ICD-10: C82.19

Follicular lymphoma grade II, classified under ICD-10 code C82.19, is a subtype of non-Hodgkin lymphoma (NHL) characterized by its indolent nature and the potential for extranodal involvement. 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 clinical characteristics. Below, we explore the standard treatment modalities for follicular lymphoma grade II.

Overview of Follicular Lymphoma Grade II

Follicular lymphoma is a type of B-cell lymphoma that typically presents as a slow-growing cancer. Grade II indicates a moderate level of aggressiveness, with a mix of small and large cells. Extranodal involvement means that the lymphoma has spread beyond the lymph nodes to other organs, which can complicate treatment and prognosis.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For patients with asymptomatic follicular lymphoma grade II, especially those with limited disease, a strategy of watchful waiting 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

When treatment is necessary, chemotherapy is often the first-line approach. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is a standard treatment for various types of NHL, including follicular lymphoma.
• 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. Rituximab enhances the effectiveness of chemotherapy and is now considered a standard part of treatment.

3. Immunotherapy

In addition to chemotherapy, immunotherapy plays a crucial role in treating follicular lymphoma. Rituximab can be used alone or in combination with chemotherapy. Other newer agents include:

• Obinutuzumab: Another anti-CD20 monoclonal antibody that may be used in combination with chemotherapy.
• Lenalidomide: An oral immunomodulatory drug that can be used in relapsed or refractory cases.

4. Radiation Therapy

Radiation therapy may be utilized in specific scenarios, particularly for localized disease or to manage symptoms. It is often used in conjunction with chemotherapy or as a palliative measure to relieve symptoms caused by tumor masses.

5. Stem Cell Transplantation

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

6. Targeted Therapies

Recent advancements have introduced targeted therapies that focus on specific pathways involved in lymphoma cell survival and proliferation. Examples include:

• Idelalisib: A PI3K inhibitor used in combination with Rituximab for patients who have received at least two prior therapies.
• Copanlisib: Another PI3K inhibitor that has shown efficacy in treating relapsed follicular lymphoma.

7. Clinical Trials

Participation in clinical trials may also be an option for patients, providing access to cutting-edge therapies and novel treatment combinations that are not yet widely available.

Conclusion

The treatment of follicular lymphoma grade II, particularly with extranodal involvement, requires a tailored approach that considers the individual patient's disease characteristics and overall health. Standard treatment options include watchful waiting, chemotherapy (often combined with immunotherapy), radiation therapy, and targeted therapies. As research continues to evolve, new treatment modalities and combinations are likely to emerge, offering hope for improved outcomes in patients with this indolent yet complex disease. For patients, discussing all available options with their healthcare team is essential to determine the most appropriate treatment strategy.

ICD-10 code C82.19 refers specifically to Follicular lymphoma grade II, particularly in extranodal and solid organ sites. This classification is part of the broader category of non-Hodgkin lymphoma (NHL), which encompasses various types of lymphomas that do not originate from Hodgkin cells. 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 emphasizes the grade of the lymphoma.
2. Follicular Lymphoma, Extranodal: This term highlights the extranodal nature of the lymphoma, indicating that it occurs outside of the lymph nodes.
3. Follicular Lymphoma, Solid Organ Involvement: This term specifies that the lymphoma affects solid organs, which can include the spleen, liver, or other tissues.

Related Terms and Classifications

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of NHL, which is a diverse group of blood cancers that includes many different types of lymphomas.
2. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, as it originates from B lymphocytes, a type of white blood cell.
3. Lymphoproliferative Disorders: This broader category includes conditions characterized by the excessive proliferation of lymphocytes, including various types of lymphomas.
4. Extranodal Lymphoma: This term refers to lymphomas that occur outside the lymphatic system, which is relevant for C82.19 as it specifies extranodal involvement.
5. Grade II Lymphoma: This term can be used to describe the aggressiveness of the lymphoma, indicating a moderate level of malignancy.

Clinical Context

Follicular lymphoma grade II is characterized by a specific histological appearance and clinical behavior. It typically presents with a more indolent course compared to higher-grade lymphomas but can still exhibit variability in clinical outcomes. Understanding the terminology and classifications associated with this condition is crucial for accurate diagnosis, treatment planning, and coding for healthcare billing purposes.

In summary, the ICD-10 code C82.19 encompasses a specific type of lymphoma with various alternative names and related terms that reflect its characteristics and clinical implications. These terms are essential for healthcare professionals in accurately communicating about the condition and ensuring appropriate management strategies.

Diagnosing Follicular Lymphoma Grade II, particularly in extranodal and solid organ sites, involves a combination of clinical evaluation, imaging studies, and histopathological examination. The ICD-10 code C82.19 specifically refers to this subtype of non-Hodgkin lymphoma, which is characterized by certain diagnostic criteria. Below is a detailed overview of the criteria used for diagnosis.

Clinical Presentation

Symptoms

Patients with Follicular Lymphoma may present with:
- Lymphadenopathy: Swollen lymph nodes, which may be painless.
- B Symptoms: These include fever, night sweats, and unexplained weight loss.
- Extranodal Involvement: Symptoms may vary depending on the organ affected, such as abdominal pain if the gastrointestinal tract is involved.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoma or other hematological disorders.
- Family history of lymphoproliferative disorders.

Diagnostic Imaging

Imaging Studies

Imaging techniques are crucial for assessing the extent of the disease:
- CT Scans: Used to evaluate lymph node involvement and detect extranodal sites.
- PET Scans: Helpful in assessing metabolic activity of the lymphoma and identifying active disease.

Histopathological Examination

Biopsy

A definitive diagnosis of Follicular Lymphoma Grade II requires a biopsy of the affected tissue. The following criteria are typically evaluated:
- Histological Features: The presence of follicular structures with a predominance of small cleaved cells (centrocytes) and larger cells (centroblasts).
- Grading: Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF). Grade II typically has 6-15 centroblasts per HPF.
- Immunophenotyping: Immunohistochemical staining is performed to confirm the diagnosis, typically showing:
- CD10 Positive: Indicates follicular origin.
- B-cell Markers: Such as CD19, CD20, and BCL-2 positivity.

Molecular Studies

• Genetic Testing: Detection of the t(14;18) translocation involving the BCL2 gene is common in follicular lymphoma and can support the diagnosis.

Staging

Staging is crucial for treatment planning and involves:
- Ann Arbor Staging System: This system classifies lymphoma based on the number of lymph node regions involved and the presence of extranodal disease.

Conclusion

The diagnosis of Follicular Lymphoma Grade II, particularly in extranodal and solid organ sites, is a multifaceted process that combines clinical evaluation, imaging studies, and histopathological analysis. The ICD-10 code C82.19 is specifically used for this diagnosis, reflecting the need for precise criteria to ensure accurate identification and appropriate management of the disease. Early diagnosis and staging are vital for effective treatment planning and improving patient outcomes.

Follicular lymphoma grade II, classified under ICD-10 code C82.19, is a subtype of non-Hodgkin lymphoma (NHL) characterized by specific clinical presentations, signs, symptoms, and patient characteristics. Understanding these aspects is crucial for diagnosis, treatment planning, and patient management.

Clinical Presentation

Follicular lymphoma is typically indolent, meaning it often progresses slowly. However, grade II indicates a more aggressive behavior compared to grade I. The clinical presentation can vary significantly among patients, but common features include:

• Lymphadenopathy: Patients often present with painless swelling of lymph nodes, which may be localized or generalized. In extranodal cases, lymphadenopathy may not be prominent, and the disease can manifest in solid organs.
• Extranodal Involvement: This subtype frequently affects organs outside the lymphatic system, such as the spleen, liver, bone marrow, and gastrointestinal tract. Symptoms may arise depending on the organ involved, such as abdominal pain or fullness if the spleen or liver is enlarged.

Signs and Symptoms

The signs and symptoms of follicular lymphoma grade II can be diverse and may include:

• B Symptoms: These are systemic symptoms that may indicate more advanced disease and include:
• Fever
• Night sweats
• Unexplained weight loss
• Fatigue: Many patients report significant fatigue, which can be debilitating.
• Abdominal Symptoms: If the lymphoma involves the gastrointestinal tract or abdominal organs, patients may experience:
• Abdominal pain
• Nausea
• Changes in bowel habits
• Skin Manifestations: In some cases, patients may develop skin lesions or rashes, particularly if the lymphoma involves the skin.

Patient Characteristics

Certain characteristics are commonly observed in patients diagnosed with follicular lymphoma grade II:

• Age: This type of lymphoma is more prevalent 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.
• Comorbidities: Patients may have other health conditions that can complicate treatment, such as cardiovascular disease or diabetes.
• Family History: A family history of lymphoma or other hematologic malignancies may be present in some patients, suggesting a potential genetic predisposition.

Diagnosis and Evaluation

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

• Biopsy: A tissue biopsy is essential for confirming the diagnosis and determining the grade of the lymphoma.
• Imaging Studies: CT scans, PET scans, or MRI may be utilized to assess the extent of disease and identify extranodal involvement.
• Laboratory Tests: Blood tests may reveal anemia or other abnormalities, and specific markers can help in the diagnosis.

Conclusion

Follicular lymphoma grade II, particularly with extranodal and solid organ involvement, presents a unique set of challenges in clinical practice. Recognizing the signs and symptoms, understanding patient characteristics, and employing appropriate diagnostic strategies are essential for effective management. As treatment options evolve, ongoing research continues to improve outcomes for patients with this type of lymphoma, emphasizing the importance of personalized care approaches tailored to individual patient needs.

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10 code C82.19 specifically refers to Follicular lymphoma grade II, which is notable for its clinical behavior and treatment implications. Below is a detailed overview of this condition, including its clinical description, characteristics, and relevant coding details.

Clinical Description of Follicular Lymphoma Grade II

Definition and Classification

Follicular lymphoma is classified as a low-grade lymphoma, but grade II indicates a more aggressive behavior compared to grade I. The World Health Organization (WHO) classifies follicular lymphoma into grades based on histological features, with grade II showing a higher proliferation index than grade I but lower than grade III. This classification is crucial for determining prognosis and treatment strategies.

Pathophysiology

Follicular lymphoma arises from the transformation of B-cells within the germinal centers of lymphoid follicles. The neoplastic cells typically express B-cell markers such as CD19, CD20, and CD10, and often exhibit the t(14;18) chromosomal translocation, which leads to the overexpression of the BCL2 protein, inhibiting apoptosis and allowing for the accumulation of malignant cells.

Clinical Presentation

Patients with follicular lymphoma grade II may present with:
- Lymphadenopathy: Painless swelling of lymph nodes, which can be localized or generalized.
- Extranodal Involvement: This subtype can affect solid organ sites, including the spleen, liver, bone marrow, and gastrointestinal tract. Symptoms may vary based on the organ involved.
- B Symptoms: Some patients may experience systemic symptoms such as fever, night sweats, and weight loss, which can indicate more advanced disease.

Diagnosis

Diagnosis typically involves:
- Histopathological Examination: A biopsy of affected lymph nodes or tissues is essential for confirming the diagnosis and determining the grade.
- Immunophenotyping: Flow cytometry or immunohistochemistry is used to identify specific B-cell markers.
- Imaging Studies: CT scans, PET scans, or MRI may be employed to assess the extent of disease and identify extranodal sites.

ICD-10 Code C82.19 Details

Code Specification

• ICD-10 Code: C82.19
• Description: Follicular lymphoma grade II, extranodal and solid organ sites
• Exclusions: This code specifically excludes other types of lymphomas and grades, as well as localized forms of follicular lymphoma that do not involve extranodal sites.

Clinical Implications

The designation of C82.19 indicates that the lymphoma is not only of grade II but also involves extranodal sites, which can complicate treatment and prognosis. Treatment options may include:
- Chemotherapy: Often used in combination with immunotherapy.
- Radiation Therapy: May be indicated for localized disease.
- Targeted Therapy: Agents such as rituximab may be utilized, especially in cases with specific genetic markers.

Prognosis

The prognosis for patients with follicular lymphoma grade II can vary significantly based on factors such as the extent of disease, response to treatment, and individual patient characteristics. Generally, the presence of extranodal disease may indicate a more advanced stage and could influence treatment decisions.

Conclusion

ICD-10 code C82.19 captures the complexity of follicular lymphoma grade II, particularly when it involves extranodal and solid organ sites. Understanding the clinical characteristics, diagnostic criteria, and treatment options is essential for healthcare providers managing patients with this condition. Accurate coding is crucial for effective communication in clinical settings and for ensuring appropriate reimbursement for healthcare services related to the management of this lymphoma subtype.