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Question: 20120076 Status
Final

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


Question
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? See Discussion.

Discussion
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.

Answer
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.

This case should be accessioned as two primaries per Rule M15. Code the histology for the first primary to 9698/3 [nodular histiocytic lymphoma. Per the Alternate Names section in the Heme DB, this histology is synonymous with follicular lymphoma, grade 3. Code the histology for the second primary to 9823/3 [B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma].

Nodular histiocytic lymphoma does not transform into CLL/SLL (Transformations to), nor does CLL/SLL transform to nodular histiocytic lymphoma (Transformations from). Rule M15 indicates we are to use the Heme DB Multiple Primaries Calculator to determine the number of primaries in this case because none of the rules from 1-14 apply. Per the calculator, the CLL/SLL is a new primary.

SEER*Educate provides training on how to use the Heme Manual and DB. If you are unsure how to arrive at the answer in this SINQ question, refer to SEER*Educate to practice coding hematopoietic and lymphoid neoplasms. Review the step-by-step instructions provided for each case scenario to learn how to use the application and manual to arrive at the answer provided. https://educate.fhcrc.org/LandingPage.aspx.

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 2012 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 small lymphocytic lymphoma 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. 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 9698 [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.

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. Stop at Rule M16. 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.

Step 6: Click on the SHOW MULTIPLE PRIMARIES CALCULATOR button. Once the MP Calculator is displayed, Enter 9698 [nodular histiocytic lymphoma] in Histology Code 1 and Enter 9823 [CLL/SLL] in Histology Code 2. Click on the CALCULATE button. The MP Calculator indicates the CLL/SLL is a new primary.



Last Updated
06/30/2014

Date Finalized
09/21/2012