SEER Inquiry System - View
Source 1: 2012 Heme & Lymph Manual & DB
Primary site--Heme & Lymphoid Neoplasms: How is the primary site coded for a diagnosis of multifocal Langerhans cell histiocytosis with involvement of the bone, liver, spleen and retroperitoneum?
For cases diagnosed 2012 and later, access the Hematopoietic Database at http://seer.cancer.gov/tools/heme/.
Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. The 2012 Hematopoietic Coding Manual (PDF) button will appear to indicate the correct version of the program is available now for query.
Code the primary site as bone, NOS [C41.9], assuming there are multiple bones involved in this case. If only one bone is involved, code the primary site to that bone. The steps used to arrive at this decision are:
Step 1: Enter in the Heme DB to find the histology. Click on the SEARCH button. Ensure that the term "Langerhans cell histiocytosis” [9751/3] is highlighted on the screen. Langerhans cell histiocytosis
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. (Indicating Module 7 appears to be a typo. Module 10 is the appropriate module.)
Step 3: Scroll down to the ABSTRACTOR NOTE section. This indicates the primary site may differ for LCH in the solitary disease and multisystem disease. This patient has multisystem disease with involvement of the bone, liver, spleen and retroperitoneum. The most common sites for multisystem involvement include three of the four above sites (bone, liver, and spleen).
Step 4: Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, go to the Primary Site and Histology Coding Rules. Scroll down to Module 10. Start at Rule PH42. The rules are intended to be reviewed in consecutive order within the module. Stop at the first rule that applies to the case you are processing. The note refers one to the ABSTRACTOR NOTE in the Heme DB. Stop at Rule PH42.
Step 5: Determine the primary site based on the knowledge of the usual sites of involvement for this disease, the actual sites of involvement for the case presented, and identifying which sites of involvement are likely metastatic and which are the potential primary sites. There are two potential primary sites of involvement to consider: the bone and the retroperitoneum. Bone is a common site of involvement for LCH while the retroperitoneum is not. Code the primary site as C41.9 [bone, NOS] because multiple bones are involved for this patient and bone is the most common site for LCH based on the documentation in the ABSTRACTOR NOTE.
NOTE: The spleen and liver are typically not considered primary sites for this disease process. They become involved when there is multisystem involvement because they filter the blood. They are typically sites of metastatic involvement. This information will be added to the ABSTRACTOR NOTE section.