MRA Thought of the Day – Lymphoid Neoplasm and MPH
A patient with a history of Stage IB Diffuse Large B-cell Lymphoma of the inguinal nodes was originally diagnosed in 2006 s/p chemotherapy and hormone therapy with remission. Now the patient presents at your facility with palpable lymphadenopathy in the right axillary region. An excision biopsy of the right axillary mass reveals B-cell lymphoma with features intermediate between DLBCL and classical Hodgkins Lymphoma.
Searching ICD-O-3 for the histology code for “B-cell lymphoma with features intermediate between DLBCL and classical Hodgkins Lymphoma” will probably get you nowhere.
Here are my thoughts…
What should you do first?
Using the SEER 2012 Hematopoietic and Lymphoid Database will help you. First, search “B-cell Lymphoma and classical Hodgkins Lymphoma” and you will be surprised with the results of your search. This search reveals a description of the disease exactly as described in your pathology report with an ICD-O-3 histology code of 9596/3. Previously, the term for this code was composite Hodgkin and non-Hodgkin lymphoma.
Now, if you search ICD-O-3 for 9596/3 you will find that this is the code assigned to composite Hodgkin and non-Hodgkin lymphoma. This stresses the usefulness of your Hematopoietic and Lymphoid Database.
Is this a new primary?
Using the 2012 Hematopoietic Coding Manual, as per Rule M8, Hodgkin lymphoma on one site and non-Hodgkin lymphoma in a different site is considered multiple primaries. DLBCL of inguinal nodes in 2006 (non-Hodgkin lymphoma) and composite Hodgkin and non-Hodgkin lymphoma of right axillary nodes in 2012 (classified as Hodgkin lymphoma) are to be abstracted as multiple primaries.
MPH: Rule M8
Seq 01 – DLBCL in 2006 with topography code C77.4 and morphology code 9680/36.
Seq 02 – composite Hodgkin and non-Hodgkin lymphoma with topography code C77.3 and morphology code 9596/36 as per Module 8 Rule PH38.
What do you think?