ICD-10: C82.12

Follicular lymphoma, particularly classified under ICD-10 code C82.12, refers to a specific type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This condition is characterized by the proliferation of follicle center (germinal center) B-cells, leading to the formation of lymphoid follicles. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with follicular lymphoma grade II, particularly when it involves intrathoracic lymph nodes.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is typically indolent, meaning it progresses slowly compared to other types of lymphoma. Grade II indicates a moderate level of aggressiveness, with a higher proliferation rate than grade I but lower than grade III. The involvement of intrathoracic lymph nodes suggests that the lymphoma has spread to the chest area, which can influence the clinical presentation.

Signs and Symptoms

Patients with follicular lymphoma grade II may present with a variety of signs and symptoms, which can include:

• Lymphadenopathy: Swelling of lymph nodes is common, particularly in the neck, armpits, and groin. In cases where intrathoracic lymph nodes are involved, patients may also experience swelling in the chest area.
• Respiratory Symptoms: Patients may report symptoms such as cough, shortness of breath, or chest pain due to the involvement of lymph nodes in the thoracic cavity, which can compress surrounding structures.
• Fatigue: A common symptom in many cancer patients, fatigue can be pronounced in those with lymphoma due to the body’s response to cancer and potential anemia.
• Weight Loss: Unintentional weight loss may occur, often due to a combination of decreased appetite and increased metabolic demands from the disease.
• Night Sweats and Fever: Some patients may experience systemic symptoms such as drenching night sweats and intermittent fevers, which are often associated with lymphoproliferative disorders.

Patient Characteristics

Certain demographic and clinical characteristics are often observed in patients diagnosed with follicular lymphoma:

• Age: Follicular lymphoma is more commonly diagnosed in adults, particularly those aged 50 and older. The median age at diagnosis is typically around 60 years.
• Gender: There is a slight male predominance in the incidence of follicular lymphoma, although it can affect both genders.
• Comorbidities: Patients may have other health conditions that can complicate treatment, such as cardiovascular disease or diabetes, which are more prevalent in older populations.
• Family History: A family history of lymphoproliferative disorders or other cancers may be noted, suggesting a potential genetic predisposition.

Diagnostic Considerations

Diagnosis of follicular lymphoma grade II typically involves a combination of imaging studies (such as CT scans to assess lymph node involvement), biopsy of affected lymph nodes, and histopathological examination to confirm the grade and subtype of lymphoma. Immunophenotyping and genetic studies may also be performed to assess the specific characteristics of the lymphoma cells.

Conclusion

Follicular lymphoma grade II, particularly with intrathoracic lymph node involvement, presents a unique set of challenges in terms of clinical management. Understanding the signs, symptoms, and patient characteristics is crucial for timely diagnosis and effective treatment planning. Given its indolent nature, patients may live for many years with this condition, but close monitoring and appropriate therapeutic interventions are essential to manage symptoms and improve quality of life. Regular follow-ups and supportive care play a vital role in the overall management of patients with this diagnosis.

ICD-10 code C82.12 refers specifically to Follicular lymphoma grade II located in the intrathoracic lymph nodes. This classification is part of the broader category of non-Hodgkin lymphomas, which are a diverse group of blood cancers that include various subtypes. Below are alternative names and related terms associated with this specific diagnosis.

Alternative Names for Follicular Lymphoma Grade II

1. Follicular Lymphoma, Grade 2: This is a direct synonym for C82.12, emphasizing the grade of the lymphoma.
2. Follicular Lymphoma, Intermediate Grade: This term highlights the lymphoma's position between low-grade and high-grade lymphomas.
3. Follicular Lymphoma, Stage II: While not a direct synonym, this term may be used in clinical contexts to describe the extent of the disease, particularly if it involves intrathoracic lymph nodes.

Related Terms

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

Clinical Context

Follicular lymphoma is characterized by its slow growth and is often diagnosed at an advanced stage. The involvement of intrathoracic lymph nodes indicates that the lymphoma has spread beyond its original site, which can influence treatment decisions and prognosis.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.12 is crucial for accurate diagnosis, treatment planning, and communication among healthcare providers. This knowledge aids in ensuring that patients receive appropriate care tailored to their specific type of lymphoma. If you need further details on treatment options or prognosis related to this condition, feel free to ask!

The diagnosis of Follicular Lymphoma, particularly for ICD-10 code C82.12, which specifies "Follicular lymphoma grade II, intrathoracic lymph nodes," involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below is a detailed overview of the criteria used for diagnosing this specific type of lymphoma.

Clinical Presentation

Symptoms

Patients with follicular lymphoma may present with:
- Lymphadenopathy: Swollen lymph nodes, often painless, which can occur in various regions, including the intrathoracic area.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more aggressive disease.
- Fatigue: Generalized fatigue is common among patients.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoproliferative disorders.
- Family history of lymphomas or other malignancies.
- Exposure to certain environmental factors or infections (e.g., Epstein-Barr virus).

Imaging Studies

Radiological Evaluation

Imaging techniques are crucial for assessing the extent of the disease:
- CT Scans: Chest CT scans are particularly useful for visualizing intrathoracic lymph nodes and determining their size and distribution.
- PET Scans: Positron Emission Tomography (PET) scans can help assess metabolic activity in lymph nodes, aiding in the differentiation between benign and malignant processes.

Histopathological Examination

Biopsy

A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes. The following criteria are evaluated:
- Histological Grade: Follicular lymphoma is classified into grades based on the number of centroblasts per high-power field (HPF). Grade II typically has 5-15 centroblasts per HPF.
- Immunophenotyping: The lymphoma cells are analyzed for specific surface markers. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2, while lacking CD5.
- Cytogenetic Analysis: The presence of the t(14;18) chromosomal translocation, which involves the BCL2 gene, is a hallmark of follicular lymphoma and is often assessed through fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR) techniques.

Staging

Ann Arbor Staging System

The Ann Arbor staging system is used to classify the extent of lymphoma:
- Stage I: Involvement of a single lymph node region.
- Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm.
- Stage III: Involvement of lymph node regions on both sides of the diaphragm.
- Stage IV: Disseminated involvement of one or more extralymphatic organs.

For C82.12, the focus is on intrathoracic lymph nodes, which may indicate at least Stage II involvement.

Conclusion

The diagnosis of Follicular Lymphoma grade II, particularly with involvement of intrathoracic lymph nodes (ICD-10 code C82.12), relies on a comprehensive approach that includes clinical evaluation, imaging studies, and histopathological confirmation. Understanding these criteria is essential for accurate diagnosis and subsequent treatment planning, which may involve chemotherapy, immunotherapy, or radiation therapy depending on the disease stage and patient factors.

Follicular lymphoma, particularly classified under ICD-10 code C82.12, refers to a specific type of non-Hodgkin lymphoma that is characterized by the proliferation of follicle center (germinal center) B-cells. This subtype is typically indolent, meaning it tends to grow slowly, but it can transform into a more aggressive form. The treatment approaches for follicular lymphoma, especially when it involves intrathoracic lymph nodes, are multifaceted and depend on various factors, including the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma.

Standard Treatment Approaches

1. Observation (Watchful Waiting)

For patients with asymptomatic follicular lymphoma, particularly those with early-stage disease, a common approach is "watchful waiting." This strategy involves regular monitoring without immediate treatment, as many patients may not require intervention until symptoms develop or the disease progresses.

2. Chemotherapy

When treatment is necessary, chemotherapy is often the first line of defense. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is a standard treatment for various types of non-Hodgkin lymphoma.
• R-CHOP: This is a variation of the CHOP regimen 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. It can also be administered as a standalone treatment for patients who are not candidates for chemotherapy or those with relapsed disease. Other immunotherapeutic agents, such as Obinutuzumab, may also be considered.

4. Radiation Therapy

Radiation therapy can be effective, particularly for localized disease or in cases where there is significant lymphadenopathy causing symptoms. It may be used as a primary treatment or as an adjunct to chemotherapy.

5. Targeted Therapy

Targeted therapies, such as PI3K inhibitors (e.g., Copanlisib), are increasingly being used for follicular lymphoma, especially in relapsed or refractory cases. These therapies specifically target pathways involved in the growth and survival of cancer cells.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, autologous stem cell transplantation may be considered. This approach involves harvesting the patient’s own stem cells, administering high-dose chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function.

7. Clinical Trials

Participation in clinical trials may provide access to new and emerging therapies that are not yet widely available. These trials often explore novel agents or combinations that could improve outcomes for patients with follicular lymphoma.

Conclusion

The management of follicular lymphoma grade II, particularly when it involves intrathoracic lymph nodes, requires a tailored approach based on individual patient factors and disease characteristics. Treatment options range from observation to chemotherapy, immunotherapy, radiation, targeted therapies, and potentially stem cell transplantation. Ongoing research and clinical trials continue to evolve the landscape of treatment, offering hope for improved outcomes in patients with this indolent yet complex disease. For the most effective management, patients should work closely with their healthcare team to determine the best course of action based on their specific situation.

Clinical Description of ICD-10 Code C82.12: Follicular Lymphoma Grade II, Intrathoracic Lymph Nodes

Overview of Follicular Lymphoma

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates from B-lymphocytes, specifically the follicle center cells. It is characterized by a slow-growing nature and is often diagnosed at an advanced stage. Follicular lymphoma is classified into different grades based on the histological features observed under a microscope, with grade II indicating a moderate level of aggressiveness. This classification is crucial for determining the appropriate treatment and prognosis.

ICD-10 Code C82.12 Specifics

The ICD-10 code C82.12 specifically refers to follicular lymphoma grade II that is localized in the intrathoracic lymph nodes. This designation is important for clinical documentation, billing, and treatment planning. The intrathoracic lymph nodes include those located within the thoracic cavity, such as the mediastinal and hilar lymph nodes, which can be involved in the disease process.

Clinical Features

1. Symptoms: Patients with follicular lymphoma may present with:
   - Painless lymphadenopathy (swelling of lymph nodes)
   - Symptoms related to compression of surrounding structures, such as cough or difficulty breathing if the intrathoracic nodes are involved
   - Systemic symptoms like fever, night sweats, and weight loss, although these are less common in early stages.

2. Diagnosis: Diagnosis typically involves:
   - Imaging studies (CT scans or PET scans) to assess lymph node involvement and staging
   - Biopsy of affected lymph nodes to confirm the diagnosis and grade of lymphoma
   - Immunophenotyping and genetic studies to further characterize the lymphoma.

3. Staging: The Ann Arbor staging system is commonly used to determine the extent of lymphoma. For follicular lymphoma, staging is crucial as it influences treatment decisions. The presence of intrathoracic lymph node involvement may indicate a more advanced stage.

Treatment Options

Treatment for follicular lymphoma grade II, particularly when it involves intrathoracic lymph nodes, may include:

• Watchful Waiting: In asymptomatic patients, a conservative approach may be taken.
• Chemotherapy: Regimens such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) are commonly used.
• Immunotherapy: Monoclonal antibodies like Rituximab are often employed.
• Radiation Therapy: This may be used for localized disease or to alleviate symptoms caused by lymph node enlargement.
• Stem Cell Transplantation: In certain cases, especially for relapsed or refractory disease, autologous or allogeneic stem cell transplantation may be considered.

Prognosis

The prognosis for patients with follicular lymphoma grade II can vary significantly based on several factors, including the extent of disease, patient age, overall health, and response to treatment. Generally, follicular lymphoma has a relatively favorable prognosis compared to other aggressive lymphomas, but it is considered incurable in many cases, necessitating ongoing management.

Conclusion

ICD-10 code C82.12 encapsulates a specific diagnosis of follicular lymphoma grade II affecting the intrathoracic lymph nodes, highlighting the importance of accurate coding for treatment and management. Understanding the clinical features, diagnostic processes, treatment options, and prognosis associated with this condition is essential for healthcare providers in delivering effective patient care.