ICD-10: C82.20

Clinical Description of Follicular Lymphoma Grade III

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, specifically from B-cells, which are a type of white blood cell. It is characterized by the proliferation of neoplastic follicle center (germinal center) cells. Follicular lymphoma is generally indolent, meaning it tends to grow slowly, but grade III variants can exhibit more aggressive behavior.

Classification and Grading

Follicular lymphoma is classified into different grades based on histological features observed under a microscope. The grading system ranges from grade I (least aggressive) to grade III (most aggressive). Grade III is further divided into:

• Grade IIIA: Predominantly follicular architecture with some diffuse areas.
• Grade IIIB: Predominantly diffuse growth pattern with few or no follicles.

The ICD-10 code C82.20 specifically refers to Follicular lymphoma grade III, unspecified, unspecified site, indicating that the lymphoma is of grade III but does not specify the exact site of involvement within the body. This code is used when the precise location of the lymphoma is not documented or is not relevant for the coding purpose.

Clinical Features

Patients with follicular lymphoma grade III may present with various symptoms, including:

• Lymphadenopathy: Swelling of lymph nodes, which may be painless.
• B-symptoms: These include fever, night sweats, and unexplained weight loss.
• Fatigue: General tiredness and lack of energy.
• Splenomegaly: Enlargement of the spleen, which may occur in some patients.

Diagnosis

Diagnosis typically involves:

• Histopathological Examination: A biopsy of the lymph node or affected tissue is essential for confirming the diagnosis and determining the grade of the lymphoma.
• Immunophenotyping: This process helps identify specific markers on the lymphoma cells, aiding in the diagnosis and treatment planning.
• Imaging Studies: CT scans, PET scans, or MRI may be used to assess the extent of the disease.

Treatment Options

Treatment for follicular lymphoma grade III may include:

• Chemotherapy: Often combined with immunotherapy, such as monoclonal antibodies (e.g., rituximab).
• Radiation Therapy: May be used in localized cases or as palliative care.
• Stem Cell Transplantation: In some cases, especially for younger patients or those with aggressive disease, an allogeneic or autologous stem cell transplant may be considered.

Prognosis

The prognosis for patients with follicular lymphoma grade III can vary significantly based on several factors, including the patient's age, overall health, and response to treatment. Generally, grade III follicular lymphoma is associated with a more aggressive clinical course compared to lower-grade variants, necessitating more intensive treatment strategies.

Conclusion

ICD-10 code C82.20 is crucial for accurately documenting cases of follicular lymphoma grade III when the specific site is not identified. Understanding the clinical features, diagnostic methods, treatment options, and prognosis associated with this condition is essential for healthcare providers in managing and treating affected patients effectively.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma (NHL) characterized by the proliferation of B-lymphocytes. The ICD-10 code C82.20 specifically refers to follicular lymphoma grade III that is unspecified in terms of site. This type of lymphoma is known for its indolent nature, but grade III indicates a more aggressive form that may require prompt and effective treatment. Below, we explore 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 has a predominance of follicular structures, while IIIB shows a diffuse pattern. The treatment approach may vary based on the specific grade, stage of the disease, and the patient's overall health.

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains a cornerstone in the treatment of 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 has shown significant efficacy in improving patient outcomes[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 effective options for treating follicular lymphoma:

• Rituximab: As a monoclonal antibody targeting CD20, Rituximab can be used alone or in combination with chemotherapy. It is particularly effective in inducing remission in patients with follicular lymphoma[3].

• Idelalisib: This is an oral inhibitor of the PI3K pathway and is used in combination with Rituximab for patients who have relapsed or refractory disease[4].

• Copanlisib: Another PI3K inhibitor, Copanlisib is indicated for adult patients with relapsed follicular lymphoma and has shown promising results in clinical trials[5].

3. Radioimmunotherapy

Radioimmunotherapy combines radiation therapy with immunotherapy. Agents like Ibritumomab tiuxetan and Tositumomab are used to deliver targeted radiation to lymphoma cells, which can be particularly beneficial for patients with localized disease or those who have not responded to other treatments[6].

4. Stem Cell Transplantation

For patients with high-risk or relapsed follicular lymphoma, autologous stem cell transplantation may be considered. This approach involves harvesting the patient's stem cells, administering high-dose chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function[7].

5. Clinical Trials

Participation in clinical trials can provide access to novel therapies and treatment strategies that are not yet widely available. Patients are encouraged to discuss potential clinical trial options with their healthcare providers, as these may offer additional benefits or insights into the most effective treatment approaches for their specific condition[8].

Conclusion

The treatment of follicular lymphoma grade III, unspecified site, involves a multifaceted approach that includes chemotherapy, targeted therapies, radioimmunotherapy, and potentially stem cell transplantation. The choice of treatment is influenced by various factors, including the patient's overall health, the specific characteristics of the lymphoma, and the presence of any comorbid conditions. Ongoing research and clinical trials continue to shape the landscape of treatment options, providing hope for improved outcomes in patients diagnosed with this challenging form of lymphoma.

For personalized treatment plans, it is essential for patients to consult with their oncologists, who can tailor therapies based on individual circumstances and the latest clinical guidelines.

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10 code C82.20 specifically refers to follicular lymphoma grade III, unspecified, at an unspecified site. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Signs and Symptoms

Patients with follicular lymphoma grade III may present with a variety of signs and symptoms, which can vary significantly among individuals. Common manifestations include:

• Lymphadenopathy: The most prominent feature is often painless swelling of lymph nodes, which may be localized or generalized. Patients may notice enlarged lymph nodes in the neck, armpits, or groin.
• 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 clothing and bedding.
• Weight Loss: Unintentional weight loss of more than 10% of body weight over six months.
• Fatigue: Patients often report significant fatigue or a general feeling of malaise.
• Abdominal Symptoms: If lymph nodes in the abdomen are involved, patients may experience abdominal pain, fullness, or discomfort due to organ compression.

Patient Characteristics

Follicular lymphoma typically affects adults, with the following characteristics often observed:

• Age: Most commonly diagnosed in individuals aged 60 years and older, although it can occur in younger 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.

Diagnosis and Evaluation

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

• Biopsy: A lymph node biopsy is essential for confirming the diagnosis and determining the grade of the lymphoma. Grade III follicular lymphoma is characterized by a higher proliferation index and may exhibit more aggressive behavior compared to lower grades.
• Imaging Studies: CT scans or PET scans may be utilized to assess the extent of disease and involvement of lymph nodes and other organs.
• Laboratory Tests: Blood tests may be performed to evaluate overall health and check for anemia or other abnormalities.

Conclusion

Follicular lymphoma grade III, unspecified, is a complex condition that presents with a range of symptoms primarily related to lymphadenopathy and systemic effects. Understanding the clinical presentation and patient characteristics is essential for timely diagnosis and appropriate management. Given the potential for variability in symptoms and disease progression, a thorough clinical evaluation and multidisciplinary approach are critical in managing patients with this diagnosis.

ICD-10 code C82.20 refers specifically to "Follicular lymphoma grade III, unspecified, unspecified site." 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 III

1. Follicular Lymphoma, Grade 3: This is the most direct alternative name, emphasizing the grade of the lymphoma.
2. High-Grade Follicular Lymphoma: Since grade III indicates a more aggressive form of the disease, it is often referred to as high-grade.
3. Follicular Lymphoma, Grade III, NOS: "NOS" stands for "Not Otherwise Specified," indicating that the specific characteristics of the lymphoma are not detailed.

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 originates from B lymphocytes (a type of white blood cell).
4. Lymphoproliferative Disorders: This term encompasses a range of conditions, including lymphomas, where there is an abnormal proliferation of lymphocytes.
5. Aggressive Lymphoma: Given that grade III indicates a more aggressive disease course, this term may be used in clinical discussions.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. Grade III indicates a higher level of malignancy compared to grades I and II, often leading to a more aggressive treatment approach. The unspecified site designation means that the lymphoma's location within the body has not been specified, which can occur in various lymphatic tissues.

Understanding these alternative names and related terms is crucial for accurate communication in clinical settings, coding, and research related to follicular lymphoma and its management.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by specific diagnostic criteria. The ICD-10 code C82.20 refers to "Follicular lymphoma grade III, unspecified, unspecified site." Here’s a detailed overview of the criteria used for diagnosing this condition.

Diagnostic Criteria for Follicular Lymphoma Grade III

1. Clinical Evaluation

• Symptoms: Patients may present with symptoms such as painless lymphadenopathy, fever, night sweats, and weight loss. These systemic symptoms are often referred to as "B symptoms" and can indicate more aggressive disease.
• Physical Examination: A thorough physical examination is essential to identify lymphadenopathy or splenomegaly.

2. Histopathological Examination

• Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node or tissue. The biopsy 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 III, there is a predominance of larger cells (centroblasts), which indicates a more aggressive form of the disease.
• Grading: Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF). Grade III is further divided into:
  • Grade IIIA: Less than 15 centroblasts per HPF.
  • Grade IIIB: 15 or more centroblasts per HPF.

3. Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers on the lymphoma cells. Follicular lymphoma typically expresses CD19, CD20, CD10, and BCL2, while lacking CD5.
• BCL2 Gene Rearrangement: The presence of the BCL2 gene rearrangement is a hallmark of follicular lymphoma and can be detected through molecular techniques.

4. Imaging Studies

• CT or PET Scans: Imaging studies are performed to assess the extent of the disease, including the involvement of lymph nodes and other organs. These scans help in staging the lymphoma, which is crucial for treatment planning.

5. Staging

• Ann Arbor Staging System: This system classifies lymphomas based on the number of lymph node regions involved and whether the disease has spread to other organs. Staging is important for determining prognosis and treatment options.

6. Exclusion of Other Conditions

• Differential Diagnosis: It is essential to rule out other types of lymphomas and reactive lymphadenopathy. Conditions such as chronic lymphocytic leukemia (CLL) or other non-Hodgkin lymphomas may present similarly.

Conclusion

The diagnosis of follicular lymphoma grade III, unspecified site (ICD-10 code C82.20), involves a comprehensive approach that includes clinical evaluation, histopathological examination, immunophenotyping, imaging studies, and staging. Accurate diagnosis is crucial for determining the appropriate treatment strategy and prognosis for patients. If you have further questions or need more specific information, feel free to ask!