ICD-10: C82.18

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that arises from B-lymphocytes, specifically follicle center (germinal center) cells. It is characterized by a slow-growing nature and is often diagnosed at an advanced stage. The ICD-10 code C82.18 specifically refers to follicular lymphoma grade II affecting lymph nodes of multiple sites. 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 into different grades based on the histological features observed under a microscope. Grade II follicular lymphoma is characterized by a moderate number of large cells (centroblasts) in the tumor, typically defined as having 5 to 15 centroblasts per high-power field. This grading indicates a more aggressive behavior compared to grade I but is generally less aggressive than grade III follicular lymphoma.

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, which may be painless and can occur in multiple regions of the body.
- B-symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more advanced disease.
- Fatigue: A common complaint among patients, often due to the disease burden or anemia.

Diagnosis

Diagnosis typically involves:
- Physical Examination: Assessment of lymph node enlargement.
- Imaging Studies: CT scans or PET scans to evaluate the extent of lymphadenopathy and any involvement of other organs.
- Biopsy: A definitive diagnosis is made through a lymph node biopsy, where histological examination reveals the characteristic follicular architecture and the presence of neoplastic follicle center cells.

Staging

Follicular lymphoma is staged using the Ann Arbor system, which considers the number of lymph node regions involved and whether the disease has spread to other organs. The presence of multiple sites of lymph node involvement, as indicated by the ICD-10 code C82.18, suggests at least stage II disease.

Treatment Options

Treatment for follicular lymphoma grade II may vary based on the stage of the disease, the presence of symptoms, and the patient's overall health. Common treatment modalities include:
- Watchful Waiting: In asymptomatic patients, especially those with early-stage disease, a "watch and wait" approach may be adopted.
- Chemotherapy: Regimens such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) are commonly used.
- Immunotherapy: Rituximab, a monoclonal antibody targeting CD20 on B-cells, is often used in combination with chemotherapy.
- Radiation Therapy: May be employed for localized disease or as a palliative measure.

Prognosis

The prognosis for patients with follicular lymphoma grade II can vary widely. Factors influencing outcomes include the patient's age, overall health, the extent of disease at diagnosis, and response to initial treatment. The overall survival rate is generally favorable, with many patients living for years with the disease, although it is often considered incurable.

Conclusion

ICD-10 code C82.18 encapsulates the clinical picture of follicular lymphoma grade II affecting multiple lymph node sites. Understanding the characteristics, symptoms, diagnostic methods, and treatment options is crucial for effective management of this condition. Regular follow-up and monitoring are essential to address any progression of the disease and to adapt treatment strategies accordingly.

ICD-10 code C82.18 refers specifically to "Follicular lymphoma grade II, lymph nodes of multiple sites." 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 diagnosis.

Alternative Names for Follicular Lymphoma Grade II

1. Follicular Lymphoma, Grade 2: This is a direct synonym for the ICD-10 code C82.18, emphasizing the grade of the lymphoma.
2. Follicular Lymphoma, Stage II: While "stage" and "grade" are distinct concepts in oncology, some may colloquially refer to the disease using "stage" when discussing its progression.
3. Follicular Lymphoma, Mixed Cellularity: This term may be used to describe a variant of follicular lymphoma that includes a mix of cell types, although it is not specific to grade II.

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 both 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. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
5. Lymphoma Grade II: This term may be used in clinical discussions to refer to the specific grade of the lymphoma without specifying the follicular subtype.

Clinical Context

Follicular lymphoma is characterized by its indolent (slow-growing) nature, and grade II indicates a moderate level of aggressiveness. The classification is crucial for determining treatment options and prognosis. Understanding these alternative names and related terms can aid healthcare professionals in communication and documentation regarding patient diagnoses.

In summary, while C82.18 specifically denotes follicular lymphoma grade II affecting multiple lymph node sites, it is important to recognize the broader context of non-Hodgkin lymphoma and related terminologies that may be used in clinical practice.

Follicular lymphoma, particularly classified under ICD-10 code C82.18, refers to a specific type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This subtype is noted for its indolent nature and can present in various stages, often involving multiple lymph nodes. The diagnosis of follicular lymphoma, especially grade II, involves several criteria that are essential for accurate classification and treatment planning.

Diagnostic Criteria for Follicular Lymphoma Grade II

1. Histopathological Examination

• Tissue Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes. The histological examination typically reveals a proliferation of follicle center cells, which are B-cells that have undergone neoplastic transformation.
• Grading: Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF). Grade II is characterized by the presence of 5 to 15 centroblasts per HPF. This grading is crucial as it influences prognosis and treatment strategies[1].

2. Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers of the lymphoma cells. Follicular lymphoma cells typically express CD19, CD20, and CD10, while being negative for CD5. The presence of the BCL2 protein due to the t(14;18) chromosomal translocation is also a hallmark of this lymphoma type[2].
• Immunohistochemistry: This method further confirms the diagnosis by identifying specific proteins associated with follicular lymphoma, aiding in distinguishing it from other lymphomas.

3. Cytogenetic Analysis

• Chromosomal Abnormalities: The detection of the t(14;18)(q32;q21) translocation is a critical factor in diagnosing follicular lymphoma. This genetic alteration leads to the overexpression of the BCL2 gene, contributing to the survival of the neoplastic B-cells[3].

4. Clinical Presentation

• Symptoms: Patients may present with painless lymphadenopathy, which can occur in multiple lymph node regions. Systemic symptoms such as fever, night sweats, and weight loss may also be present, although they are less common in indolent forms like grade II follicular lymphoma[4].
• Physical Examination: A thorough examination will reveal enlarged lymph nodes, often in multiple sites, which is consistent with the diagnosis of C82.18.

5. Imaging Studies

• CT or PET Scans: Imaging studies are often employed to assess the extent of lymphadenopathy and to evaluate for any extranodal involvement. These studies help in staging the disease, which is crucial for treatment planning[5].

6. Staging and Classification

• Ann Arbor Staging System: The staging of follicular lymphoma is essential for determining the prognosis and treatment approach. The Ann Arbor system classifies the disease based on the number of lymph node regions involved and the presence of systemic symptoms[6].

Conclusion

The diagnosis of follicular lymphoma grade II (ICD-10 code C82.18) is a multifaceted process that combines histopathological, immunophenotypic, cytogenetic, and clinical evaluations. Accurate diagnosis is critical for effective management and treatment planning, as it influences the therapeutic approach and helps predict patient outcomes. If you have further questions or need more detailed information on 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 C82.18 specifically refers to follicular lymphoma grade II affecting lymph nodes at multiple sites. Treatment approaches for this condition can vary based on several factors, including the patient's overall health, the extent of the disease, and specific clinical characteristics. Below is a detailed overview of standard treatment approaches for this diagnosis.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For patients with asymptomatic follicular lymphoma, especially those with low tumor burden, a strategy of watchful waiting may be employed. This approach involves regular monitoring without immediate treatment, as many patients may not require intervention for years. This is particularly relevant for grade II cases where the disease may progress slowly.

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 and is standard for most patients.

3. Immunotherapy

• Rituximab: As mentioned, Rituximab is commonly used in combination with chemotherapy. It can also be used as a single agent in patients who are not candidates for chemotherapy or in relapsed cases.
• Other Monoclonal Antibodies: Newer agents like Obinutuzumab may also be considered, particularly in specific clinical scenarios.

4. Radioimmunotherapy

This approach combines radiation therapy with immunotherapy. Agents like Ibritumomab tiuxetan deliver targeted radiation to lymphoma cells, which can be effective in treating localized disease or as a consolidation therapy after chemotherapy.

5. 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 is typically reserved for younger patients or those with a good performance status.

6. Targeted Therapy

• BCL-2 Inhibitors: Agents like Venetoclax are being explored in clinical trials and may be used in specific cases, particularly for patients with relapsed disease.
• PI3K Inhibitors: Drugs such as Idelalisib are also under investigation and may be used in certain scenarios, especially for patients who are not candidates for chemotherapy.

7. Clinical Trials

Participation in clinical trials can provide access to cutting-edge therapies and should be considered for eligible patients. Trials may focus on novel agents, combinations, or new treatment strategies.

Conclusion

The treatment of follicular lymphoma grade II (ICD-10 code C82.18) is multifaceted and tailored to the individual patient. While watchful waiting may be appropriate for some, others may require chemotherapy, immunotherapy, or more advanced treatments like stem cell transplantation. Ongoing research and clinical trials continue to shape the landscape of treatment options, offering hope for improved outcomes in this patient population. It is essential for patients to discuss their specific case with their healthcare provider to determine the most appropriate treatment strategy based on their unique circumstances.

Follicular lymphoma, particularly classified under ICD-10 code C82.18, refers to a specific subtype of non-Hodgkin lymphoma (NHL) characterized by the proliferation of follicle center (germinal center) B-cells. This type of lymphoma is typically indolent but can present with various clinical features depending on the extent of the disease and the individual patient characteristics. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with follicular lymphoma grade II affecting lymph nodes at multiple sites.

Clinical Presentation

General Characteristics

Follicular lymphoma is often diagnosed in adults, with a median age of diagnosis around 60 years. It is more prevalent in women than in men, although the gender distribution can vary by region and population. The disease is characterized by the presence of neoplastic follicle-like structures in lymphoid tissue, which can lead to lymphadenopathy and other systemic symptoms.

Lymphadenopathy

Patients with follicular lymphoma grade II typically present with:
- Painless lymphadenopathy: Enlargement of lymph nodes is the most common initial symptom. Patients may notice swollen lymph nodes in various regions, including the neck, axilla, and groin.
- Multiple sites: As indicated by the ICD-10 code, lymphadenopathy often occurs in multiple lymph node regions, which can be confirmed through imaging studies such as CT scans or PET scans.

Systemic Symptoms

In addition to lymphadenopathy, patients may experience systemic symptoms, which can include:
- Fatigue: A common complaint among patients, often due to the underlying disease or anemia.
- Weight loss: Unintentional weight loss may occur, often defined as losing more than 10% of body weight over six months.
- Night sweats: Patients may report drenching night sweats, which can be a hallmark symptom of lymphoma.
- Fever: Low-grade fevers may be present, contributing to the overall feeling of malaise.

Signs and Symptoms

Physical Examination Findings

During a physical examination, healthcare providers may observe:
- Palpable lymph nodes: Enlarged lymph nodes that are typically firm but not tender.
- Splenomegaly: Enlargement of the spleen may be noted in some patients, which can be detected during abdominal examination.
- Hepatomegaly: Liver enlargement may also occur, although it is less common.

Laboratory Findings

Laboratory tests may reveal:
- Anemia: A decrease in red blood cell count may be present, contributing to fatigue.
- Thrombocytopenia: Low platelet counts can occur, particularly in advanced disease.
- Elevated lactate dehydrogenase (LDH): This enzyme may be elevated, indicating a higher tumor burden or more aggressive disease.

Patient Characteristics

Demographics

• Age: Most commonly diagnosed in individuals aged 50-70 years.
• Gender: Slightly more common in females, with a ratio of approximately 1.5:1 compared to males.

Risk Factors

Several risk factors have been associated with the development of follicular lymphoma, including:
- 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.
- Environmental exposures: Certain chemical exposures, such as pesticides, have been suggested as potential risk factors.

Comorbidities

Patients may present with various comorbid conditions, which can complicate the management of follicular lymphoma. Common comorbidities include:
- Cardiovascular disease: Due to age and lifestyle factors.
- Diabetes: Metabolic syndrome may be prevalent in older populations.

Conclusion

Follicular lymphoma grade II, as classified under ICD-10 code C82.18, presents with a range of clinical features primarily characterized by painless lymphadenopathy at multiple sites, systemic symptoms such as fatigue and weight loss, and specific laboratory findings. Understanding these clinical presentations and patient characteristics is crucial for timely diagnosis and effective management of this indolent form of non-Hodgkin lymphoma. Early recognition and appropriate staging can significantly influence treatment decisions and patient outcomes.