ICD-10: C82.14

Diagnosing Follicular Lymphoma, particularly grade II, involves a combination of clinical evaluation, imaging studies, and histopathological examination. The ICD-10 code C82.14 specifically refers to Follicular Lymphoma grade II located in the lymph nodes of the axilla and upper limb. Below is a detailed overview of the criteria used for diagnosis.

Clinical Presentation

Symptoms

Patients with Follicular Lymphoma may present with:
- Painless lymphadenopathy: Swelling of lymph nodes, particularly in the axillary region.
- B symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more aggressive disease.

Physical Examination

• Lymph node examination: Enlarged lymph nodes in the axilla and upper limb are typically noted during a physical exam.
• General health assessment: Evaluating for signs of systemic illness or other lymphatic involvement.

Imaging Studies

Radiological Evaluation

• CT Scans: Computed tomography scans of the chest, abdomen, and pelvis can help identify lymphadenopathy and assess the extent of disease.
• PET Scans: Positron emission tomography may be used to evaluate metabolic activity in lymph nodes, helping to distinguish between active disease and benign conditions.

Histopathological Criteria

Biopsy

• Excisional or Core Needle Biopsy: A definitive diagnosis is made through the histological examination of lymph node tissue. The biopsy should show:
• Follicular architecture: The presence of neoplastic follicles.
• Cellularity: Increased number of follicle center (germinal center) cells.
• Cytological features: The presence of centrocytes and centroblasts, with a predominance of centrocytes in grade II.

Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers on the cells. Follicular lymphoma typically expresses:
• CD10: A marker for germinal center B-cells.
• BCL2: Overexpression due to the t(14;18) translocation, which is characteristic of follicular lymphoma.
• CD19 and CD20: Common B-cell markers.

Molecular and Genetic Testing

Genetic Analysis

• Cytogenetic Studies: Detection of the t(14;18) translocation is crucial for confirming the diagnosis of follicular lymphoma. This translocation leads to the overexpression of the BCL2 gene, inhibiting apoptosis and contributing to the survival of malignant B-cells.

Staging and Grading

Ann Arbor Staging System

• The disease is staged based on the extent of lymph node involvement and any systemic symptoms. For C82.14, the focus is on stage II, indicating involvement of lymph nodes on both sides of the diaphragm.

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.

Conclusion

The diagnosis of Follicular Lymphoma grade II (ICD-10 code C82.14) requires a comprehensive approach that includes clinical evaluation, imaging studies, histopathological examination, and genetic testing. The combination of these criteria ensures an accurate diagnosis, which is essential for determining the appropriate treatment strategy. If you have further questions or need more specific information, feel free to ask!

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10 code C82.14 specifically refers to follicular lymphoma grade II that affects the lymph nodes of the axilla (armpit area) and upper limb. 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, which means it typically grows slowly compared to aggressive forms of lymphoma. The World Health Organization (WHO) classifies follicular lymphoma into grades based on histological features, with grade II indicating a moderate level of malignancy. This classification is determined by the number of centroblasts (a type of B-cell) present in the lymph node tissue, with grade II having 5 to 15 centroblasts per high-power field.

Symptoms

Patients with follicular lymphoma may present with:
- Painless swelling of lymph nodes, particularly in the axillary region.
- Fatigue and weakness.
- Unexplained weight loss.
- Night sweats.
- Fever.

These symptoms can vary significantly among individuals, and some patients may remain asymptomatic for extended periods.

Diagnosis

Diagnosis typically involves:
- Physical Examination: Assessment of lymph node enlargement.
- Imaging Studies: CT scans or PET scans to evaluate the extent of lymph node involvement and any potential organ involvement.
- Biopsy: A definitive diagnosis is made through a lymph node biopsy, where tissue is examined histologically to confirm the presence of follicular lymphoma and determine the grade.

Staging

Staging of follicular lymphoma is crucial for treatment planning and prognosis. The Ann Arbor staging system is commonly used, which categorizes the disease based on the number of lymph node regions involved and whether extranodal sites are affected.

Treatment Options

Treatment for follicular lymphoma grade II may include:
- Watchful Waiting: In cases where the disease is asymptomatic and not rapidly progressing, a "watch and wait" approach may be adopted.
- Chemotherapy: Common regimens include combinations of drugs such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or bendamustine.
- Immunotherapy: Monoclonal antibodies like rituximab are often used in conjunction with chemotherapy.
- Radiation Therapy: May be employed for localized disease or to alleviate symptoms.

Prognosis

The prognosis for patients with follicular lymphoma grade II varies based on several factors, including the extent of disease at diagnosis, the patient's age, overall health, and response to treatment. Generally, follicular lymphoma is considered manageable, with many patients experiencing long periods of remission.

Conclusion

ICD-10 code C82.14 encapsulates the clinical aspects of follicular lymphoma grade II affecting the lymph nodes of the axilla and upper limb. Understanding the characteristics, symptoms, diagnosis, and treatment options for this condition is essential for effective management and improving patient outcomes. Regular follow-up and monitoring are crucial for managing this indolent lymphoma effectively.

Follicular lymphoma, particularly classified under ICD-10 code C82.14, 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 axilla (armpit) and upper limb. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is characterized by the proliferation of B-lymphocytes in a follicular pattern. It is generally considered an indolent (slow-growing) form of lymphoma, but it can transform into a more aggressive form over time. Grade II indicates a moderate level of aggressiveness, with a higher proliferation rate than grade I but lower than grade III.

Common Signs and Symptoms

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

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the axillary region and upper limbs. Patients may notice enlarged lymph nodes that feel rubbery or firm.
• B Symptoms: These include systemic symptoms such as:
• Fever: Unexplained fevers that may be intermittent.
• Night Sweats: Profuse sweating during the night that can soak through clothing.
• Weight Loss: Unintentional weight loss of more than 10% of body weight over six months.
• Fatigue: Patients often report a general sense of tiredness or lack of energy, which can be debilitating.
• Pruritus: Some patients may experience itching, which is not necessarily related to the presence of a rash.

Patient Characteristics

Certain demographic and clinical characteristics are commonly associated with patients diagnosed with follicular lymphoma:

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is rare in children and young adults.
• Gender: There is a slight male predominance, with men being more frequently diagnosed than women.
• History of Autoimmune Disorders: Some patients may have a history of autoimmune diseases, which has been associated with an increased risk of developing lymphomas.
• Family History: A family history of lymphoproliferative disorders may also be noted in some patients, suggesting a potential genetic predisposition.

Diagnostic Considerations

Diagnosis of follicular lymphoma grade II involves a combination of clinical evaluation, imaging studies, and histopathological examination. Key diagnostic tools include:

• Biopsy: A lymph node biopsy is essential for confirming the diagnosis and determining the grade of the lymphoma.
• Imaging Studies: CT scans or PET scans may be utilized to assess the extent of disease and involvement of lymph nodes in the axilla and upper limb.
• Laboratory Tests: Blood tests may be performed to evaluate overall health and detect any abnormalities associated with lymphoma.

Conclusion

Follicular lymphoma grade II, particularly affecting the lymph nodes of the axilla and upper limb, presents with a range of clinical signs and symptoms, including lymphadenopathy, systemic B symptoms, and fatigue. Understanding the patient characteristics, such as age and gender predisposition, is essential for healthcare providers in diagnosing and managing this condition effectively. Early recognition and appropriate treatment can significantly impact patient outcomes and quality of life.

ICD-10 code C82.14 refers specifically to Follicular lymphoma grade II, which is a type of non-Hodgkin lymphoma primarily affecting the lymph nodes in the axilla (armpit) and upper limb. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some relevant terms and alternative names associated with this diagnosis.

Alternative Names for Follicular Lymphoma Grade II

1. Follicular Lymphoma, Grade 2: This is a direct alternative name that specifies the grade of the lymphoma.
2. Follicular Lymphoma, Intermediate Grade: This term is often used to describe grade II lymphomas, indicating a level of aggressiveness that is between low-grade and high-grade lymphomas.
3. Follicular Lymphoma, Stage II: While this refers to the staging of the disease rather than the grade, it may sometimes be used interchangeably in discussions about the disease's progression.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of non-Hodgkin lymphoma, which encompasses a variety of lymphoid malignancies.
2. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both 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 arises from B-lymphocytes (a type of white blood cell).
5. Lymphoma Grade II: A broader term that may refer to any lymphoma classified as grade II, not limited to follicular types.

Clinical Context

Follicular lymphoma grade II is characterized by a moderate proliferation of neoplastic follicle center cells. It is important to differentiate it from other grades of follicular lymphoma (grade I and grade III) and other types of lymphomas, as treatment approaches and prognoses can vary significantly.

In clinical practice, accurate coding and terminology are crucial for effective communication among healthcare providers, insurance companies, and researchers. Understanding these alternative names and related terms can facilitate better patient care and documentation practices.

In summary, while ICD-10 code C82.14 specifically identifies follicular lymphoma grade II in the lymph nodes of the axilla and upper limb, various alternative names and related terms exist that can aid in the understanding and communication of this condition.

Follicular lymphoma, particularly grade II, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10 code C82.14 specifically refers to follicular lymphoma grade II located in the lymph nodes of the axilla and upper limb. Treatment approaches for this condition can vary based on several factors, including the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma. Below is a detailed overview of standard treatment strategies.

Standard Treatment Approaches

1. Observation (Watchful Waiting)

For patients with asymptomatic follicular lymphoma, especially those with early-stage disease, a strategy of observation may be employed. This approach involves regular monitoring without immediate treatment, as many patients may not require intervention until symptoms develop or the disease progresses.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for follicular lymphoma, particularly in cases where the disease is symptomatic or has progressed. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for more aggressive forms of lymphoma but can be effective in follicular lymphoma as well.
• R-CHOP: The addition of Rituximab (a monoclonal antibody targeting CD20 on B-cells) to the CHOP regimen has significantly improved outcomes for patients with follicular lymphoma.

3. Immunotherapy

Rituximab is a key component in the treatment of 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 can be effective for localized disease, particularly in cases where the lymphoma is confined to a specific area, such as the axilla. It may be used as a primary treatment or as a consolidation therapy following chemotherapy.

5. Targeted Therapy

Targeted therapies have emerged as important options for treating follicular lymphoma. These include:

• PI3K Inhibitors: Such as Copanlisib (Aliqopa), which is indicated for patients who have received at least two prior therapies.
• BCL-2 Inhibitors: Like Venetoclax, which can be used in combination with other agents for relapsed or refractory 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 own stem cells, administering high-dose chemotherapy, and then reinfusing the stem cells to restore bone marrow function.

7. Clinical Trials

Participation in clinical trials may be an option for patients seeking access to new therapies or treatment combinations that are not yet widely available. These trials can provide cutting-edge treatment options and contribute to the advancement of knowledge in the field.

Conclusion

The treatment of follicular lymphoma grade II, particularly in the axilla and upper limb, is multifaceted and tailored to the individual patient. A combination of observation, chemotherapy, immunotherapy, radiation, targeted therapies, and potentially stem cell transplantation forms the basis of management strategies. As research continues to evolve, new therapies and combinations are likely to emerge, offering hope for improved outcomes in patients with this type of lymphoma. For personalized treatment plans, consultation with a hematologist or oncologist specializing in lymphomas is essential.