consecutive order. Start in Module 7, rule PH18 and stop at the first rule that applies to the case you are processing. Stop at Rule PH22. Code the primary site to C77.9 [lymph nodes, NOS] when lymphoma is present in multiple organs and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. There are two extranodal sites of involvement and only one chain of lymph nodes is considered regional to one of those sites so this rule applies.



History
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

http://seer.cancer.gov/tools/heme/.

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.

Apply rule PH36 and code the primary site to lymph nodes, NOS [C77.9]. 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.

Step 2: Check the PRIMARY SITE(S) section. No specific primary site is stated. There is a reference to the Abstractor Notes and Module 7.

Step 3: Scroll down to the ABSTRACTOR NOTE section. While the pathology does not indicate that this is the B-cell lymphoma, unclassifiable with features intermediate between DLBCL and Burkitt variant, the ABSTRACTOR NOTE does indicate that diffuse large B-cell lymphoma, “may have lesions in ileocecal region or jaws. Bone marrow and peripheral blood may be involved. Patients present with lymphadenopathy or mass lesions in extranodal site.” This patient has involvement of two extranodal sites and involvement of regional lymph nodes for only one of those sites.

Step 4: 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 Primary Site and Histology Rules. The Heme DB PRIMARY SITE(S) information states Module 7 applies to DLBCL. The rules within the Module are intended to be reviewed in consecutive order. Start in Module 7, rule PH25 and stop at the first rule that applies to the case you are processing. Stop at Rule PH36. Code the primary site to C77.9 [lymph nodes, NOS] when lymphoma is present in multiple organs and lymph nodes that are not regional for that organ and the origin cannot be determined even after consulting the physician. There are two extranodal sites of involvement and only one chain of lymph nodes is considered regional to one of those sites so this rule applies.



Last Updated
02/16/2014

Date Finalized
08/29/2012