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SEER Inquiry System - Report
Produced: 01/18/2025 9:30 PM
Question 20120039
Inquiry Details
References:
Heme & Lymph Manual & DB
Question:
Primary site--Heme & Lymphoid Neoplasms: What primary site and heme rule applies when a PET scan shows bilateral renal masses, hypermetabolic liver lesions and retroperitoneal lymphadenopathy, a right kidney biopsy was positive for diffuse large B-cell lymphoma, and the bone marrow biopsy was negative? See Discussion.
Discussion:
Patient has a history of chronic lymphocytic leukemia (CLL). February 2011 abdomen/pelvis x-ray showed development of bilateral renal masses. April 2011 PET scan showed intense areas of hypermetabolic activity corresponding to known bilateral renal masses, new hypermetabolic liver lesions, as well as left upper retroperitoneal lymphadenopathy. All findings are worrisome for malignancy. March 2011 right kidney mass biopsy was positive for diffuse large B-cell lymphoma (DLBCL). Bone marrow biopsy was negative for lymphoma.
Answer:
For cases diagnosed 2010 and forward, access the Hematopoietic Database at http://seer.cancer.gov/seertools/hemelymph.
Per Rule PH25, code the primary site of the diffuse large B-cell lymphoma to C649 (kidneys) and laterality to 4 (bilateral). Per PH25, code the primary site to the organ when a lymphoma is present in an and that . This patient had involvement of an organ (bilateral kidneys) as well as regional lymph nodes for that organ. The retroperitoneal lymph nodes are regional for the kidney.
The diffuse large B-cell lymphoma is an acute transformation of the chronic lymphocytic leukemia. Because the DLBCL occurred more than 21 days after the CLL, it is a new primary per Rule M10.
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 2010
For cases diagnosed 2010-2011, access the Hematopoietic Database at
http://seer.cancer.gov/tools/heme/.
Click on Hematopoietic Project. Click on Hematopoietic and Lymphoid Database. For 2010-2011 diagnoses, click on the "use the 2010 database" label in the upper right corner of the screen. The 2010 Hematopoietic Coding Manual (PDF) will appear which indicates the correct version of the program is available now for query.
The diffuse large B-cell lymphoma is an acute transformation of the chronic lymphocytic leukemia. Because the DLBCL occurred more than 21 days after the CLL, it is considered a new primary per Rule M10.
Code the primary site of the diffuse large B-cell lymphoma to C649 (kidneys) and laterality to 4 (bilateral). The steps used to arrive at this decision are as follows:
Enter in the Heme DB to find the histology. Click on the SEARCH button. Ensure that the term "diffuse large B-cell lymphoma (DLBCL)" [9680/3] is highlighted on the screen.
Note that no Primary Site is listed for DLBCL. Scroll down to the ABSTRACTOR NOTE section and review the documentation. No primary site is specified. However, under the MODULE RULE section, it indicates one should check Module 6, PH 16, PH 19, PH 20.
Click on the 2010 HEMATOPOIETIC CODING MANUAL (PDF). Once in the manual, locate one of the three formats (i.e., flowchart, matrix or text) to check the Primary Site and Histology Coding Rules. The rules are intended to be reviewed in consecutive order within the applicable Module.
Go to MODULE 6 as the Heme DB indicated. Start at Rule PH 16. The rules are intended to be reviewed in consecutive order with a module. No rule applied in MODULE 6 so continue to MODULE 7, which is the Primary Site for Lymphomas Only Module. Start at Rule PH 25. Code the primary site to the bilateral kidneys [C649]. This patient had involvement of an organ (bilateral kidneys) as well as regional lymph nodes for that organ. The retroperitoneal lymph nodes are considered regional for the kidney.
