SEER Inquiry System - View

Question: 20130081 Status
Final

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


Question
Multiple primaries--Heme & Lymphoid Neoplasms: For this case presentation should I follow these Hematopoietic Rules? M4 Single Primary; Module 6, PH11. See discussion.

Discussion
1/27/12 R neck mass FNA: Suspicious for B-cell Non-Hodgkin lymphoma.

2/17/12 Cervical node Bx: In situ involvement by follicular lymphoma-like B cells of uncertain significance +CD10. Two other cervical bxs show infarcted, extensively necrotic lymphoid tissue highly suspicious for B-cell lymphoma.

3/20/12 Bone marrow: Low grade B-cell lymphoproliferative disorder with plasmacytic differential.

4/18/12 Medical Oncology treats for Stage III follicular lymphoma.

10/16/12 Cervical LN core bx: CD10+ large B-cell lymphoma.

Answer
There are two primaries, first is follicular lymphoma and the second is Diffuse Large B Cell Lymphoma.

The first primary is follicular lymphoma. Date of diagnosis is 1/27/12 because "suspicious" is an ambiguous term we use to collect cases. When the physician confirms FL on 4/12, change the histology from B-cell lymphoma (NOS) to follicular lymphoma. Not only is this case one that would be put into the registry DB based on ambiguous terminology, that DX was followed by a physician DX and treatment for FL. All of these (ambiguous terminology, physician diagnosis, and treatment for the disease) make this case reportable.

The diagnosis of DLBCL was made 9 months after the DX of FL. Do not use M4 to make this a single primary - M4 specifically says that two NHL's are SIMULTANEOUSLY present AND in the same location. These were not simultaneous diagnoses, there were 9 months between them.

Use Rule M10, Abstract multiple primaries when a neoplasm is originally diagnosed as a chronic (FL) and there is a second diagnosis of an acute neoplasm (DLBCL) MORE THAN 21 DAYS AFTER THE CHRONIC DIAGNOSIS.

History
ORIGINAL QUESTION: Multiple primaries--Heme & Lymphoid Neoplasms: For this case presentation should I follow these Hematopoietic Rules? M5 Single Primary; Module 6, PH16. See discussion. 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 There are two primaries, first is follicular lymphoma and the second is Diffuse Large B Cell Lymphoma.

The first primary is follicular lymphoma. Date of diagnosis is 1/27/12 because "suspicious" is an ambiguous term we use to collect cases. When the physician confirms FL on 4/12, change the histology from B-cell lymphoma (NOS) to follicular lymphoma. Not only is this case one that would be put into the registry DB based on ambiguous terminology, that DX was followed by a physician DX and treatment for FL. All of these (ambiguous terminology, physician diagnosis, and treatment for the disease) make this case reportable.

The diagnosis of DLBCL was made 9 months after the DX of FL. Do not use M5 to make this a single primary - M5 specifically says the FL and DLBCL are SIMULTANEOUSLY present. These were not simultaneous diagnoses, there were 9 months between them.

Use Rule M12, Abstract multiple primaries when a neoplasm is originally diagnosed as a chronic (FL) and there is a second diagnosis of an acute neoplasm (DLBCL) MORE THAN 21 DAYS AFTER THE CHRONIC DIAGNOSIS.

Last Updated
02/24/2014

Date Finalized
07/11/2013