ICD-10: C81.22

Clinical Description of ICD-10 Code C81.22

ICD-10 Code C81.22 specifically refers to Mixed Cellularity Hodgkin Lymphoma (MCHL) that is localized to the intrathoracic lymph nodes. This classification is part of the broader category of Hodgkin lymphoma, which is a type of lymphatic cancer characterized by the presence of Reed-Sternberg cells.

Characteristics of Mixed Cellularity Hodgkin Lymphoma

1. Histological Features:
   - Mixed cellularity Hodgkin lymphoma is noted for a diverse cellular composition, including a mixture of Reed-Sternberg cells, lymphocytes, eosinophils, and plasma cells. This variety contributes to its classification and can influence treatment decisions and prognosis[1][2].

2. Clinical Presentation:
   - Patients with MCHL may present with symptoms such as lymphadenopathy (swollen lymph nodes), fever, night sweats, and weight loss, commonly referred to as "B symptoms." The involvement of intrathoracic lymph nodes can lead to respiratory symptoms, including cough or difficulty breathing, depending on the extent of lymph node enlargement[3][4].

3. Diagnosis:
   - Diagnosis typically involves a combination of imaging studies (such as CT scans) and biopsy of affected lymph nodes. The biopsy is crucial for confirming the presence of Reed-Sternberg cells and determining the specific subtype of Hodgkin lymphoma[5].

4. Staging:
   - The staging of Hodgkin lymphoma, including MCHL, is essential for treatment planning. The Ann Arbor staging system is commonly used, where the presence of intrathoracic lymph node involvement may indicate a more advanced stage of the disease[6].

Treatment Options

1. Chemotherapy:
   - The primary treatment for mixed cellularity Hodgkin lymphoma often involves chemotherapy regimens, such as ABVD (Adriamycin, Bleomycin, Vinblastine, and Dacarbazine), which have shown effectiveness in treating this subtype[7].

2. Radiation Therapy:
   - In some cases, radiation therapy may be used, particularly if the disease is localized to specific areas, including the intrathoracic lymph nodes. This approach can help reduce the size of tumors and alleviate symptoms[8].

3. Targeted Therapies:
   - Newer treatments, including targeted therapies like brentuximab vedotin (Adcetris®), may be considered, especially in cases that are refractory to standard chemotherapy[9].

Conclusion

ICD-10 code C81.22 encapsulates a specific diagnosis of Mixed Cellularity Hodgkin Lymphoma affecting the intrathoracic lymph nodes. Understanding the clinical features, diagnostic criteria, and treatment options is crucial for healthcare providers managing patients with this condition. Early diagnosis and appropriate treatment are vital for improving patient outcomes and managing symptoms effectively. For further information or specific case management, consulting with a hematologist or oncologist is recommended.

Mixed cellularity Hodgkin lymphoma (MCHL), classified under ICD-10 code C81.22, is a subtype of Hodgkin lymphoma characterized by a specific histological pattern. Understanding its clinical presentation, signs, symptoms, and patient characteristics is crucial for diagnosis and management.

Clinical Presentation

Overview of Mixed Cellularity Hodgkin Lymphoma

MCHL is one of the most common subtypes of Hodgkin lymphoma, typically presenting with a mix of different cell types, including Reed-Sternberg cells, lymphocytes, and eosinophils. This subtype is often associated with a more advanced stage of disease at diagnosis compared to other types of Hodgkin lymphoma[11][13].

Common Signs and Symptoms

Patients with MCHL may exhibit a variety of signs and symptoms, which can vary in severity:

• Lymphadenopathy: The most common initial symptom is painless swelling of lymph nodes, particularly in the cervical, axillary, or inguinal regions. In the case of C81.22, intrathoracic lymph nodes may also be involved, leading to mediastinal lymphadenopathy[11][12].

• B Symptoms: These systemic symptoms include:

• Fever: Often low-grade and intermittent.
• Night Sweats: Profuse sweating during the night that can soak clothing and bedding.

• Weight Loss: Unintentional weight loss exceeding 10% of body weight over six months[11][12].

• Respiratory Symptoms: If intrathoracic lymph nodes are significantly enlarged, patients may experience:

• Cough: Persistent cough due to compression of the airways.

• Dyspnea: Shortness of breath, particularly during exertion, caused by mediastinal mass effect[11][12].

• Pruritus: Some patients report generalized itching, which can be distressing and is thought to be related to the release of cytokines[13].

Patient Characteristics

MCHL can affect individuals of various ages, but certain demographic trends are noted:

• Age: It commonly presents in two age groups: young adults (ages 15-35) and older adults (over 55). The peak incidence occurs in the third decade of life[11][12].

• Gender: MCHL has a slight male predominance, with a male-to-female ratio of approximately 1.5:1[11][12].

• Geographic and Ethnic Factors: The incidence of Hodgkin lymphoma, including MCHL, varies by geographic region and ethnicity, with higher rates observed in developed countries and among certain ethnic groups[11][12].

• Associated Conditions: There is an association between MCHL and certain immunocompromised states, such as HIV infection, which can influence the clinical presentation and prognosis[11][12].

Conclusion

Mixed cellularity Hodgkin lymphoma, particularly with involvement of intrathoracic lymph nodes (ICD-10 code C81.22), presents with a range of symptoms primarily related to lymphadenopathy and systemic effects. Recognizing these clinical features is essential for timely diagnosis and treatment. Given the demographic trends, healthcare providers should maintain a high index of suspicion in young adults and older patients presenting with the aforementioned symptoms, particularly in the context of lymphadenopathy and B symptoms. Early intervention can significantly improve patient outcomes in this condition.

ICD-10 code C81.22 refers specifically to "Mixed cellularity Hodgkin lymphoma, intrathoracic lymph nodes." This classification is part of the broader category of Hodgkin lymphoma, which is a type of lymphatic cancer. Below are alternative names and related terms associated with this specific diagnosis:

Alternative Names

1. Mixed Cellularity Hodgkin Lymphoma: This is the primary name for the condition, emphasizing the mixed cellular composition of the tumor.
2. Hodgkin's Disease: A common term used interchangeably with Hodgkin lymphoma, though it is less specific.
3. Intrathoracic Hodgkin Lymphoma: This term highlights the location of the lymphoma within the thoracic cavity, specifically affecting the lymph nodes in that area.

Related Terms

1. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes Hodgkin and non-Hodgkin lymphomas.
2. Lymphadenopathy: Refers to the enlargement of lymph nodes, which is a common symptom in Hodgkin lymphoma.
3. Hodgkin Lymphoma Staging: The process of determining the extent of the disease, which can include stages I through IV, depending on the spread of the lymphoma.
4. Chemotherapy for Hodgkin Lymphoma: A common treatment approach for this type of cancer, often involving a combination of drugs.
5. Radiation Therapy: Another treatment modality that may be used, particularly for localized disease.

Clinical Context

Mixed cellularity Hodgkin lymphoma is characterized by a predominance of mixed inflammatory cells, including Reed-Sternberg cells, which are indicative of the disease. The designation of "intrathoracic lymph nodes" specifies that the affected lymph nodes are located within the thoracic cavity, which can influence treatment decisions and prognosis.

Understanding these alternative names and related terms can be crucial for healthcare professionals when discussing diagnosis, treatment options, and patient management strategies related to C81.22.

The diagnosis of Mixed Cellularity Hodgkin Lymphoma (MCHL), specifically coded as ICD-10 code C81.22 for cases involving intrathoracic lymph nodes, follows a set of established clinical and pathological criteria. Understanding these criteria is essential for accurate diagnosis and appropriate coding. Below is a detailed overview of the diagnostic criteria for MCHL.

Clinical Presentation

Symptoms

Patients with MCHL may present with a variety of symptoms, which can include:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the neck, axilla, or groin.
- B Symptoms: These are systemic symptoms that may include:
- Fever
- Night sweats
- Unexplained weight loss
- Respiratory Symptoms: If intrathoracic lymph nodes are involved, patients may experience cough, chest pain, or difficulty breathing due to lymph node enlargement affecting the thoracic cavity.

Diagnostic Imaging

Imaging Studies

To assess the involvement of intrathoracic lymph nodes, several imaging modalities may be utilized:
- Chest X-ray: Can reveal enlarged lymph nodes or masses in the thoracic region.
- CT Scan: A computed tomography scan of the chest is more sensitive and can provide detailed images of lymph node involvement and any associated mediastinal or pulmonary masses.
- PET Scan: Positron emission tomography may be used to evaluate metabolic activity in lymph nodes, helping to distinguish between benign and malignant processes.

Pathological Evaluation

Biopsy

A definitive diagnosis of MCHL requires histological confirmation through biopsy. The following methods may be employed:
- Excisional Biopsy: Removal of an entire lymph node for examination.
- Core Needle Biopsy: A less invasive option that can provide sufficient tissue for diagnosis.

Histological Criteria

The pathological examination will typically reveal:
- Reed-Sternberg Cells: These are large, abnormal cells that are characteristic of Hodgkin lymphoma. Their presence is crucial for diagnosis.
- Mixed Cellularity: The histological subtype is defined by a predominance of Reed-Sternberg cells along with a varied inflammatory background, including lymphocytes, eosinophils, and plasma cells.

Immunophenotyping

Flow Cytometry

Immunophenotyping through flow cytometry may be performed to characterize the cell types present in the biopsy. Reed-Sternberg cells typically express:
- CD30: A marker commonly associated with Hodgkin lymphoma.
- CD15: Another marker that helps in identifying Reed-Sternberg cells.

Staging

Ann Arbor Staging System

Once diagnosed, the disease is staged using the Ann Arbor classification, which considers the number of lymph node regions involved and the presence of systemic symptoms. For MCHL with intrathoracic lymph node involvement, it is crucial to determine whether the disease is localized (Stage I or II) or has spread (Stage III or IV).

Conclusion

In summary, the diagnosis of Mixed Cellularity Hodgkin Lymphoma (ICD-10 code C81.22) involving intrathoracic lymph nodes is based on a combination of clinical presentation, imaging studies, histological findings, and immunophenotyping. Accurate diagnosis is essential for effective treatment planning and management of the disease. If you have further questions or need additional information on this topic, feel free to ask!

Mixed cellularity Hodgkin lymphoma (MCHL), classified under ICD-10 code C81.22, is a subtype of Hodgkin lymphoma characterized by a diverse mix of cell types within the tumor. This specific type often presents with lymphadenopathy, particularly in the intrathoracic region, and requires a tailored treatment approach based on various factors, including the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma.

Standard Treatment Approaches

1. Chemotherapy

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

• ABVD Regimen: This consists of Adriamycin (doxorubicin), Bleomycin, Vinblastine, and Dacarbazine. ABVD is typically the first-line treatment for advanced-stage Hodgkin lymphoma and is known for its effectiveness and manageable side effects[1].

• BEACOPP Regimen: This regimen includes Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin (Vincristine), Procarbazine, and Prednisone. BEACOPP may be used in more aggressive cases or for patients with a higher risk of treatment failure[2].

2. Radiation Therapy

Radiation therapy may be employed in conjunction with chemotherapy, particularly for localized disease or after chemotherapy to eliminate residual disease. In cases where intrathoracic lymph nodes are involved, involved-field radiation therapy (IFRT) is often utilized to target specific areas affected by the lymphoma[3].

3. Stem Cell Transplantation

For patients with relapsed or refractory MCHL, 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[4].

4. Targeted Therapy

Brentuximab vedotin (Adcetris®) is a targeted therapy that may be used for patients with relapsed or refractory Hodgkin lymphoma, including MCHL. It is an antibody-drug conjugate that targets CD30, a protein commonly expressed on Hodgkin lymphoma cells[5]. This treatment can be particularly beneficial for patients who have not responded to standard chemotherapy.

5. Clinical Trials

Participation in clinical trials may also be an option for patients with MCHL, especially those with advanced disease or those who have not responded to standard treatments. Trials may offer access to new therapies or combinations that are not yet widely available[6].

Conclusion

The treatment of mixed cellularity Hodgkin lymphoma, particularly when involving intrathoracic lymph nodes, typically involves a combination of chemotherapy, radiation therapy, and potentially stem cell transplantation or targeted therapies. The choice of treatment is highly individualized, taking into account the specific characteristics of the disease and the patient's overall health. Ongoing research and clinical trials continue to evolve the treatment landscape, offering hope for improved outcomes in patients with this condition. For the most effective management, patients should consult with a healthcare provider specializing in hematology-oncology to determine the best treatment plan tailored to their needs.