ICD-10: C82.06

ICD-10 code C82.06 refers specifically to Follicular lymphoma grade I located in the intrapelvic lymph nodes. This classification falls under the broader category of non-Hodgkin lymphoma, which encompasses a variety of lymphoid malignancies characterized by the proliferation of lymphocytes.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that originates from B-lymphocytes, specifically from the follicle center (germinal center) of lymphoid tissue. It is one of the most common forms of non-Hodgkin lymphoma and is typically classified into different grades based on histological features, with grade I being the least aggressive.

Characteristics of Grade I Follicular Lymphoma

• Histology: Follicular lymphoma grade I is characterized by a predominance of small, cleaved lymphoid cells. The architecture of the lymphoid tissue is typically preserved, and there is a low proliferation index.
• Clinical Behavior: This grade is associated with a relatively favorable prognosis compared to higher-grade lymphomas. Patients may remain asymptomatic for extended periods, and the disease often presents with lymphadenopathy (swollen lymph nodes) rather than systemic symptoms.

Intrapelvic Involvement

When follicular lymphoma grade I is specified as affecting the intrapelvic lymph nodes, it indicates that the lymphoma has localized to lymph nodes within the pelvic cavity. This can include nodes associated with the iliac vessels, as well as nodes near the bladder, rectum, and reproductive organs.

Symptoms

Patients with intrapelvic lymph node involvement may experience:
- Abdominal or pelvic discomfort
- Swelling or a palpable mass in the pelvic region
- Symptoms related to compression of adjacent structures, such as urinary frequency or difficulty, depending on the extent of lymph node enlargement.

Diagnosis

Diagnosis typically involves:
- Imaging Studies: CT scans or MRI may be used to visualize lymph node enlargement and assess the extent of disease.
- Biopsy: A definitive diagnosis is made through histological examination of lymph node tissue, often obtained via excisional biopsy or fine-needle aspiration.

Treatment

Treatment options for follicular lymphoma grade I may include:
- Watchful Waiting: In asymptomatic cases, especially in older patients, a conservative approach may be adopted.
- Chemotherapy: Regimens may include agents such as bendamustine or rituximab, particularly if the disease progresses or symptoms develop.
- Radiation Therapy: Localized radiation may be considered for symptomatic relief or localized disease.

Conclusion

ICD-10 code C82.06 captures the specific diagnosis of follicular lymphoma grade I affecting the intrapelvic lymph nodes, highlighting the importance of accurate coding for treatment and management. Understanding the clinical characteristics, symptoms, and treatment options is crucial for healthcare providers in managing patients with this condition effectively. 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 C82.06, refers to a specific subtype of non-Hodgkin lymphoma (NHL) that primarily affects the lymphatic system. This type of lymphoma is characterized by its indolent nature and is often diagnosed at a later stage due to its subtle clinical presentation. Below, we explore the clinical presentation, signs, symptoms, and patient characteristics associated with follicular lymphoma grade I, particularly when it involves intrapelvic lymph nodes.

Clinical Presentation

General Characteristics

Follicular lymphoma is a type of B-cell lymphoma that typically arises from follicle center (germinal center) B-cells. It is classified as low-grade (grade I) when the neoplastic cells are predominantly small and well-differentiated. The disease often presents in a disseminated form, affecting multiple lymph nodes and potentially other organs.

Involvement of Intrapelvic Lymph Nodes

When follicular lymphoma involves intrapelvic lymph nodes, it may lead to specific symptoms and signs due to the anatomical location. The intrapelvic lymph nodes are part of the lymphatic drainage system for the lower abdomen and pelvis, and their enlargement can have various clinical implications.

Signs and Symptoms

Common Symptoms

1. Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, which may be palpable in the groin or abdomen. In cases of intrapelvic involvement, lymphadenopathy may not be easily detectable unless imaging studies are performed.

2. Abdominal Discomfort: Patients may experience vague abdominal pain or discomfort due to the pressure exerted by enlarged lymph nodes on surrounding structures.

3. B Symptoms: Some patients may present with systemic symptoms known as "B symptoms," which include:
   - Unexplained fever
   - Night sweats
   - Unintentional weight loss

4. Gastrointestinal Symptoms: If the lymphoma affects lymph nodes near the gastrointestinal tract, patients may experience symptoms such as nausea, vomiting, or changes in bowel habits.

5. Fatigue: A common symptom in many cancer patients, fatigue can be pronounced in those with follicular lymphoma due to the body's response to the malignancy.

Physical Examination Findings

• Palpable Lymph Nodes: On examination, lymph nodes in the inguinal region or lower abdomen may be enlarged.
• Splenomegaly: In some cases, splenomegaly (enlargement of the spleen) may be noted, although it is less common in early-stage disease.

Patient Characteristics

Demographics

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is relatively rare 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 hematologic 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 for developing lymphomas, including follicular lymphoma.

Comorbidities

Patients may present with various comorbid conditions, which can complicate the management of follicular lymphoma. Common comorbidities include cardiovascular diseases, diabetes, and other malignancies.

Conclusion

Follicular lymphoma grade I, particularly when involving intrapelvic lymph nodes, presents with a range of clinical features that can be subtle and easily overlooked. The indolent nature of this lymphoma often leads to a delayed diagnosis, emphasizing the importance of awareness of its signs and symptoms among healthcare providers. Early recognition and appropriate imaging studies are crucial for effective management and treatment planning for affected patients.

ICD-10 code C82.06 refers specifically to "Follicular lymphoma grade I, intrapelvic lymph nodes." This classification falls under the broader category of follicular lymphoma, which is a type of non-Hodgkin lymphoma. Below are alternative names and related terms associated with this diagnosis:

Alternative Names

1. Follicular Lymphoma, Grade 1: This is a direct synonym for C82.06, emphasizing the grade of the lymphoma.
2. Low-Grade Follicular Lymphoma: This term is often used interchangeably with grade I follicular lymphoma, indicating a less aggressive form of the disease.
3. Indolent Follicular Lymphoma: This term highlights the slow-growing nature of grade I follicular lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of non-Hodgkin lymphoma, which encompasses a variety of lymphoid malignancies.
2. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which can occur in patients with follicular lymphoma.
3. Lymphoma: A general term for cancers that originate in the lymphatic system, including both Hodgkin and non-Hodgkin lymphomas.
4. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, as it arises from B lymphocytes.
5. Stage IV Lymphoma: If the disease has spread to the intrapelvic lymph nodes, it may be classified as stage IV, depending on the extent of involvement.

Clinical Context

Follicular lymphoma grade I is characterized by a relatively favorable prognosis compared to higher-grade lymphomas. It is important for healthcare providers to understand these terms for accurate diagnosis, treatment planning, and coding for insurance purposes. The specific mention of "intrapelvic lymph nodes" indicates the location of the lymphoma, which can influence treatment decisions and patient management strategies.

In summary, understanding the alternative names and related terms for ICD-10 code C82.06 is crucial for healthcare professionals involved in the diagnosis and treatment of patients with follicular lymphoma. This knowledge aids in effective communication and documentation within clinical settings.

Follicular lymphoma, particularly classified under ICD-10 code C82.06, refers to a specific type of non-Hodgkin lymphoma that is characterized by its indolent nature and arises from B-lymphocytes. The diagnosis of follicular lymphoma, including grade I, involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosis:

Clinical Presentation

• Symptoms: Patients may present with painless lymphadenopathy, which is the most common symptom. Other symptoms can include fever, night sweats, and weight loss, although these are less common in grade I cases.
• Physical Examination: A thorough physical examination is essential to identify lymph node enlargement, particularly in the intrapelvic region, which is relevant for C82.06.

Imaging Studies

• CT or PET Scans: Imaging techniques such as computed tomography (CT) or positron emission tomography (PET) scans are utilized to assess the extent of lymphadenopathy and to identify any involvement of the intrapelvic lymph nodes. These imaging studies help in staging the disease and determining the appropriate treatment approach.

Histopathological Examination

• Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node. The biopsy can be performed via excisional, incisional, or fine-needle aspiration methods.
• Microscopic Analysis: The histological examination reveals a characteristic follicular pattern of neoplastic proliferation of B-cells. In grade I follicular lymphoma, the neoplastic follicles are well-formed and typically contain a low number of centroblasts (less than 5 per high-power field).
• Immunophenotyping: Flow cytometry or immunohistochemistry is used to confirm the B-cell lineage of the lymphoma cells. The presence of specific markers such as CD10, CD19, CD20, and BCL2 is indicative of follicular lymphoma.

Molecular Studies

• Genetic Testing: The presence of the t(14;18) chromosomal translocation, which results in the overexpression of the BCL2 gene, is a hallmark of follicular lymphoma. This genetic alteration can be detected through techniques such as fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR).

Staging

• Ann Arbor Staging System: The disease is staged according to the Ann Arbor classification, which considers the number of lymph node regions involved and whether there is extranodal involvement. For C82.06, the focus is on intrapelvic lymph nodes.

Conclusion

The diagnosis of follicular lymphoma grade I, particularly in the context of intrapelvic lymph nodes (ICD-10 code C82.06), relies on a comprehensive approach that includes clinical assessment, imaging studies, histopathological evaluation, and molecular testing. Each of these components plays a crucial role in confirming the diagnosis and guiding treatment decisions. If you have further questions or need more specific information, feel free to ask!

Follicular lymphoma, particularly classified under ICD-10 code C82.06, refers to a type of non-Hodgkin lymphoma that is characterized by its indolent nature and typically arises in the lymphatic system. This specific code indicates follicular lymphoma grade I located in the intrapelvic lymph nodes. The treatment approaches for this condition can vary based on several factors, including the stage of the disease, the patient's overall health, and the presence of symptoms. Below is a detailed overview of standard treatment strategies for follicular lymphoma grade I.

Overview of Follicular Lymphoma

Follicular lymphoma is a slow-growing (indolent) form of non-Hodgkin lymphoma that originates from B-cells in the lymphatic system. It is often diagnosed at an advanced stage and can be asymptomatic for long periods. The grading of follicular lymphoma is based on the number of large cells (centroblasts) present in the tissue, with grade I indicating a lower number of these cells and a generally better prognosis compared to higher grades.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For many patients with grade I follicular lymphoma, especially those who are asymptomatic, a strategy known as "watchful waiting" or active surveillance may be employed. This approach involves regular monitoring of the patient's condition without immediate treatment. It is often recommended for patients who do not exhibit significant symptoms or whose disease is not progressing rapidly. Regular follow-ups and imaging studies are conducted to assess any changes in the lymphoma's status.

2. Radiation Therapy

Radiation therapy can be an effective treatment for localized follicular lymphoma, particularly when the disease is confined to a specific area, such as the intrapelvic lymph nodes. This treatment involves the use of high-energy rays to target and kill cancer cells. Radiation therapy may be used as a primary treatment or in conjunction with other therapies, especially if the lymphoma is causing symptoms or if there is a risk of complications.

3. Chemotherapy

Chemotherapy is often used for patients with more advanced disease or those who present with symptoms. Common chemotherapy regimens for follicular lymphoma may include combinations of drugs such as:

• CHOP (Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone)
• R-CHOP (adding Rituximab, a monoclonal antibody targeting CD20 on B-cells)

These regimens aim to reduce the tumor burden and manage symptoms effectively. The choice of chemotherapy regimen may depend on the patient's overall health and specific disease characteristics.

4. Immunotherapy

Rituximab, a monoclonal antibody, is a cornerstone of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. Rituximab targets the CD20 protein on the surface of B-cells, leading to their destruction. This treatment has been shown to improve outcomes and prolong remission in patients with follicular lymphoma.

5. Targeted Therapy

In recent years, targeted therapies have emerged as a promising option for treating follicular lymphoma. These therapies focus on specific pathways involved in cancer cell growth and survival. For instance, drugs like Idelalisib and Copanlisib are used in certain cases, particularly for patients who have relapsed or are refractory to standard treatments.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those who have undergone multiple lines of therapy, stem cell transplantation (either autologous or allogeneic) may be considered. This approach involves high-dose chemotherapy followed by the infusion of stem cells to restore bone marrow function.

Conclusion

The treatment of follicular lymphoma grade I, particularly in the context of intrapelvic lymph nodes, is multifaceted and tailored to the individual patient. While watchful waiting may be appropriate for asymptomatic patients, more active interventions such as radiation therapy, chemotherapy, immunotherapy, and targeted therapies are available for those with symptomatic or advanced disease. Ongoing research continues to refine these treatment strategies, aiming to improve patient outcomes and quality of life. Regular consultations with a hematologist or oncologist specializing in lymphoma are essential for determining the most appropriate treatment plan based on the latest clinical guidelines and individual patient circumstances.