ICD-10: C81.31

ICD-10 code C81.31 refers specifically to Lymphocyte Depleted Hodgkin Lymphoma affecting the lymph nodes of the head, face, and neck. This classification is part of the broader category of Hodgkin lymphoma, which is a type of cancer that originates in the lymphatic system, particularly from a specific type of white blood cell known as lymphocytes.

Clinical Description

Definition

Lymphocyte Depleted Hodgkin Lymphoma is characterized by a predominance of Reed-Sternberg cells, which are large, abnormal lymphocytes. This subtype is less common than other forms of Hodgkin lymphoma and is often associated with a poorer prognosis. The term "lymphocyte depleted" indicates that there is a significant reduction in the number of normal lymphocytes in the affected tissue, which can lead to a compromised immune response.

Symptoms

Patients with lymphocyte depleted Hodgkin lymphoma may present with various symptoms, including:
- Swollen lymph nodes: Typically in the neck, face, or other regions.
- Fever: Often intermittent and may be accompanied by night sweats.
- Weight loss: Unintentional weight loss can occur.
- Fatigue: A general feeling of tiredness or lack of energy.
- Itching: Some patients report generalized itching without a rash.

Diagnosis

Diagnosis of lymphocyte depleted Hodgkin lymphoma typically involves:
- Physical examination: Assessment of swollen lymph nodes.
- Imaging studies: CT scans or PET scans to evaluate the extent of the disease.
- Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, where the presence of Reed-Sternberg cells can be confirmed.

Treatment

Treatment options for lymphocyte depleted Hodgkin lymphoma may include:
- Chemotherapy: Often the first line of treatment, using a combination of drugs to target cancer cells.
- Radiation therapy: May be used in conjunction with chemotherapy, especially if the disease is localized.
- Stem cell transplant: In cases of relapse or refractory disease, a stem cell transplant may be considered.

Coding and Documentation

When documenting a diagnosis of lymphocyte depleted Hodgkin lymphoma, it is essential to use the correct ICD-10 code (C81.31) to ensure accurate billing and coding practices. This code specifically indicates the location of the lymphoma in the lymph nodes of the head, face, and neck, which is crucial for treatment planning and epidemiological tracking.

Related Codes

• C81.3: This is the broader category for Hodgkin lymphoma, which includes various subtypes.
• C81.32: Refers to lymphocyte depleted Hodgkin lymphoma in other locations.

Conclusion

ICD-10 code C81.31 is a critical classification for healthcare providers dealing with lymphocyte depleted Hodgkin lymphoma affecting the lymph nodes of the head, face, and neck. Understanding the clinical features, diagnostic criteria, and treatment options is essential for effective patient management and accurate coding practices. Proper documentation and coding not only facilitate appropriate treatment but also contribute to the overall understanding of this rare lymphoma subtype in clinical research and epidemiology.

Lymphocyte depleted Hodgkin lymphoma (LDHL) is a rare subtype of Hodgkin lymphoma characterized by a predominance of Reed-Sternberg cells and a significant depletion of lymphocytes. This condition is classified under the ICD-10 code C81.31, which specifically refers to lymphocyte depleted Hodgkin lymphoma affecting the lymph nodes of the head, face, and neck. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for accurate diagnosis and management.

Clinical Presentation

Patient Characteristics

• Demographics: LDHL typically presents in older adults, with a median age of diagnosis around 50 years. It is more common in males than females, with a male-to-female ratio of approximately 2:1[1].
• Risk Factors: Patients may have a history of immunosuppression, such as those with HIV/AIDS or those who have undergone organ transplantation, which increases the risk of developing this subtype of lymphoma[1][2].

Signs and Symptoms

• Lymphadenopathy: The most common clinical finding is painless lymphadenopathy, particularly in the cervical (neck) region. Patients may notice swollen lymph nodes in the head, face, and neck areas[2].
• B Symptoms: Many patients experience systemic symptoms known as "B symptoms," which include:
• Fever: Unexplained fevers that may be intermittent.
• Night Sweats: Profuse sweating during the night, often soaking bedclothes.
• Weight Loss: Unintentional weight loss exceeding 10% of body weight over six months[3].
• Fatigue: Patients often report significant fatigue and malaise, which can be debilitating and affect daily activities[2].
• Pruritus: Some patients may experience itching, which is not necessarily related to the presence of skin lesions[3].

Additional Symptoms

• Respiratory Symptoms: If the lymphoma involves mediastinal lymph nodes, patients may present with cough, dyspnea, or chest discomfort due to compression of the airways[2].
• Abdominal Symptoms: In cases where lymph nodes in the abdomen are affected, symptoms may include abdominal pain or discomfort, and in some cases, bowel obstruction[3].

Diagnostic Considerations

• Histological Examination: Diagnosis is confirmed through biopsy of affected lymph nodes, revealing the characteristic Reed-Sternberg cells amidst a background of sparse lymphocytes[1].
• Imaging Studies: CT scans of the neck, chest, abdomen, and pelvis are often utilized to assess the extent of disease and involvement of lymph nodes[2].
• Staging: The Ann Arbor staging system is commonly used to determine the extent of the disease, which is crucial for treatment planning[3].

Conclusion

Lymphocyte depleted Hodgkin lymphoma, particularly affecting the lymph nodes of the head, face, and neck, presents with distinct clinical features that necessitate careful evaluation. The combination of lymphadenopathy, systemic B symptoms, and patient demographics plays a critical role in the diagnosis and management of this rare lymphoma subtype. Early recognition and appropriate staging are essential for optimizing treatment outcomes and improving patient prognosis.

For further information or specific case studies, consulting recent literature or clinical guidelines on Hodgkin lymphoma may provide additional insights into management strategies and emerging therapies.

ICD-10 code C81.31 refers specifically to "Lymphocyte depleted Hodgkin lymphoma, lymph nodes of head, face, and neck." This classification is part of the broader category of Hodgkin lymphoma, which is a type of cancer that originates in the lymphatic system. Below are alternative names and related terms associated with this specific diagnosis.

Alternative Names for C81.31

1. Lymphocyte Depleted Hodgkin's Disease: This term is often used interchangeably with Hodgkin lymphoma, particularly when referring to the lymphocyte-depleted subtype.

2. Hodgkin Lymphoma, Lymphocyte Depleted Type: This is a more descriptive term that emphasizes the specific subtype of Hodgkin lymphoma.

3. Hodgkin's Lymphoma, Mixed Cellularity Variant: While not a direct synonym, this term is related as it describes another subtype of Hodgkin lymphoma that may be confused with lymphocyte-depleted forms due to overlapping characteristics.

Related Terms

1. Hodgkin Lymphoma: The broader category under which C81.31 falls, encompassing various subtypes, including lymphocyte-depleted.

2. Non-Hodgkin Lymphoma: While distinct from Hodgkin lymphoma, this term is often mentioned in discussions about lymphatic cancers and may be relevant in differential diagnoses.

3. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in Hodgkin lymphoma and can be associated with C81.31.

4. Lymphoma: A general term for cancers that affect the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.

5. Stage II Hodgkin Lymphoma: If the lymphoma is localized to the lymph nodes of the head, face, and neck, it may be classified under this staging, which is relevant for treatment and prognosis discussions.

6. Lymphocyte Depletion: This term describes the pathological feature of the lymphoma, indicating a significant reduction in lymphocytes, which is characteristic of this subtype.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C81.31 is crucial for accurate diagnosis, treatment planning, and communication among healthcare professionals. These terms help clarify the specific type of Hodgkin lymphoma being discussed and its implications for patient care. If you need further information on treatment options or prognosis related to this condition, feel free to ask!

Lymphocyte depleted Hodgkin lymphoma (LDHL) is a rare subtype of Hodgkin lymphoma characterized by a predominance of Reed-Sternberg cells and a significant depletion of lymphocytes. The diagnosis of LDHL, particularly when it involves the lymph nodes of the head, face, and neck, follows specific criteria that align with the ICD-10 code C81.31. Below, we explore the diagnostic criteria and relevant considerations for this condition.

Diagnostic Criteria for Lymphocyte Depleted Hodgkin Lymphoma

1. Clinical Presentation

• Symptoms: Patients may present with symptoms such as painless lymphadenopathy, fever, night sweats, and weight loss, commonly referred to as "B symptoms." In cases involving the head, face, and neck, swelling or discomfort in these areas may be noted[1].
• Physical Examination: A thorough examination may reveal enlarged lymph nodes in the cervical region, which can be firm and non-tender.

2. Histopathological Examination

• Biopsy: A definitive diagnosis requires a lymph node biopsy. The histological examination is crucial for identifying the characteristic Reed-Sternberg cells, which are large, atypical cells that are a hallmark of Hodgkin lymphoma[2].
• Cellularity: In LDHL, there is a notable depletion of lymphocytes, with a predominance of Reed-Sternberg cells and a fibrotic background. This contrasts with other subtypes of Hodgkin lymphoma, which typically have a more balanced cellular composition[3].

3. Immunophenotyping

• Immunohistochemistry: The use of immunohistochemical stains is essential to confirm the diagnosis. Reed-Sternberg cells typically express CD30 and CD15, while they lack B-cell markers such as CD20. The presence of these markers helps differentiate LDHL from other lymphomas[4].

4. Radiological Assessment

• Imaging Studies: Imaging techniques such as CT scans or PET scans are often employed to assess the extent of disease involvement, particularly in the lymph nodes of the head, face, and neck. These studies help in staging the disease and planning treatment[5].

5. Staging

• Ann Arbor Staging System: The Ann Arbor classification is used to stage Hodgkin lymphoma, which is critical for determining prognosis and treatment options. Staging considers the number of lymph node regions involved and whether the disease has spread to other organs[6].

6. Exclusion of Other Conditions

• Differential Diagnosis: It is important to rule out other conditions that may mimic LDHL, such as non-Hodgkin lymphomas or reactive lymphadenopathy due to infections. This is typically done through clinical evaluation and additional laboratory tests[7].

Conclusion

The diagnosis of lymphocyte depleted Hodgkin lymphoma, particularly in the lymph nodes of the head, face, and neck, involves a comprehensive approach that includes clinical evaluation, histopathological examination, immunophenotyping, imaging studies, and staging. Accurate diagnosis is crucial for effective treatment planning and management of the disease. If you have further questions or need more specific information regarding treatment options or prognosis, feel free to ask!

Lymphocyte depleted Hodgkin lymphoma (LDHL), classified under ICD-10 code C81.31, is a rare subtype of Hodgkin lymphoma characterized by a predominance of Reed-Sternberg cells and a scarcity of lymphocytes. This specific type often presents in the lymph nodes of the head, face, and neck, 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 this condition.

Treatment Approaches for Lymphocyte Depleted Hodgkin Lymphoma

1. Chemotherapy

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

• ABVD Regimen: This includes Adriamycin (doxorubicin), Bleomycin, Vinblastine, and Dacarbazine. While ABVD is standard for many Hodgkin lymphoma cases, its effectiveness in LDHL may be limited due to the aggressive nature of this subtype.

• BEACOPP Regimen: This regimen (Bleomycin, Etoposide, Adriamycin, Cyclophosphamide, Oncovin, Procarbazine, and Prednisone) is often considered for patients with advanced disease or those who do not respond adequately to ABVD. BEACOPP has shown improved outcomes in some studies for aggressive forms of Hodgkin lymphoma, including LDHL[1].

2. Radiation Therapy

Radiation therapy may be employed as a part of the treatment plan, particularly in localized cases. It can be used:

• Post-Chemotherapy: To target residual disease after chemotherapy, especially if there is a significant mass remaining.

• Palliative Care: In cases where the disease is advanced and symptomatic, radiation can help alleviate symptoms by reducing tumor size and associated discomfort[2].

3. Stem Cell Transplantation

For patients with relapsed or refractory LDHL, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) may be considered. This approach is particularly relevant for those who do not achieve a complete response to initial treatments. ASCT allows for the administration of higher doses of chemotherapy, which can be more effective against resistant disease[3].

4. Targeted Therapy and Immunotherapy

While traditional chemotherapy remains the primary treatment, there is growing interest in targeted therapies and immunotherapy for Hodgkin lymphoma:

• Brentuximab Vedotin (Adcetris®): This is an antibody-drug conjugate that targets CD30, a protein expressed on Reed-Sternberg cells. It is often used in relapsed cases or as part of a combination therapy for patients who are not candidates for standard chemotherapy[4].

• Checkpoint Inhibitors: Drugs such as nivolumab and pembrolizumab, which target PD-1, have shown promise in treating relapsed Hodgkin lymphoma and may be considered in specific cases[5].

5. Clinical Trials

Given the rarity of LDHL, participation in clinical trials may be an option for patients. These trials often explore new treatment combinations or novel therapies that could provide additional benefits over standard approaches.

Conclusion

The treatment of lymphocyte depleted Hodgkin lymphoma, particularly in the lymph nodes of the head, face, and neck, requires a tailored approach that considers the aggressive nature of the disease. Standard treatment typically involves chemotherapy, possibly followed by radiation therapy and stem cell transplantation for advanced cases. Emerging therapies, including targeted treatments and immunotherapy, are also becoming integral to the management of this challenging condition. Patients are encouraged to discuss all available options, including clinical trials, with their healthcare providers to determine the best course of action for their specific situation.

References

1. Article - Billing and Coding: Radiation Therapies (A59350).
2. Medical Necessity Tool for Flow Cytometry.
3. Adcetris® (brentuximab vedotin).
4. ICD - O International Classification of Diseases for Oncology.
5. 2025 ICD-10-CM Diagnosis Code C81.31.