ICD-10: C82.04

Follicular lymphoma, particularly grade I, is a type of non-Hodgkin lymphoma characterized by slow growth and a generally favorable prognosis. The ICD-10 code C82.04 specifically refers to follicular lymphoma grade I located in the lymph nodes of the axilla and upper limb. Treatment approaches for this condition can vary based on several factors, including the patient's overall health, the extent of the disease, and individual preferences. Below is a detailed overview of standard treatment approaches for this specific diagnosis.

Standard Treatment Approaches

1. Observation (Watchful Waiting)

For patients with asymptomatic follicular lymphoma grade I, especially those with limited disease, a common approach is "watchful waiting." This strategy involves regular monitoring without immediate treatment. It is often recommended for older patients or those with other health issues, as the disease typically progresses slowly.

2. Chemotherapy

When treatment is necessary, chemotherapy is a cornerstone of therapy for follicular lymphoma. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for more aggressive forms but can be applied in certain cases of follicular lymphoma.
• R-CHOP: This is a variation that includes Rituximab, a monoclonal antibody that targets CD20 on B-cells, enhancing the effectiveness of chemotherapy.

3. Immunotherapy

Rituximab is frequently used in combination with chemotherapy or as a standalone treatment for patients who are not candidates for chemotherapy. It can be administered as:

• Monotherapy: For patients with low tumor burden or those who are asymptomatic.
• Combination Therapy: Alongside chemotherapy regimens like R-CHOP.

4. Radiation Therapy

Localized radiation therapy may be considered for patients with limited-stage disease, particularly if they have bulky lymph nodes or if the lymphoma is causing symptoms. Radiation can help reduce the size of the tumor and alleviate symptoms.

5. Targeted Therapy

Recent advancements have introduced targeted therapies that focus on specific pathways involved in the growth of lymphoma cells. For follicular lymphoma, options may include:

• PI3K Inhibitors: Such as Copanlisib (Aliqopa), which is approved for relapsed follicular lymphoma.
• BCL-2 Inhibitors: Like Venetoclax, which can be effective in certain cases.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those who have undergone multiple lines of therapy, autologous stem cell transplantation may be considered. This approach involves harvesting the patient's stem cells, administering high-dose chemotherapy, and then reinfusing the stem cells to restore bone marrow function.

Conclusion

The treatment of follicular lymphoma grade I, particularly in the axilla and upper limb, is multifaceted and tailored to the individual patient. While watchful waiting may be appropriate for some, others may require chemotherapy, immunotherapy, or targeted treatments based on their specific circumstances. Ongoing clinical trials and research continue to refine these approaches, offering hope for improved outcomes in patients with this type of lymphoma. Regular follow-up and monitoring are essential to adapt treatment plans as needed and to manage any potential side effects effectively.

ICD-10 code C82.04 specifically refers to Follicular lymphoma grade I located in the lymph nodes of the axilla and upper limb. This classification is part of the broader category of non-Hodgkin lymphomas, which are a diverse group of blood cancers that originate in the lymphatic system.

Clinical Description of Follicular Lymphoma Grade I

Overview

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. It is classified into different grades based on histological features, with grade I being the least aggressive form. The disease typically presents with painless lymphadenopathy, which can occur in various regions, including the axillary (armpit) and upper limb lymph nodes.

Symptoms

Patients with follicular lymphoma grade I may experience:
- Painless swelling of lymph nodes, particularly in the axilla and upper limb.
- Fatigue and general malaise.
- Unexplained weight loss.
- Night sweats and fever, although these are less common in grade I compared to higher grades.

Diagnosis

Diagnosis of follicular lymphoma grade I involves:
- Physical examination to assess lymph node enlargement.
- Imaging studies such as CT scans or PET scans to evaluate the extent of lymph node involvement.
- Biopsy of affected lymph nodes to confirm the diagnosis and determine the grade of lymphoma through histopathological examination.

Treatment Options

Treatment for follicular lymphoma grade I may vary based on the stage of the disease and the patient's overall health. Common approaches include:
- Watchful waiting: In cases where the lymphoma is asymptomatic and not causing significant issues, a "watch and wait" approach may be adopted.
- Chemotherapy: Regimens may include agents such as bendamustine or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).
- Immunotherapy: Monoclonal antibodies like rituximab are often used in conjunction with chemotherapy.
- Radiation therapy: This may be considered for localized disease.

Prognosis

The prognosis for patients with follicular lymphoma grade I is generally favorable, with many individuals living for years without significant symptoms. The indolent nature of this lymphoma allows for a variety of management strategies, and many patients may not require immediate treatment.

Conclusion

ICD-10 code C82.04 encapsulates a specific diagnosis of follicular lymphoma grade I affecting the lymph nodes of the axilla and upper limb. Understanding the clinical features, diagnostic methods, and treatment options is crucial for effective management of this condition. Regular follow-up and monitoring are essential to address any changes in the disease status and to adapt treatment plans accordingly.

Follicular lymphoma, particularly classified under ICD-10 code C82.04, refers to a specific subtype of non-Hodgkin lymphoma (NHL) characterized by its indolent nature and distinct histological features. This lymphoma primarily affects the lymph nodes, and in the case of C82.04, it specifically involves the lymph nodes of the axilla and upper limb. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is a type of B-cell lymphoma that arises from follicle center (germinal center) B-cells. It is typically classified into different grades based on histological features, with grade I being the least aggressive form. The disease often presents in a nodal form, affecting lymph nodes, but can also involve extranodal sites.

Common Sites of Involvement

For C82.04, the primary sites of involvement are:
- Axillary lymph nodes: Located in the armpit area, these nodes are often the first to show enlargement.
- Upper limb lymph nodes: This includes nodes in the shoulder and upper arm regions.

Signs and Symptoms

Lymphadenopathy

• Painless lymph node enlargement: The most common symptom is the presence of enlarged lymph nodes, which are typically non-tender and may be felt in the axilla or upper limb. Patients often notice these enlargements during self-examination or routine physical exams.

Systemic Symptoms

• B symptoms: Some patients may experience systemic symptoms, which can include:
• Fever: Intermittent fevers that may not have an obvious cause.
• Night sweats: Profuse sweating during the night that can soak clothing and bedding.
• Weight loss: Unintentional weight loss of more than 10% of body weight over six months.

Other Symptoms

• Fatigue: Patients often report a general sense of tiredness or lack of energy.
• Pruritus: Some individuals may experience itching, which can be localized or generalized.

Patient Characteristics

Demographics

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. However, it can occur in younger individuals.
• Gender: There is a slight male predominance in the incidence of follicular lymphoma.

Risk Factors

• Family history: A family history of lymphoma or other hematological malignancies may increase risk.
• Immunosuppression: Patients with compromised immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, are at higher risk.
• Environmental exposures: Certain environmental factors, including exposure to pesticides and solvents, have been suggested as potential risk factors.

Comorbidities

• Patients may present with other health conditions, such as cardiovascular disease or diabetes, which can complicate the management of lymphoma.

Conclusion

Follicular lymphoma grade I, particularly affecting the lymph nodes of the axilla and upper limb (ICD-10 code C82.04), is characterized by painless lymphadenopathy, potential systemic symptoms, and specific patient demographics. Understanding these clinical presentations and patient characteristics is crucial for timely diagnosis and management. If you suspect follicular lymphoma or have concerns about symptoms, it is essential to consult a healthcare professional for further evaluation and potential diagnostic testing.

ICD-10 code C82.04 refers specifically to Follicular lymphoma grade I, localized in the lymph nodes of the axilla and upper limb. This classification falls under the broader category of non-Hodgkin lymphoma, which encompasses various types of lymphatic cancers. Below are alternative names and related terms associated with this specific diagnosis.

Alternative Names for Follicular Lymphoma Grade I

1. Follicular Lymphoma, Low-Grade: This term emphasizes the indolent nature of grade I follicular lymphoma, which typically has a slower progression compared to higher-grade lymphomas.

2. Grade I Follicular Lymphoma: A straightforward alternative that highlights the specific grade of the lymphoma.

3. Indolent Follicular Lymphoma: This term is often used to describe the slow-growing characteristics of grade I follicular lymphoma.

4. Follicular Lymphoma, Stage I: While not a direct synonym, this term may be used in clinical settings to indicate the localized nature of the disease.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of non-Hodgkin lymphoma, which is a broader category of lymphatic cancers.

2. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes various types, including Hodgkin and non-Hodgkin lymphomas.

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

4. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, as it originates from B-lymphocytes.

5. Lymphoma Grade: Refers to the classification of lymphomas based on their histological characteristics, with grade I indicating a less aggressive form.

6. Lymphoma Staging: While C82.04 specifies a particular site, staging (I-IV) is crucial for understanding the extent of the disease.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.04 is essential for accurate communication in clinical settings, research, and patient education. These terms help in identifying the specific characteristics and classifications of follicular lymphoma grade I, particularly in relation to its location and behavior within the lymphatic system. If you need further details or specific information about treatment options or prognosis, feel free to ask!

Diagnosing Follicular Lymphoma, particularly for the ICD-10 code C82.04, which specifies "Follicular lymphoma grade I, lymph nodes of axilla and upper limb," involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below is a detailed overview of the criteria used for diagnosis.

Clinical Evaluation

Symptoms

Patients may present with:
- Painless swelling of lymph nodes, particularly in the axillary and upper limb regions.
- Systemic symptoms such as fever, night sweats, and unexplained weight loss, although these are less common in early-stage follicular lymphoma.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoproliferative disorders.
- Family history of lymphoma or other malignancies.

Imaging Studies

Lymph Node Assessment

• Ultrasound: Often the first imaging modality used to assess lymph node enlargement.
• CT Scan: A computed tomography scan of the chest, abdomen, and pelvis can help evaluate the extent of lymphadenopathy and any potential involvement of other organs.
• PET Scan: Positron emission tomography may be utilized to assess metabolic activity in lymph nodes and to differentiate between benign and malignant processes.

Histopathological Examination

Biopsy

• Excisional Biopsy: The gold standard for diagnosis is an excisional biopsy of an affected lymph node. This allows for comprehensive histological evaluation.
• Fine Needle Aspiration (FNA): While less invasive, FNA may not provide sufficient tissue for a definitive diagnosis.

Microscopic Features

• Follicular Architecture: The presence of neoplastic follicles that resemble normal germinal centers is characteristic of follicular lymphoma.
• Cell Type: The neoplastic cells are typically small to medium-sized lymphoid cells with a predominance of follicle center (germinal center) B-cells.
• Grading: Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF):
• Grade I: 0-5 centroblasts per HPF.
• Grade II: 6-15 centroblasts per HPF.
• Grade III: More than 15 centroblasts per HPF.

Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers on the lymphoid cells. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2, while lacking CD5.

Molecular Studies

Genetic Testing

• t(14;18) Translocation: Detection of the BCL2 gene rearrangement is a hallmark of follicular lymphoma and can be confirmed through techniques such as PCR or FISH (Fluorescence In Situ Hybridization).

Conclusion

The diagnosis of Follicular Lymphoma grade I, particularly in the lymph nodes of the axilla and upper limb, is a multifaceted process that combines clinical assessment, imaging studies, histopathological evaluation, and molecular testing. Each of these components plays a critical role in confirming the diagnosis and determining the appropriate management strategy. If you have further questions or need additional information on treatment options or prognosis, feel free to ask!