ICD-10: C82.22

ICD-10 code C82.22 refers specifically to Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes. This classification falls under the broader category of non-Hodgkin lymphoma, which encompasses a variety of lymphoid malignancies, including follicular lymphoma.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is a type of non-Hodgkin lymphoma that originates in the follicle center of lymph nodes, characterized by the proliferation of B-lymphocytes. It is generally considered an indolent (slow-growing) form of lymphoma, but grade III follicular lymphoma indicates a more aggressive behavior compared to grades I and II. The grading system is crucial as it helps determine the prognosis and treatment approach.

Grade III Characteristics

• Histological Features: Follicular lymphoma is graded based on the number of large cells (centroblasts) present in the tissue. Grade III is further divided into IIIA and IIIB, with IIIA having fewer than 15 large cells per high-power field and IIIB having 15 or more. The unspecified designation in C82.22 indicates that the specific grade (A or B) is not detailed.
• Clinical Presentation: Patients may present with lymphadenopathy (swollen lymph nodes), which can be localized or generalized. In the case of C82.22, the involvement of intrathoracic lymph nodes suggests that the lymphoma is affecting lymph nodes located within the thoracic cavity, which may lead to symptoms such as cough, chest pain, or respiratory distress due to compression of surrounding structures.

Diagnosis and Staging

Diagnosis typically involves a combination of imaging studies (such as CT scans) and biopsy of affected lymph nodes. The staging of follicular lymphoma is crucial for treatment planning and is based on the Ann Arbor staging system, which considers the number of lymph node regions involved and the presence of systemic symptoms.

Treatment Options

Treatment for follicular lymphoma, particularly grade III, may include:
- Chemotherapy: Common regimens may involve combinations of agents such as bendamustine, rituximab, or other chemotherapeutic drugs.
- Targeted Therapy: Agents like copanlisib (Aliqopa) may be used, especially in relapsed cases.
- Radiation Therapy: This may be considered for localized disease or as part of a combined modality approach.
- Stem Cell Transplantation: In certain cases, particularly for aggressive forms or relapsed disease, allogeneic hematopoietic cell transplantation may be indicated.

Prognosis

The prognosis for patients with follicular lymphoma can vary significantly based on the grade, stage at diagnosis, and response to treatment. Grade III follicular lymphoma generally has a poorer prognosis compared to lower grades, necessitating more aggressive treatment strategies.

Conclusion

ICD-10 code C82.22 captures a specific and clinically significant diagnosis of follicular lymphoma grade III affecting intrathoracic lymph nodes. Understanding the clinical implications, treatment options, and prognosis associated with this condition is essential for effective management and patient care. For healthcare providers, accurate coding is crucial for appropriate treatment planning and reimbursement processes.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by its indolent nature and specific clinical presentations. The ICD-10 code C82.22 refers to follicular lymphoma grade III, unspecified, specifically involving intrathoracic lymph nodes. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is a type of B-cell non-Hodgkin lymphoma that typically arises from follicle center (germinal center) B-cells. It is classified into different grades based on histological features, with grade III being more aggressive than grades I and II. Grade III follicular lymphoma is further divided into IIIA and IIIB, depending on the presence of large cell components.

Signs and Symptoms

Patients with follicular lymphoma grade III may present with a variety of signs and symptoms, which can include:

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the neck, axilla, or groin. In the case of C82.22, there is specific involvement of intrathoracic lymph nodes, which may lead to mediastinal or hilar lymphadenopathy.
• B Symptoms: These include fever, night sweats, and unexplained weight loss. The presence of B symptoms can indicate a more aggressive disease and may influence treatment decisions.
• Respiratory Symptoms: If intrathoracic lymph nodes are significantly enlarged, patients may experience cough, dyspnea (shortness of breath), or chest pain due to compression of surrounding structures.
• Fatigue: Generalized fatigue is common and can be attributed to the disease itself or associated anemia.

Patient Characteristics

Certain demographic and clinical characteristics are often observed in patients diagnosed with follicular lymphoma grade III:

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. However, it can occur in younger individuals as well.
• 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 hematological malignancies may be present in some patients, suggesting a potential genetic predisposition.

Conclusion

Follicular lymphoma grade III, particularly with involvement of intrathoracic lymph nodes (ICD-10 code C82.22), presents with a range of clinical signs and symptoms, including lymphadenopathy, B symptoms, and respiratory issues. Understanding these presentations, along with patient characteristics such as age and gender, is essential for healthcare providers in diagnosing and managing this type of lymphoma effectively. Early recognition and appropriate treatment can significantly impact patient outcomes and quality of life.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by specific diagnostic criteria. The ICD-10 code C82.22 refers to follicular lymphoma grade III that is unspecified and located in the intrathoracic lymph nodes. Here’s a detailed overview of the criteria used for diagnosis:

Diagnostic Criteria for Follicular Lymphoma Grade III

1. Histological Examination

• Tissue Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes or other involved tissues. The histological examination is crucial for identifying the characteristic follicular architecture.
• Grading: Follicular lymphoma is graded based on the number of large cells (centroblasts) present. Grade III is further divided into:
  • Grade IIIA: Predominantly follicular architecture with a higher number of centroblasts.
  • Grade IIIB: Diffuse pattern with a predominance of centroblasts, often lacking the follicular structure.

2. 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.
• Immunohistochemistry: This method helps confirm the diagnosis by detecting specific proteins associated with follicular lymphoma.

3. Cytogenetic Analysis

• Chromosomal Abnormalities: The presence of the t(14;18) translocation, which involves the BCL2 gene, is a hallmark of follicular lymphoma. Cytogenetic studies can help identify this and other chromosomal abnormalities.

4. Clinical Evaluation

• Symptoms: Patients may present with lymphadenopathy, splenomegaly, or systemic symptoms such as fever, night sweats, and weight loss.
• Physical Examination: A thorough examination to assess the extent of lymphadenopathy, particularly in the intrathoracic region, is essential.

5. Imaging Studies

• CT or PET Scans: Imaging studies are used to evaluate the extent of disease involvement, particularly in the thoracic lymph nodes. These scans help in staging the lymphoma and assessing any mediastinal or hilar lymphadenopathy.

6. Staging

• Ann Arbor Staging System: This system classifies lymphomas based on the number of lymph node regions involved and the presence of systemic symptoms. For intrathoracic lymph nodes, the disease may be classified as stage II or III, depending on the extent of involvement.

Conclusion

The diagnosis of follicular lymphoma grade III, particularly in the context of intrathoracic lymph nodes, relies on a combination of histological, immunophenotypic, and cytogenetic evaluations, alongside clinical and imaging assessments. 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!

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 C82.22 refers to follicular lymphoma grade III that is unspecified and located in the intrathoracic lymph nodes. Here’s a detailed overview of the standard treatment approaches for this condition.

Overview of Follicular Lymphoma Grade III

Follicular lymphoma is classified into grades based on the histological features observed under a microscope. Grade III follicular lymphoma is further divided into two subcategories: grade IIIA, which retains some follicular architecture, and grade IIIB, which is more diffuse and aggressive. The presence of intrathoracic lymph nodes indicates that the disease has spread beyond its initial site, necessitating a more comprehensive treatment approach.

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains a cornerstone of treatment for advanced follicular lymphoma. The most commonly used regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for aggressive forms of lymphoma and can be effective in grade III cases.
• R-CHOP: The addition of Rituximab (a monoclonal antibody) to the CHOP regimen has significantly improved outcomes for patients with follicular lymphoma. Rituximab targets CD20-positive B cells, which are prevalent in follicular lymphoma.

2. Targeted Therapy

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

• PI3K Inhibitors: Copanlisib (Aliqopa) is a PI3K inhibitor approved for the treatment of relapsed follicular lymphoma. It is particularly useful for patients who have received at least two prior therapies.
• Bruton’s Tyrosine Kinase (BTK) Inhibitors: Ibrutinib is another targeted therapy that has shown promise in treating various forms of B-cell malignancies, including follicular lymphoma.

3. Immunotherapy

Immunotherapy, particularly with monoclonal antibodies, plays a significant role in the management of follicular lymphoma:

• Rituximab: As mentioned, Rituximab is often used in combination with chemotherapy but can also be used as a single agent for maintenance therapy after initial treatment.
• CAR T-cell Therapy: Chimeric Antigen Receptor (CAR) T-cell therapy is an innovative treatment option for patients with relapsed or refractory follicular lymphoma. This approach involves modifying a patient’s T cells to better recognize and attack lymphoma cells.

4. Radiation Therapy

Radiation therapy may be utilized in specific scenarios, particularly for localized disease or to manage symptoms. It is less common as a primary treatment for advanced follicular lymphoma but can be effective in palliative care settings.

5. 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, and then reinfusing the stem cells to restore bone marrow function.

Conclusion

The treatment of follicular lymphoma grade III, particularly when involving intrathoracic lymph nodes, requires a multidisciplinary approach tailored to the individual patient’s disease characteristics and overall health. Standard treatment typically involves a combination of chemotherapy, targeted therapies, and immunotherapy, with radiation and stem cell transplantation reserved for specific cases. Ongoing clinical trials and advancements in treatment modalities continue to improve outcomes for patients with this complex disease. Regular follow-up and monitoring are essential to assess treatment response and manage any potential complications.

ICD-10 code C82.22 refers specifically to "Follicular lymphoma grade III, unspecified, intrathoracic lymph nodes." 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 a direct alternative name that specifies the grade of the lymphoma.
2. Follicular Lymphoma, High-Grade: Grade III follicular lymphoma is often considered high-grade due to its aggressive nature compared to lower grades.
3. Follicular Lymphoma, Grade III, Unspecified: This term emphasizes the unspecified nature of the lymphoma's characteristics.

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. Intrathoracic Lymph Nodes: This term refers to the lymph nodes located within the thoracic cavity, which can be involved in various lymphomas, including follicular lymphoma.
4. Lymphadenopathy: This term describes the enlargement of lymph nodes, which can occur in cases of lymphoma.
5. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, indicating that it originates from B lymphocytes, a type of white blood cell.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. Grade III indicates a more aggressive form of the disease, which may require different treatment approaches compared to lower-grade follicular lymphomas. The involvement of intrathoracic lymph nodes suggests that the lymphoma has spread beyond its original site, which can impact prognosis and treatment strategies.

In summary, understanding the alternative names and related terms for ICD-10 code C82.22 can aid healthcare professionals in accurately diagnosing and discussing this specific type of lymphoma, as well as in coding and billing processes related to treatment and management.