SEER Inquiry System - View
Source 1: 2012 Heme & Lymph Manual & DB
Multiple primaries/Histology--Heme & Lymphoid Neoplasms: How many primaries are accessioned and what histology codes are used for a 2005 diagnosis of nodular histiocytic lymphoma followed by a 2012 diagnosis of B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma?
Per the history and physical, patient was diagnosed in 2005 with nodular histiocytic lymphoma and had chemo at that time. Now the patient presents with enlarged right axillary lymph nodes. A lymph node core biopsy confirmed B-cell small lymphocytic lymphoma/chronic lymphocytic leukemia. Flow cytometry was most consistent with B-cell chronic lymphocytic leukemia.
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.
This case should be accessioned as two primaries: nodular histiocytic lymphoma [9698/3] and B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma [9823/3]. The steps used to arrive at this decision are:
Step 1: Use the ICD-O-3 to determine the histology code for the 2005 diagnosis of nodular histiocytic lymphoma. Per the ICD-O-3, the correct histology code for the 2005 diagnosis is 9698/3.
Step 2: Enter in the Heme DB to find the histology for the 2012 diagnosis. Click on the SEARCH button. Chronic lymphocytic leukemia/small lymphocytic lymphoma [9823/3] is automatically highlighted. small lymphocytic lymphoma NOTE: Malignant lymphoma, small B lymphocytes NOS [9670/3] is stated to be obsolete, the correct code is 9823/3.
Step 3: Next, Enter code [nodular histiocytic lymphoma] in the Heme DB. Click on the SEARCH button. Ensure that the term “follicular lymphoma, grade 3” [9698/3] is highlighted on the screen. The 2005 diagnosis of nodular histiocytic lymphoma is synonymous with the diagnosis of follicular lymphoma, grade 3 in 2012 per the ALTERNATIVE NAMES information. 9698
Step 4: Scroll down to the TRANSFORMATIONS section. Nodular histiocytic lymphoma does not transform into CLL/SLL.
Step 5: Click on the 2012 HEMATOPOIETIC CODING MANUAL (PDF) button. Once in the manual, go to the Multiple Primary Rules. The rules are intended to be reviewed in consecutive order from Rule M1 to Rule M16. Stop at the first rule that applies to the case you are processing. Use the Hematopoietic DB Multiple Primaries Calculator to determine the number of primaries in this case because none of the rules from 1-15 apply. Stop at Rule M16.
Step 6: Click on the SHOW MULTIPLE PRIMARIES CALCULATOR button. Once the MP Calculator is displayed, Enter [nodular histiocytic lymphoma] in Histology Code 1 and Enter 9698 [CLL/SLL] in Histology Code 2. Click on the CALCULATE button. The MP Calculator indicates the CLL/SLL is a new primary. 9823