ICD-10: C82.11

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10-CM code C82.11 specifically refers to follicular lymphoma grade II located in the lymph nodes of the head, face, and neck. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Follicular Lymphoma Grade II

Definition and Classification

Follicular lymphoma is classified as a low-grade (indolent) lymphoma, but grade II indicates a more aggressive behavior compared to grade I. The World Health Organization (WHO) classifies follicular lymphoma based on histological features, with grade II showing a higher proliferation index than grade I, which can influence treatment decisions and prognosis.

Pathophysiology

Follicular lymphoma arises from B-lymphocytes in the germinal centers of lymphoid follicles. The neoplastic cells typically express B-cell markers such as CD19, CD20, and CD10. The genetic hallmark of follicular lymphoma is the t(14;18) chromosomal translocation, which leads to the overexpression of the BCL2 gene, inhibiting apoptosis and allowing for the accumulation of malignant cells.

Symptoms

Patients with follicular lymphoma may present with:
- Painless lymphadenopathy, particularly in the cervical (neck), axillary (armpit), or inguinal (groin) regions.
- Systemic symptoms such as fever, night sweats, and weight loss (B symptoms), although these are less common in early-stage disease.
- Fatigue and malaise.

Diagnosis

Diagnosis typically involves:
- Physical Examination: Assessment of lymph node enlargement.
- Imaging Studies: CT scans or PET scans to evaluate the extent of disease.
- Biopsy: Excisional biopsy of affected lymph nodes to confirm the diagnosis through histopathological examination.
- Immunophenotyping: Flow cytometry or immunohistochemistry to identify specific B-cell markers.

Staging

Staging of follicular lymphoma is crucial for treatment planning and is based on the Ann Arbor system. The involvement of lymph nodes in the head, face, and neck would be classified as stage II if it is localized to one side of the diaphragm.

Treatment Options

Treatment for follicular lymphoma grade II may include:
- Watchful Waiting: In asymptomatic patients, especially those with early-stage disease.
- Chemotherapy: Common regimens include R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone).
- Immunotherapy: Rituximab is often used as a single agent or in combination with chemotherapy.
- Radiation Therapy: May be considered for localized disease.
- Stem Cell Transplantation: In select cases, particularly for relapsed or refractory disease.

Prognosis

The prognosis for patients with follicular lymphoma grade II varies based on several factors, including age, overall health, and response to treatment. The International Prognostic Index (IPI) is often used to assess risk and guide treatment decisions.

Conclusion

ICD-10 code C82.11 captures the specific diagnosis of follicular lymphoma grade II affecting the lymph nodes of the head, face, and neck. Understanding the clinical features, diagnostic criteria, and treatment options is essential for effective management of this indolent yet potentially progressive lymphoma. Regular follow-up and monitoring are crucial for managing this condition, given its variable course and potential for transformation to a more aggressive form of lymphoma.

Follicular lymphoma, particularly classified under ICD-10 code C82.11, is a type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This specific code refers to follicular lymphoma grade II located in 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

Definition and Characteristics

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. Grade II indicates an intermediate level of aggressiveness, with a higher number of centroblasts (a type of B-cell) compared to grade I but fewer than grade III. This classification impacts treatment decisions and prognosis.

Common Patient Demographics

• Age: Typically occurs in adults, with a median age of diagnosis around 60 years.
• Gender: Slightly more common in males than females.
• Ethnicity: No significant ethnic predisposition has been noted, but variations may exist based on geographic regions.

Signs and Symptoms

Lymphadenopathy

• Swollen Lymph Nodes: Patients often present with painless swelling of lymph nodes, particularly in the cervical (neck), axillary (armpit), or inguinal (groin) regions. In the case of C82.11, the lymph nodes of the head, face, and neck are specifically affected.

Systemic Symptoms

• B Symptoms: These include fever, night sweats, and unexplained weight loss. The presence of these symptoms may indicate a more advanced disease stage.
• Fatigue: Patients frequently report a general sense of tiredness or lack of energy, which can be debilitating.

Other Symptoms

• Itching: Some patients may experience pruritus (itching) without an apparent rash.
• Abdominal Symptoms: If the lymphoma spreads to the abdomen, symptoms may include abdominal pain or fullness due to enlarged lymph nodes or spleen.

Diagnostic Considerations

Imaging and Biopsy

• Imaging Studies: CT scans or PET scans are often utilized to assess the extent of lymphadenopathy and to evaluate for any involvement of other organs.
• Biopsy: A definitive diagnosis is made through a lymph node biopsy, which reveals the characteristic follicular architecture and the presence of centroblasts.

Laboratory Tests

• Blood Tests: Routine blood tests may show anemia or elevated lactate dehydrogenase (LDH) levels, which can indicate a more aggressive disease.

Conclusion

Follicular lymphoma grade II, particularly in the lymph nodes of the head, face, and neck, presents with specific clinical features that are essential for diagnosis and management. Recognizing the signs and symptoms, such as lymphadenopathy and systemic B symptoms, along with understanding patient demographics, aids healthcare providers in formulating an effective treatment plan. Early detection and appropriate intervention are crucial for improving patient outcomes in this type of lymphoma.

ICD-10 code C82.11 refers specifically to Follicular lymphoma grade II located in the lymph nodes of the head, face, and neck. This classification is part of 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

1. Follicular Lymphoma, Grade II: This is the primary alternative name, emphasizing the grade of the lymphoma.
2. Follicular Lymphoma, Stage II: While "stage" typically refers to the extent of disease rather than grade, it may sometimes be used interchangeably in casual discussions.
3. Follicular Lymphoma, Lymph Nodes of the Head and Neck: A descriptive term that specifies the anatomical location of the lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes follicular lymphoma as one of its subtypes.
2. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
3. Lymphadenopathy: Refers to the disease of the lymph nodes, which may be associated with follicular lymphoma.
4. B-cell Lymphoma: Follicular lymphoma is a type of B-cell lymphoma, indicating the origin of the cancer cells.
5. Lymphoma Grade II: A simplified term that may be used in clinical settings to refer to the grade without specifying the type.

Clinical Context

Follicular lymphoma is characterized by its indolent nature, often presenting with painless lymphadenopathy. The grade indicates the aggressiveness of the lymphoma, with grade II being intermediate. Understanding these terms is crucial for accurate diagnosis, treatment planning, and communication among healthcare providers.

In summary, while C82.11 specifically denotes follicular lymphoma grade II in the lymph nodes of the head, face, and neck, it is essential to recognize the broader context of non-Hodgkin lymphoma and related terminologies that may arise in clinical discussions.

Follicular lymphoma grade II, classified under ICD-10 code C82.11, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This indolent form of lymphoma typically presents in lymph nodes, particularly in the head, face, and neck regions. The treatment approaches for this condition are multifaceted and depend on various factors, including the stage of the disease, the patient's overall health, and specific symptoms.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For patients with asymptomatic follicular lymphoma grade II, especially those with early-stage disease, a strategy of watchful waiting may be employed. This approach involves regular monitoring without immediate treatment, as the disease often progresses slowly. Treatment is initiated only if symptoms develop or if there is evidence of disease progression.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for symptomatic follicular lymphoma. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used in combination with monoclonal antibodies.
• R-CHOP: The addition of Rituximab (a monoclonal antibody targeting CD20) to the CHOP regimen has significantly improved outcomes for patients with follicular lymphoma. Rituximab enhances the effectiveness of chemotherapy by targeting and destroying lymphoma cells.

3. Immunotherapy

Rituximab is a key component of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. Other monoclonal antibodies, such as Obinutuzumab, may also be considered, particularly in relapsed cases.

4. Radiation Therapy

Radiation therapy may be utilized in specific scenarios, such as localized disease or to alleviate symptoms caused by enlarged lymph nodes. It is particularly effective for patients with limited-stage disease and can be used as a curative approach in some cases.

5. Targeted Therapy

Targeted therapies, such as Bruton’s tyrosine kinase (BTK) inhibitors (e.g., Ibrutinib) and PI3K inhibitors, have emerged as treatment options for relapsed or refractory follicular lymphoma. These therapies work by specifically targeting pathways involved in the survival and proliferation of lymphoma cells.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, autologous stem cell transplantation may be considered. This approach is typically reserved for younger patients or those with more aggressive disease features, as it involves high-dose chemotherapy followed by the infusion of the patient’s own stem cells.

7. Clinical Trials

Participation in clinical trials may be an option for patients seeking access to novel therapies or treatment combinations that are not yet widely available. These trials often explore new drugs, combinations, or treatment strategies that could offer improved outcomes.

Conclusion

The management of follicular lymphoma grade II (ICD-10 code C82.11) is tailored to the individual patient, taking into account the disease's characteristics and the patient's overall health. A multidisciplinary approach involving oncologists, hematologists, and other healthcare professionals is essential to optimize treatment outcomes. Regular follow-up and monitoring are crucial to assess treatment efficacy and manage any potential side effects. As research continues to evolve, new therapies and strategies are likely to emerge, further enhancing the management of this indolent lymphoma.

The diagnosis of Follicular Lymphoma, particularly for the ICD-10 code C82.11, which specifies grade II follicular lymphoma located in the lymph nodes of the head, face, and neck, involves several key criteria. These criteria are essential for accurate diagnosis and classification, which can influence treatment decisions and prognosis.

Diagnostic Criteria for Follicular Lymphoma

1. Histological Examination

• Tissue Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node. The histological examination will reveal the characteristic follicular architecture, which is essential for identifying the lymphoma type.
• Grading: Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF). Grade II typically indicates 5 to 15 centroblasts per HPF, which is crucial for classification under the ICD-10 code C82.11.

2. Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers on the lymphoma cells. Follicular lymphoma cells typically express CD19, CD20, and CD10, along with B-cell markers, while lacking T-cell markers.
• BCL2 Gene Rearrangement: The presence of the BCL2 gene rearrangement is a hallmark of follicular lymphoma, which can be confirmed through molecular testing.

3. Clinical Presentation

• Symptoms: Patients may present with painless lymphadenopathy, particularly in the head, face, and neck regions. Other systemic symptoms may include fever, night sweats, and weight loss, although these are less common in early-stage follicular lymphoma.
• Physical Examination: A thorough examination will help identify the extent of lymphadenopathy and any other affected areas.

4. Imaging Studies

• CT or PET Scans: Imaging studies are often employed to assess the extent of disease involvement in lymph nodes and to rule out other conditions. These scans can help determine if the lymphoma is localized or has spread to other areas.

5. Staging

• Ann Arbor Staging System: The staging of follicular lymphoma is crucial for treatment planning. The Ann Arbor system classifies the disease based on the number of lymph node regions involved and whether there is extranodal involvement.

6. Exclusion of Other Conditions

• Differential Diagnosis: It is important to rule out other types of lymphomas and reactive lymphadenopathy. Conditions such as Hodgkin lymphoma, other non-Hodgkin lymphomas, and infections must be considered.

Conclusion

The diagnosis of Follicular Lymphoma grade II (ICD-10 code C82.11) in the lymph nodes of the head, face, and neck is a multifaceted process that relies on histological, immunophenotypic, clinical, and imaging criteria. Accurate diagnosis is essential for effective treatment and management of the disease. If you have further questions or need more specific information regarding treatment options or prognosis, feel free to ask!