ICD-10: C82.2

Follicular lymphoma grade III, unspecified, is classified under the ICD-10 code C82.2. This specific type of lymphoma is part of a broader category of non-Hodgkin lymphomas and has several alternative names and related terms that are commonly used in medical literature and practice. Below is a detailed overview of these terms.

Alternative Names for Follicular Lymphoma Grade III

1. Follicular Lymphoma, Grade 3: This is a direct synonym for C82.2, emphasizing the grade of the lymphoma.
2. Follicular Lymphoma, Grade III: Another variation that specifies the grade using Roman numerals.
3. Follicular Lymphoma, High-Grade: Since grade III is considered high-grade, this term is often used interchangeably in clinical discussions.
4. Follicular Lymphoma, Aggressive Type: This term reflects the more aggressive nature of grade III compared to lower grades of follicular lymphoma.

Related Terms and Classifications

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. B-cell Lymphoma: Follicular lymphoma arises from B-cells, a type of white blood cell, and is thus categorized under B-cell lymphomas.
4. ICD-10 Code C82: This broader code encompasses all follicular lymphomas, with C82.2 specifically denoting grade III, unspecified.
5. SEER Classification: The Surveillance, Epidemiology, and End Results (SEER) program classifies follicular lymphoma grade III under the code 9698/3, indicating its histological type and behavior.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in the diagnosis, treatment, and coding of follicular lymphoma. Accurate terminology ensures effective communication among medical teams and aids in the proper documentation and billing processes.

In summary, follicular lymphoma grade III, unspecified (ICD-10 code C82.2), is recognized by various alternative names and related terms that reflect its classification within the broader context of lymphomas. These terms are essential for accurate diagnosis, treatment planning, and coding in medical records.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by its indolent nature and specific treatment challenges. The ICD-10 code C82.2 refers to follicular lymphoma grade III, which is often more aggressive than lower-grade variants. Here’s a comprehensive overview of the standard treatment approaches for this condition.

Overview of Follicular Lymphoma Grade III

Follicular lymphoma is classified into different grades based on histological features, with grade III being further divided into IIIA and IIIB. Grade IIIA typically retains some follicular architecture, while IIIB is characterized by a diffuse pattern. The treatment approach may vary depending on the specific grade, stage of the disease, and patient factors such as age and overall health.

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains a cornerstone of treatment for grade III follicular lymphoma. Common regimens include:

• R-CHOP: This regimen combines Rituximab (a monoclonal antibody) with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. R-CHOP is often the first-line treatment for advanced-stage follicular lymphoma and is effective in inducing remission[1].
• R-CVP: This regimen includes Rituximab, Cyclophosphamide, Vincristine, and Prednisone, and may be used in patients who are not candidates for more intensive chemotherapy[2].

2. Targeted Therapy

Targeted therapies have emerged as significant options for treating follicular lymphoma:

• Rituximab: As a monoclonal antibody targeting CD20, Rituximab is frequently used in combination with chemotherapy or as a maintenance therapy after initial treatment[3].
• Idelalisib: This is an oral inhibitor of PI3K that can be used in relapsed or refractory cases, particularly in patients who are not candidates for chemotherapy[4].

3. Radiation Therapy

Radiation therapy may be employed in specific scenarios:

• Localized Disease: For patients with localized grade III follicular lymphoma, involved-field radiation therapy can be effective, especially if the disease is confined to a limited area[5].
• Palliative Care: Radiation can also be used to alleviate symptoms in advanced disease stages, particularly for bulky lymphadenopathy[6].

4. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those with grade III disease, stem cell transplantation may be considered:

• Autologous Stem Cell Transplant (ASCT): This is often used after achieving a complete or partial response to initial therapy, particularly in younger patients with good performance status[7].
• Allogeneic Stem Cell Transplant: This option is less common but may be considered in certain cases, especially for patients with high-risk features[8].

5. Clinical Trials

Participation in clinical trials can provide access to novel therapies and treatment strategies. Patients are encouraged to discuss potential clinical trial options with their healthcare providers, as these may offer promising new treatments that are not yet widely available[9].

Conclusion

The treatment of follicular lymphoma grade III (ICD-10 code C82.2) involves a multifaceted approach that includes chemotherapy, targeted therapies, radiation, and potentially stem cell transplantation. The choice of treatment is highly individualized, taking into account the specific characteristics of the lymphoma, patient health, and preferences. Ongoing research and clinical trials continue to shape the landscape of treatment options, offering hope for improved outcomes in this challenging disease. Patients should work closely with their oncology team to determine the best course of action tailored to their unique situation.

References

1. Treatment Patterns of Follicular Lymphoma in the United States.
2. Non-Hodgkin Lymphoma Treatment Guidelines.
3. Follicular Lymphoma - SEER Cancer.
4. MolDX: Minimal Residual Disease Testing for Cancer.
5. Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma.
6. Billing and Coding: Intensity Modulated Radiation Therapy.
7. Mortality of lymphoma and myeloma in China, 2004–2017.
8. ICDO3_to_ICD10_1-to-1.
9. Topic Packet September 2023.

Follicular lymphoma, particularly classified under ICD-10 code C82.2 as "Follicular lymphoma grade III, unspecified," is a type of non-Hodgkin lymphoma (NHL) that arises from B-lymphocytes. This condition is characterized by a range of clinical presentations, signs, symptoms, and patient characteristics that can vary significantly among individuals. Below is a detailed overview of these aspects.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is typically indolent, meaning it often progresses slowly. However, grade III follicular lymphoma is considered more aggressive than lower grades, indicating a higher proliferation of malignant cells. This subtype can present with a variety of symptoms and clinical findings.

Common Signs and Symptoms

1. Lymphadenopathy:
   - The most common presentation is painless swelling of lymph nodes, which may occur in the neck, armpits, or groin. Patients may notice enlarged lymph nodes during routine examinations or while feeling for lumps.

2. B Symptoms:
   - Patients may experience systemic symptoms known as "B symptoms," which include:

   • Fever: Unexplained fevers that may be intermittent.
   • Night Sweats: Profuse sweating during the night that can soak clothing and bedding.
   • Weight Loss: Unintentional weight loss of more than 10% of body weight over six months.

3. Fatigue:
   - Many patients report significant fatigue, which can be debilitating and affect daily activities.

4. Abdominal Symptoms:
   - In some cases, lymphadenopathy may occur in the abdomen, leading to symptoms such as abdominal pain, fullness, or discomfort.

5. Skin Manifestations:
   - Rarely, patients may develop skin lesions or rashes associated with lymphoma.

Advanced Symptoms

As the disease progresses, patients may experience more severe symptoms, including:
- Cough or Shortness of Breath: If lymph nodes in the chest are involved.
- Bone Pain: If the lymphoma spreads to the bone marrow or bones.

Patient Characteristics

Demographics

• Age: Follicular lymphoma typically affects adults, with a median age of diagnosis around 60 years. It is less common in younger individuals.
• Gender: There is a slight male predominance, with men being more frequently diagnosed than women.

Risk Factors

• Family History: A family history of lymphoma or other hematologic 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.
• Environmental Exposures: Certain environmental factors, including 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 treatment and management, such as:
- Cardiovascular Disease: Pre-existing heart conditions can affect treatment options.
- Diabetes: May influence overall health and treatment response.

Conclusion

Follicular lymphoma grade III, unspecified (ICD-10 code C82.2), presents with a range of clinical signs and symptoms, primarily characterized by lymphadenopathy and systemic B symptoms. Understanding the patient demographics and risk factors is crucial for early diagnosis and effective management. Given the variability in presentation, a thorough clinical evaluation is essential for appropriate diagnosis and treatment planning. If you suspect lymphoma or have concerns about symptoms, consulting a healthcare professional for further evaluation is recommended.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by specific histological features and clinical behavior. The diagnosis of follicular lymphoma, including grade III, is guided by a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosing follicular lymphoma grade III, unspecified, which corresponds to the ICD-10 code C82.2.

Clinical Presentation

1. Symptoms: Patients may present with painless lymphadenopathy, which is the most common symptom. Other symptoms can include fever, night sweats, weight loss, and fatigue, often referred to as "B symptoms" in lymphoma.

2. Physical Examination: A thorough physical examination is essential to identify lymph node enlargement, splenomegaly, or hepatomegaly.

Imaging Studies

1. CT Scans: Computed tomography (CT) scans of the chest, abdomen, and pelvis are typically performed to assess the extent of lymphadenopathy and to identify any organ involvement.

2. PET Scans: Positron emission tomography (PET) scans may be utilized to evaluate metabolic activity in lymph nodes and to help stage the disease.

Histopathological Criteria

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node or tissue. The biopsy specimen is examined microscopically.

2. Histological Features: Follicular lymphoma is characterized by the presence of neoplastic follicles composed of small to medium-sized lymphoid cells. In grade III, there is a predominance of larger cells, which may include a mix of centroblasts and centrocytes. The grading is based on the number of centroblasts per high-power field (HPF):
   - Grade III: More than 15 centroblasts per HPF.

3. Immunophenotyping: Immunohistochemical staining is performed to confirm the diagnosis. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2, while lacking CD5.

4. Cytogenetic Analysis: The presence of the t(14;18) chromosomal translocation, which results in the overexpression of the BCL2 gene, is a hallmark of follicular lymphoma and can be assessed through fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR).

Staging

The Ann Arbor staging system is commonly used to determine the extent of the disease, which is crucial for treatment planning. Staging involves assessing the number of lymph node regions involved and whether there is extranodal involvement.

Conclusion

The diagnosis of follicular lymphoma grade III, unspecified (ICD-10 code C82.2), relies on a combination of clinical findings, imaging studies, and detailed histopathological evaluation. Accurate diagnosis is essential for determining the appropriate treatment strategy and prognosis for the patient. If you have further questions or need more specific information, feel free to ask!

Clinical Description of Follicular Lymphoma Grade III (ICD-10 Code C82.2)

Overview of Follicular Lymphoma

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates from B-lymphocytes, specifically in the follicle or germinal center of lymphoid tissue. It is characterized by a slow progression 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 III indicating a more aggressive form of the disease.

ICD-10 Code C82.2

The ICD-10-CM code C82.2 specifically refers to Follicular lymphoma grade III, unspecified. This classification is used in medical coding to identify cases of follicular lymphoma that are of grade III but do not specify the site of the lymphoma. The grade III designation indicates a higher proliferation of malignant cells compared to lower grades, which can influence treatment decisions and prognosis.

Clinical Features

1. Symptoms: Patients with follicular lymphoma may present with:
   - Painless lymphadenopathy (swollen lymph nodes)
   - Fever
   - Night sweats
   - Unexplained weight loss
   - Fatigue

2. Diagnosis: Diagnosis typically involves:
   - Histopathological Examination: A biopsy of the lymph node is performed to assess the grade of lymphoma. Grade III follicular lymphoma shows a higher number of large cells (centroblasts) compared to lower grades.
   - Imaging Studies: CT scans or PET scans may be used to determine the extent of the disease.
   - Blood Tests: These may include complete blood counts and tests for lactate dehydrogenase (LDH) levels, which can indicate tumor burden.

3. Prognosis: The prognosis for patients with grade III follicular lymphoma is generally poorer than for those with lower grades. The International Prognostic Index (IPI) is often used to assess risk and guide treatment options.

Treatment Options

Treatment for follicular lymphoma grade III may include:

• Chemotherapy: Often combined with immunotherapy (e.g., rituximab) to enhance effectiveness.
• Radiation Therapy: May be used in localized cases or as palliative care.
• Targeted Therapy: Newer agents that specifically target cancer cells may be considered.
• Stem Cell Transplantation: In some cases, especially for younger patients or those with aggressive disease, autologous stem cell transplantation may be an option.

Conclusion

ICD-10 code C82.2 is crucial for accurately documenting and coding cases of follicular lymphoma grade III, unspecified. Understanding the clinical features, diagnostic criteria, and treatment options associated with this condition is essential for healthcare providers in managing patient care effectively. As research continues, treatment protocols may evolve, emphasizing the importance of ongoing education and adaptation in clinical practice.