ICD-10: C82.17

ICD-10 code C82.17 specifically refers to Follicular lymphoma grade II that is localized to the spleen. 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 Grade II

Overview

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that originates from B-lymphocytes. It is classified into different grades based on histological features, with grade II indicating a moderate level of aggressiveness. The lymphoma typically presents as a mass of abnormal lymphoid tissue, which can affect various organs, including the spleen.

Pathophysiology

Follicular lymphoma arises from the germinal center B-cells and is often associated with chromosomal translocations, particularly the t(14;18) translocation, which leads to the overexpression of the BCL2 gene. This genetic alteration inhibits apoptosis (programmed cell death), allowing malignant cells to survive longer than normal cells.

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, which may be painless.
- Splenomegaly: Enlargement of the spleen, which can lead to discomfort or a feeling of fullness.
- B-symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more advanced disease.

Diagnosis

Diagnosis typically involves:
- Imaging Studies: CT scans or PET scans to assess the extent of the disease and involvement of the spleen.
- Biopsy: A tissue sample from the affected lymph node or spleen is examined histologically to confirm the diagnosis and grade of lymphoma.
- Immunophenotyping: This process helps to identify the specific type of lymphoma based on the surface markers present on the cells.

Treatment

Treatment options for follicular lymphoma grade II may include:
- Watchful Waiting: In cases where the disease is asymptomatic and not rapidly progressing.
- Chemotherapy: Common regimens may include agents like bendamustine or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).
- Immunotherapy: Monoclonal antibodies such as rituximab are often used in conjunction with chemotherapy.
- Radiation Therapy: May be considered for localized disease, particularly if the spleen is significantly involved.

Prognosis

The prognosis for patients with follicular lymphoma grade II varies based on several factors, including the stage of the disease at diagnosis, the patient's overall health, and response to treatment. Generally, follicular lymphoma has a relatively favorable prognosis compared to more aggressive forms of lymphoma, but it is considered incurable, with a tendency for relapse.

Conclusion

ICD-10 code C82.17 captures the specific diagnosis of follicular lymphoma grade II localized to the spleen, highlighting the importance of accurate coding for treatment and management purposes. Understanding the clinical features, diagnostic criteria, and treatment options is essential for healthcare providers managing patients with this condition. Regular follow-up and monitoring are crucial to address any potential relapses or complications associated with the disease.

Follicular lymphoma, particularly classified under ICD-10 code C82.17, refers to a specific type of non-Hodgkin lymphoma that primarily affects the spleen and is characterized by its indolent nature. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for effective diagnosis and management.

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 grades based on the histological features observed under a microscope. Grade II follicular lymphoma indicates a moderate level of cell proliferation, which can influence the clinical behavior of the disease.

Common Signs and Symptoms

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

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, which may be localized or generalized. In the case of C82.17, splenic involvement may lead to splenomegaly (enlargement of the spleen) that can be palpated during a physical examination.
• Abdominal Discomfort: Patients may experience discomfort or fullness in the abdomen due to splenomegaly or lymphadenopathy in the abdominal region.
• Fatigue: A common symptom in many cancer patients, fatigue can be significant and may be attributed to the disease itself or associated anemia.
• Weight Loss: Unintentional weight loss can occur, often due to the metabolic demands of the lymphoma or decreased appetite.
• Night Sweats and Fever: Some patients may experience systemic symptoms such as night sweats and low-grade fevers, which can be indicative of lymphoma.

Additional Symptoms

• Pruritus: Some patients report itching, which can be a paraneoplastic symptom.
• Bone Marrow Involvement: In advanced cases, patients may exhibit signs of bone marrow infiltration, leading to cytopenias (low blood cell counts), which can manifest as increased bruising, bleeding, or recurrent infections.

Patient Characteristics

Demographics

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is relatively rare in children and young adults.
• 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.
• Immune System Status: 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.
• Environmental Exposures: Certain environmental factors, such as exposure to pesticides or solvents, have been suggested as potential risk factors.

Comorbidities

Patients with follicular lymphoma may have other health conditions that can complicate management, including cardiovascular disease, diabetes, or other malignancies. These comorbidities can influence treatment decisions and overall prognosis.

Conclusion

Follicular lymphoma grade II, particularly when involving the spleen (ICD-10 code C82.17), presents with a range of clinical features, including lymphadenopathy, splenomegaly, and systemic symptoms like fatigue and weight loss. Understanding the typical patient profile, including age, gender, and risk factors, is essential for healthcare providers in diagnosing and managing this indolent form of lymphoma effectively. Early recognition of symptoms and appropriate diagnostic workup can lead to timely intervention and improved patient outcomes.

ICD-10 code C82.17 refers specifically to "Follicular lymphoma grade II, spleen." 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 II

1. Follicular Lymphoma, Grade 2: This is a direct alternative name that maintains the same meaning as the ICD-10 code.
2. Follicular Lymphoma, Intermediate Grade: This term emphasizes the grade of the lymphoma, indicating it is neither low-grade nor high-grade.
3. Follicular Lymphoma, Stage II: While this may refer to the stage of the disease rather than the grade, it is sometimes 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 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. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, as it arises from B-lymphocytes, a type of white blood cell.
4. Spleen Involvement: This term highlights the specific anatomical location affected by the lymphoma, which can be relevant in treatment and prognosis discussions.

Clinical Context

Follicular lymphoma is characterized by its indolent nature, often presenting with painless lymphadenopathy. Grade II indicates a moderate level of aggressiveness, which can influence treatment decisions and prognosis. Understanding these alternative names and related terms is crucial for healthcare professionals when discussing diagnoses, treatment plans, and patient education.

In summary, the ICD-10 code C82.17 is associated with various alternative names and related terms that reflect its classification within the broader context of lymphatic cancers. Recognizing these terms can enhance communication among healthcare providers and improve patient understanding of their diagnosis.

Follicular lymphoma, particularly grade II, is a type of non-Hodgkin lymphoma characterized by specific histological features and clinical criteria. The ICD-10 code C82.17 specifically refers to follicular lymphoma grade II located in the spleen. Here’s a detailed overview of the diagnostic criteria used for this condition.

Diagnostic Criteria for Follicular Lymphoma Grade II

1. Clinical Presentation

• Symptoms: Patients may present with symptoms such as painless lymphadenopathy, splenomegaly (enlarged spleen), and systemic symptoms like fever, night sweats, and weight loss. However, many patients may be asymptomatic at diagnosis.
• Physical Examination: A thorough physical examination may reveal enlarged lymph nodes and spleen, which are common findings in lymphoma.

2. Histopathological Examination

• Biopsy: A biopsy of the affected lymph node or spleen is essential for diagnosis. The tissue sample is examined microscopically.
• Histological Features: Follicular lymphoma is characterized by the presence of neoplastic follicles composed of small to medium-sized lymphoid cells. In grade II, there is a mixture of small and large cells, with a higher proportion of large cells compared to grade I.
• Cellularity: The tumor typically shows a follicular pattern with at least 15% of the cells being large cells, which is a defining feature of grade II.

3. 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, and they often lack surface immunoglobulin.
• BCL2 Gene Rearrangement: The presence of the BCL2 gene rearrangement is a hallmark of follicular lymphoma, which can be confirmed through molecular techniques.

4. Imaging Studies

• CT or PET Scans: Imaging studies are often performed to assess the extent of the disease, including the involvement of lymph nodes and the spleen. These scans help in staging the lymphoma and determining the appropriate treatment approach.

5. Staging and Grading

• Ann Arbor Staging System: This system is used to stage the lymphoma based on the extent of disease spread. Follicular lymphoma is typically classified as indolent, but the grade can influence prognosis and treatment decisions.
• Grade II Classification: This indicates a moderate proliferation of cells, which can affect treatment strategies and expected outcomes.

6. Exclusion of Other Conditions

• Differential Diagnosis: It is crucial to rule out other types of lymphomas and reactive lymphoid hyperplasia. This may involve additional tests and clinical correlation.

Conclusion

The diagnosis of follicular lymphoma grade II, particularly in the spleen, involves a combination of clinical evaluation, histopathological examination, immunophenotyping, and imaging studies. Accurate diagnosis is essential for determining the appropriate treatment and management plan for patients. If you have further questions or need more specific information regarding treatment options or prognosis, feel free to ask!

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 C82.17 specifically refers to follicular lymphoma grade II localized to the spleen. Treatment approaches for this condition can vary based on several factors, including the stage of the disease, the patient's overall health, and specific clinical characteristics. Below is an overview of standard treatment strategies for follicular lymphoma grade II.

Standard Treatment Approaches

1. Watchful Waiting

In cases where the lymphoma is asymptomatic and not causing significant health issues, a strategy of "watchful waiting" may be employed. This involves regular monitoring without immediate treatment, as follicular lymphoma can often be indolent (slow-growing) and may not require immediate intervention.

2. Chemotherapy

For symptomatic patients or those with more aggressive disease, chemotherapy is a common treatment option. The most frequently used regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is a standard treatment for various types of non-Hodgkin lymphoma, including follicular 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 a cornerstone of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. In cases of relapsed or refractory disease, Rituximab may be administered as a single agent or in combination with other agents like Lenalidomide (Revlimid) to improve outcomes[6].

4. Radiation Therapy

Localized radiation therapy may be considered for patients with localized disease, particularly if the lymphoma is confined to the spleen and causing symptoms. This approach can help reduce tumor burden and alleviate symptoms.

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be an option. This approach is typically reserved for younger patients or those with more aggressive disease features.

6. Targeted Therapies

Recent advancements have introduced targeted therapies such as:

• Copanlisib (Aliqopa): This is a PI3K inhibitor that has shown efficacy in treating relapsed follicular lymphoma[9].
• Other Novel Agents: Newer agents and combinations are continually being studied in clinical trials, offering hope for improved outcomes in patients with follicular lymphoma.

Conclusion

The treatment of follicular lymphoma grade II, particularly when localized to the spleen, is multifaceted and tailored to the individual patient. While watchful waiting may be appropriate for some, others may require chemotherapy, immunotherapy, or radiation. Emerging therapies continue to enhance the treatment landscape, providing additional options for patients. It is crucial for patients to discuss their specific case with a healthcare provider to determine the most appropriate treatment strategy based on their unique circumstances and disease characteristics.