ICD-10: C81.14

Nodular sclerosis Hodgkin lymphoma (NSHL) is a subtype of Hodgkin lymphoma characterized by specific histological features and clinical presentations. The ICD-10 code C81.14 specifically refers to this condition when it affects the lymph nodes of the axilla and upper limb. Below are alternative names and related terms associated with this diagnosis.

Alternative Names for Nodular Sclerosis Hodgkin Lymphoma

1. Nodular Sclerosis Lymphoma: This term is often used interchangeably with nodular sclerosis Hodgkin lymphoma, emphasizing the nodular pattern observed in histological examinations.

2. Nodular Sclerosis Type of Hodgkin Lymphoma: This phrase highlights that it is a specific type within the broader category of Hodgkin lymphoma.

3. Hodgkin's Disease, Nodular Sclerosis Variant: This term reflects the historical nomenclature where Hodgkin lymphoma was commonly referred to as Hodgkin's disease.

4. Lymphocyte-Predominant Hodgkin Lymphoma: While this is technically a different subtype, it is sometimes confused with nodular sclerosis due to overlapping clinical features.

Related Terms

1. Hodgkin Lymphoma: The broader category that includes all subtypes of Hodgkin lymphoma, including nodular sclerosis.

2. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with Hodgkin lymphoma.

3. Axillary Lymph Nodes: Specifically refers to the lymph nodes located in the armpit area, which are often involved in nodular sclerosis Hodgkin lymphoma.

4. Upper Limb Lymph Nodes: This term encompasses lymph nodes in the upper extremities, which may also be affected in cases of NSHL.

5. Histological Subtypes of Hodgkin Lymphoma: This includes various classifications based on microscopic examination, with nodular sclerosis being one of the most common subtypes.

6. B-cell Lymphoma: While Hodgkin lymphoma is distinct from non-Hodgkin lymphomas, it is important to note that NSHL has a B-cell lineage, which can sometimes lead to confusion in terminology.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C81.14 is crucial for accurate diagnosis, treatment planning, and communication among healthcare professionals. These terms not only facilitate better understanding of the condition but also aid in the classification and coding processes essential for patient management and billing. If you need further information or clarification on this topic, feel free to ask!

Nodular sclerosis Hodgkin lymphoma (NSHL) is a subtype of Hodgkin lymphoma characterized by the presence of Reed-Sternberg cells and a specific histological pattern. The ICD-10 code C81.14 specifically refers to cases of nodular sclerosis Hodgkin lymphoma that are localized to the lymph nodes of the axilla (armpit area) and upper limb.

Clinical Description of Nodular Sclerosis Hodgkin Lymphoma

Overview

Nodular sclerosis Hodgkin lymphoma is the most common subtype of Hodgkin lymphoma, accounting for approximately 60-80% of all cases. It typically presents in young adults, particularly those aged 15 to 35, and is slightly more prevalent in females than males. The disease is characterized by the presence of fibrous tissue and a nodular pattern of Reed-Sternberg cells within the lymph nodes.

Symptoms

Patients with NSHL may present with a variety of symptoms, including:
- Lymphadenopathy: Painless swelling of lymph nodes, particularly in the cervical, axillary, or mediastinal regions.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which are indicative of systemic involvement.
- Pruritus: Itching without an apparent rash can also occur.
- Fatigue: Generalized fatigue is common among patients.

Diagnosis

Diagnosis of NSHL typically involves:
- Physical Examination: Assessment of lymphadenopathy and other systemic symptoms.
- Imaging Studies: CT scans or PET scans to evaluate the extent of lymph node involvement and any potential extranodal disease.
- Biopsy: A lymph node biopsy is essential for histological confirmation, where the characteristic Reed-Sternberg cells can be identified.

Staging

The staging of Hodgkin lymphoma is crucial for determining treatment options and prognosis. The Ann Arbor staging system is commonly used, which classifies the disease based on the number of affected lymph node regions and the presence of systemic symptoms.

Specifics of ICD-10 Code C81.14

Definition

ICD-10 code C81.14 is designated for nodular sclerosis Hodgkin lymphoma specifically affecting the lymph nodes of the axilla and upper limb. This localization indicates that the disease is primarily affecting the lymphatic tissues in these areas, which can influence treatment decisions and prognosis.

Treatment Options

Treatment for NSHL typically involves:
- Chemotherapy: The most common regimen includes ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine).
- Radiation Therapy: Often used in conjunction with chemotherapy, especially for localized disease.
- Stem Cell Transplantation: Considered for relapsed or refractory cases.

Prognosis

The prognosis for patients with nodular sclerosis Hodgkin lymphoma is generally favorable, particularly when diagnosed at an early stage. The five-year survival rate can exceed 80% for early-stage disease, but it may vary based on factors such as age, overall health, and response to treatment.

Conclusion

Nodular sclerosis Hodgkin lymphoma, particularly when localized to the lymph nodes of the axilla and upper limb (ICD-10 code C81.14), is a treatable condition with a generally positive prognosis. Early diagnosis and appropriate treatment are critical for improving outcomes. Regular follow-up and monitoring for potential recurrence are essential components of post-treatment care.

Nodular sclerosis Hodgkin lymphoma (NSHL) is a subtype of Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. The ICD-10 code C81.14 specifically refers to NSHL affecting the lymph nodes of the axilla and upper limb. Below is a detailed overview of this condition.

Clinical Presentation

General Overview

Nodular sclerosis Hodgkin lymphoma is the most common subtype of Hodgkin lymphoma, particularly prevalent among young adults and adolescents. It is characterized by the presence of Reed-Sternberg cells within a background of fibrous tissue, which can lead to distinctive clinical features.

Signs and Symptoms

Patients with NSHL may present with a variety of signs and symptoms, which can include:

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the axillary region and upper limbs. Patients may notice enlarged lymph nodes that can be firm and rubbery to the touch.
• B Symptoms: These systemic symptoms include:
• Fever: Often low-grade and intermittent.
• Night Sweats: Profuse sweating during the night that can soak through clothing and bedding.
• Weight Loss: Unintentional weight loss of more than 10% of body weight over six months.
• Pruritus: Some patients may experience itching, which can be generalized or localized.
• Fatigue: A common complaint among patients, often related to the disease process and systemic effects.

Patient Characteristics

Certain demographic and clinical characteristics are commonly associated with NSHL:

• Age: NSHL typically affects younger individuals, with a peak incidence in those aged 15 to 30 years and a second peak in older adults (over 55 years) [1].
• Gender: There is a slight male predominance in the incidence of Hodgkin lymphoma, including NSHL [1].
• Geographic Variation: The incidence of Hodgkin lymphoma can vary by geographic region, with higher rates observed in developed countries [1].
• Family History: A family history of Hodgkin lymphoma or other lymphoproliferative disorders may increase risk [1].

Diagnosis and Evaluation

Diagnosis of NSHL involves a combination of clinical evaluation, imaging studies, and histopathological examination:

• Imaging: CT scans or PET scans are often used to assess the extent of lymphadenopathy and to evaluate for any mediastinal involvement.
• Biopsy: A lymph node biopsy is essential for definitive diagnosis, where histological examination reveals the characteristic Reed-Sternberg cells and the nodular sclerosis pattern [1].
• Staging: The Ann Arbor staging system is commonly used to determine the extent of disease, which is crucial for treatment planning.

Conclusion

Nodular sclerosis Hodgkin lymphoma, particularly affecting the lymph nodes of the axilla and upper limb, presents with distinctive clinical features, including lymphadenopathy and systemic B symptoms. Understanding the patient characteristics and clinical presentation is vital for timely diagnosis and effective management. If you suspect NSHL based on these signs and symptoms, it is essential to pursue further diagnostic evaluation to confirm the diagnosis and initiate appropriate treatment.

References

1. ICD-10-CM TABULAR LIST of DISEASES and INJURIES.

Nodular sclerosis Hodgkin lymphoma (NSHL) is a subtype of Hodgkin lymphoma characterized by specific histological features and clinical presentations. The ICD-10 code C81.14 specifically refers to NSHL affecting the lymph nodes of the axilla and upper limb. The diagnosis of this condition involves several criteria, which can be categorized into clinical, histological, and imaging assessments.

Clinical Criteria

1. Symptoms: Patients may present with symptoms such as:
   - Painless lymphadenopathy, particularly in the axillary region.
   - Systemic symptoms like fever, night sweats, and unexplained weight loss (often referred to as "B symptoms").
   - Fatigue and pruritus (itching) may also be reported.

2. Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes, particularly in the axillary and upper limb regions, which are indicative of NSHL.

Histological Criteria

1. Biopsy: A definitive diagnosis of NSHL requires a lymph node biopsy. The histological examination typically reveals:
   - The presence of Reed-Sternberg cells, which are large, atypical lymphoid cells that are characteristic of Hodgkin lymphoma.
   - A background of inflammatory cells, including lymphocytes, eosinophils, and plasma cells, often in a fibrotic stroma.

2. Immunohistochemistry: Additional tests may include immunohistochemical staining to confirm the presence of Reed-Sternberg cells and to differentiate NSHL from other types of lymphoma. Common markers include:
   - CD30 positivity (a hallmark of Reed-Sternberg cells).
   - CD15 positivity.
   - Negative for other lymphoid markers such as CD20.

Imaging Criteria

1. Radiological Assessment: Imaging studies are crucial for staging and assessing the extent of the disease. Common imaging modalities include:
   - CT Scans: Chest, abdomen, and pelvis CT scans help visualize lymphadenopathy and any potential organ involvement.
   - PET Scans: Positron emission tomography (PET) scans can assess metabolic activity in lymph nodes and help in staging the disease.

2. Staging: The Ann Arbor staging system is often used to classify the extent of Hodgkin lymphoma, which includes:
   - Stage I: Involvement of a single lymph node region.
   - Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm.
   - Stage III: Involvement of lymph node regions on both sides of the diaphragm.
   - Stage IV: Disseminated involvement of one or more extralymphatic organs.

Conclusion

The diagnosis of nodular sclerosis Hodgkin lymphoma, particularly with involvement of the lymph nodes in the axilla and upper limb, relies on a combination of clinical evaluation, histological confirmation through biopsy, and imaging studies to assess the extent of the disease. Accurate diagnosis is crucial for determining the appropriate treatment plan and improving patient outcomes. If you have further questions or need more specific information, feel free to ask!

Nodular sclerosis Hodgkin lymphoma (NSHL), classified under ICD-10 code C81.14, is a subtype of Hodgkin lymphoma characterized by the presence of Reed-Sternberg cells and a specific histological pattern. This type of lymphoma often affects lymph nodes in the axilla and upper limb, and its treatment typically involves a combination of chemotherapy, radiation therapy, and, in some cases, stem cell transplantation. Below is a detailed overview of the standard treatment approaches for NSHL.

Treatment Overview

1. Chemotherapy

Chemotherapy is the cornerstone of treatment for NSHL. The most commonly used regimens include:

• ABVD Regimen: This is the standard first-line treatment and consists of:
• Adriamycin (Doxorubicin)
• Bleomycin
• Vinblastine
• Dacarbazine

The ABVD regimen is typically administered in cycles, often over a period of 6 months, depending on the stage of the disease and the patient's response to treatment[7][8].

• Escalated BEACOPP: For patients with advanced-stage disease or those at high risk of treatment failure, an escalated BEACOPP regimen may be considered. This includes:
• Bleomycin
• Etoposide
• Doxorubicin
• Cyclophosphamide
• Oncovin (Vincristine)
• Procarbazine
• Prednisone

This regimen is more intensive and may be associated with a higher risk of side effects but can improve outcomes in certain patient populations[6][7].

2. Radiation Therapy

Radiation therapy is often used in conjunction with chemotherapy, particularly for localized disease. It may be employed in the following scenarios:

• Involved Field Radiation Therapy (IFRT): This technique targets only the lymph nodes that are involved with cancer, minimizing exposure to surrounding healthy tissues. It is typically used after chemotherapy to eliminate any residual disease[6][8].

• Consolidation Radiation: For patients who achieve a complete response to chemotherapy, radiation may be used as a consolidation treatment to further reduce the risk of relapse, especially in early-stage disease[7].

3. Stem Cell Transplantation

For patients with relapsed or refractory NSHL, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) may be considered. This approach allows for the administration of higher doses of chemotherapy than would be tolerable without the support of stem cell rescue[6][8].

4. Targeted Therapy and Immunotherapy

Recent advancements in treatment have introduced targeted therapies and immunotherapies, such as:

• Brentuximab vedotin (Adcetris): This is an antibody-drug conjugate that targets CD30, a protein expressed on Reed-Sternberg cells. It is used in cases of relapsed or refractory Hodgkin lymphoma and can be combined with chemotherapy or used as a single agent[6][8].

• Checkpoint Inhibitors: Drugs like nivolumab and pembrolizumab, which are PD-1 inhibitors, have shown promise in treating relapsed or refractory Hodgkin lymphoma, providing another option for patients who do not respond to standard therapies[6][8].

Conclusion

The treatment of nodular sclerosis Hodgkin lymphoma (ICD-10 code C81.14) involves a multidisciplinary approach that typically includes chemotherapy, radiation therapy, and potentially stem cell transplantation for advanced cases. Emerging therapies such as targeted treatments and immunotherapies are also becoming integral to the management of this disease, particularly for patients with relapsed or refractory conditions. As treatment protocols continue to evolve, ongoing clinical trials and research are essential to optimize outcomes for patients with NSHL.