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Question: 20130002 Status
Final

References
Source 1:   Heme & Lymph Manual & DB
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Notes:  
Source 2:   MP Calculator
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Notes:  


Question
Multiple Primaries--Heme & Lymphoid Neoplasms: This is a FOUR-PART question.

Based on the new Hematopoietic Rules, is the following scenario (see discussion) just ONE lymphoma case with follow-up for recurrences only? Or, do we abstract the transformation (2008) when the lymphoma recurs in 2010?

If the 2008 transformation is picked up as another primary, what is the accession year?

And to which primary would the 4/22/2010 recurrence apply?

See discussion.

Discussion
Case Scenario:

Poorly diffuse lymphocytic lymphoma, small cleaved cell (9591/3) Left groin biopsy; Diagnosed and Abstracted in 5/1991;

- In 2008, AFTER multiple recurrences, found to have transformed to malignant lymphoma, large B-cell. Small focus of follicular lymphoma (Left axillary biopsy) on 7/1/2008; Followed to a No Evidence of Disease status.

-THEN, found with recurrence on 4/22/2010 to follicular lymphoma grade 1 (Left axillary biopsy). No large cell component. Bone marrow biopsy was negative for lymphoma. On observation.

Progressed on 11/2/2010 to follicular lymphoma grade 3. No large cell component. Clinically no evidence of disease on maintenance Rituxan.

Answer
The 2008 diagnosis and both diagnoses in 2010 are recurrences of the 1991 diagnosis, not new primaries.

Since the latest diagnosis is 2010, follow the rules in the Hematopoietic Manual and Database.

Initial diagnosis: 9591/3. Second occurrence Malignant Lymphoma, Large B-cell. Small focus of follicuar lymphoma: 9690/3. This is the same primary.

4/2010: Follicular lymphoma, grade 1: 9695 and 11/2010: Follicular lymphoma, grade 3: 9698/3. The multiple primaries calculator shows all of these as the same primary.

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 The 2008 diagnosis and both diagnoses in 2010 are recurrences of the 1991 diagnosis, not new primaries.

Since the latest diagnosis is 2010, follow the rules in the 2010 Hematopoietic Manual and Database; however, there was an error in the 2010 multiple primaries calculator which has been corrected in the 2012 version.

Initial diagnosis: 9591/3. Second occurrence Malignant Lymphoma, Large B-cell. Small focus of follicuar lymphoma: 9690/3. This is the same primary.

4/2010: Follicular lymphoma, grade 1: 9695 and 11/2010: Follicular lymphoma, grade 3: 9698/3. The multiple primaries calculator in the 2012 Hematopoietic Database shows all of these as the same primary. The 2010 Hematopoietic Database would result in 3 primaries, which is incorrect.

Last Updated
02/24/2014

Date Finalized
03/14/2013