ICD-10: C82.23

Clinical Description of ICD-10 Code C82.23

ICD-10 Code C82.23 refers specifically to Follicular lymphoma grade III, unspecified, intra-abdominal lymph nodes. This classification falls under the broader category of non-Hodgkin lymphoma (NHL), which encompasses a diverse group of blood cancers that originate in the lymphatic system. Follicular lymphoma is characterized by the proliferation of B-lymphocytes, a type of white blood cell, and is known for its typically indolent (slow-growing) nature, although grade III indicates a more aggressive form of the disease.

Characteristics of Follicular Lymphoma Grade III

1. Histological Features:
   - Follicular lymphoma is classified into grades based on the number of large cells (centroblasts) present in the tissue. Grade III is further divided into IIIA and IIIB, with IIIA having a predominance of small cells and IIIB being predominantly large cells. The presence of a higher number of large cells correlates with a more aggressive clinical behavior and poorer prognosis compared to lower grades[1].

2. Clinical Presentation:
   - Patients with follicular lymphoma may present with painless lymphadenopathy, which can occur in various regions, including the intra-abdominal area. Symptoms may also include fatigue, weight loss, fever, and night sweats, although these are more common in advanced stages of the disease[1][2].

3. Intra-abdominal Involvement:
   - Intra-abdominal lymph nodes can be involved in follicular lymphoma, leading to complications such as abdominal pain, obstruction, or ascites. The involvement of intra-abdominal lymph nodes is significant as it may indicate a more advanced stage of the disease, necessitating a thorough evaluation and potentially more aggressive treatment strategies[2].

Diagnosis and Staging

The diagnosis of follicular lymphoma grade III typically involves a combination of clinical evaluation, imaging studies (such as CT scans), and histopathological examination of lymph node biopsies. The Ann Arbor staging system is commonly used to determine the extent of the disease, which is crucial for guiding treatment decisions. Staging may involve assessing the number of lymph node regions involved and whether the disease has spread to other organs[1][3].

Treatment Options

Treatment for follicular lymphoma grade III may vary based on the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma. Common treatment modalities include:

• Chemotherapy: Regimens often include agents such as bendamustine, rituximab, or other combinations tailored to the patient's needs.
• Immunotherapy: Monoclonal antibodies like rituximab are frequently used to target CD20-positive B-cells.
• Radiation Therapy: This may be employed in localized disease or as palliative care for symptomatic relief.
• Stem Cell Transplantation: In select cases, particularly for younger patients or those with relapsed disease, autologous stem cell transplantation may be considered[2][3].

Conclusion

ICD-10 code C82.23 encapsulates a specific and clinically significant diagnosis of follicular lymphoma grade III affecting intra-abdominal lymph nodes. Understanding the characteristics, diagnosis, and treatment options for this condition is essential for healthcare providers managing patients with this type of lymphoma. As research continues to evolve, treatment strategies may further improve outcomes for patients diagnosed with this aggressive form of lymphoma.

[1] Article - Billing and Coding: Allogeneic Hematopoietic Cell ...
[2] NON-HODGKIN LYMPHOMA Includes Follicular, ...
[3] Medical Policy: Aliqopa (Copanlisib)

Diagnosing Follicular Lymphoma Grade III, unspecified, particularly when it involves intra-abdominal lymph nodes (ICD-10 code C82.23), requires a comprehensive approach that includes clinical evaluation, imaging studies, and histopathological examination. Below is a detailed overview of the criteria and processes typically involved in the diagnosis of this specific type of lymphoma.

Clinical Evaluation

Symptoms

Patients may present with a variety of symptoms, which can include:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the abdomen.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which can indicate more aggressive disease.
- Abdominal Symptoms: Discomfort or pain in the abdominal area due to enlarged lymph nodes.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoma or other hematological disorders.
- Family history of lymphoproliferative disorders.
- Exposure to risk factors such as certain infections (e.g., Epstein-Barr virus) or environmental toxins.

Imaging Studies

CT or PET Scans

Imaging studies play a crucial role in identifying the extent of the disease:
- CT Scan: Helps visualize enlarged lymph nodes in the abdomen and assess the involvement of other organs.
- PET Scan: Useful for evaluating metabolic activity of the lymph nodes, which can indicate the aggressiveness of the lymphoma.

Histopathological Examination

Biopsy

A definitive diagnosis of Follicular Lymphoma Grade III requires a biopsy of the affected lymph nodes:
- Excisional Biopsy: Preferred method to obtain a representative tissue sample.
- Fine Needle Aspiration (FNA): May be used but is less definitive.

Immunophenotyping

The biopsy sample is analyzed using immunohistochemistry to determine the presence of specific markers:
- B-cell Markers: Such as CD19, CD20, and CD10, which are typically expressed in follicular lymphoma.
- Ki-67 Proliferation Index: A higher Ki-67 index indicates a more aggressive form of lymphoma, which is characteristic of Grade III.

Genetic Studies

Cytogenetic analysis may be performed to identify chromosomal abnormalities, such as the t(14;18) translocation, which is commonly associated with follicular lymphoma.

Staging

The Ann Arbor staging system is often used to classify the extent of lymphoma:
- Stage I: Involvement of a single lymph node region.
- Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm.
- Stage III: Involvement of lymph nodes on both sides of the diaphragm, which may include intra-abdominal lymph nodes.
- Stage IV: Disseminated involvement of one or more extralymphatic organs.

Conclusion

The diagnosis of Follicular Lymphoma Grade III, unspecified, involving intra-abdominal lymph nodes (ICD-10 code C82.23) is a multifaceted process that combines clinical assessment, imaging studies, and histopathological evaluation. Accurate diagnosis is crucial for determining the appropriate treatment strategy and prognosis. 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 C82.23 refers to follicular lymphoma grade III that is unspecified and localized in intra-abdominal 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 and grade IIIB, with the latter being more aggressive. The presence of the disease in intra-abdominal lymph nodes indicates a need for careful evaluation and management due to potential complications and the risk of transformation to a more aggressive form of lymphoma.

Standard Treatment Approaches

1. Watchful Waiting

In cases where the lymphoma is asymptomatic and not causing significant health issues, a strategy of watchful waiting may be employed. This involves regular monitoring without immediate treatment, as many patients with follicular lymphoma can live for years without requiring intervention.

2. Chemotherapy

For symptomatic patients or those with rapidly progressing disease, chemotherapy is often the first line of treatment. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is a standard treatment for aggressive lymphomas and may be used in combination with other therapies.
• R-CHOP: The addition of Rituximab (a monoclonal antibody) to the CHOP regimen has significantly improved outcomes for patients with follicular lymphoma, including those with grade III disease.

3. Immunotherapy

Rituximab is a cornerstone of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. In cases of grade III follicular lymphoma, the use of Rituximab in combination with chemotherapy (R-CHOP) is particularly effective.

4. Radiation Therapy

Localized radiation therapy may be considered for patients with limited-stage disease or for those who have bulky disease in specific areas, such as intra-abdominal lymph nodes. Radiation can help reduce tumor size and alleviate symptoms.

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those with grade III disease, autologous stem cell transplantation may be an option. This approach is typically reserved for younger patients or those with a good performance status.

6. Targeted Therapies

Recent advancements have introduced targeted therapies that may be effective for follicular lymphoma. These include:

• PI3K Inhibitors: Such as Copanlisib (Aliqopa), which has shown efficacy in treating relapsed follicular lymphoma.
• BCL-2 Inhibitors: Like Venetoclax, which is being studied for its effectiveness in combination with other therapies.

7. Clinical Trials

Participation in clinical trials may provide access to new and emerging therapies that are not yet widely available. Patients are encouraged to discuss this option with their healthcare providers.

Conclusion

The treatment of follicular lymphoma grade III, particularly when involving intra-abdominal lymph nodes, requires a tailored approach based on the individual patient's condition, symptoms, and overall health. A combination of chemotherapy, immunotherapy, and possibly radiation therapy or stem cell transplantation forms the backbone of treatment strategies. Continuous advancements in targeted therapies and clinical trials offer hope for improved outcomes in this patient population. It is essential for patients to work closely with their oncology team to determine the most appropriate treatment plan based on their specific circumstances.

Follicular lymphoma, particularly classified under ICD-10 code C82.23, represents a subtype of non-Hodgkin lymphoma characterized by its indolent nature and specific clinical presentations. This lymphoma type primarily affects the lymphatic system and can manifest in various ways, especially when it involves intra-abdominal lymph nodes. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

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, with grade III being more aggressive than grades I and II. Grade III is further divided into IIIa and IIIb, with IIIa being characterized by a predominance of large cells but still retaining some follicular architecture.

Intra-abdominal Involvement

When follicular lymphoma involves intra-abdominal lymph nodes, it can lead to a variety of clinical manifestations. The intra-abdominal lymph nodes may include those in the mesentery, retroperitoneum, or other abdominal regions.

Signs and Symptoms

Common Symptoms

Patients with follicular lymphoma grade III, particularly with intra-abdominal lymph node involvement, may present with the following symptoms:

• Lymphadenopathy: Swelling of lymph nodes, which may be palpable in the abdomen or groin.
• Abdominal Pain or Discomfort: Patients may experience vague abdominal pain or discomfort due to lymph node enlargement.
• B Symptoms: These include fever, night sweats, and unexplained weight loss, which are indicative of systemic involvement.
• Fatigue: A common symptom due to the body’s response to cancer and potential anemia.
• Nausea or Vomiting: This may occur if lymph nodes compress surrounding structures or if there is gastrointestinal involvement.

Physical Examination Findings

During a physical examination, clinicians may note:

• Palpable Abdominal Masses: Enlarged lymph nodes may be felt during abdominal examination.
• Splenomegaly: Enlargement of the spleen may occur, which can be detected during a physical exam.
• Hepatomegaly: Liver enlargement may also be present, depending on the extent of disease involvement.

Patient Characteristics

Demographics

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. However, it can occur in younger individuals.
• Gender: There is a slight male predominance in the incidence of follicular lymphoma.

Risk Factors

• 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 environmental factors, including exposure to pesticides or solvents, 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 diseases, diabetes, and other malignancies.

Conclusion

Follicular lymphoma grade III, particularly with intra-abdominal lymph node involvement, presents a unique set of clinical challenges. Understanding the signs, symptoms, and patient characteristics is crucial for timely diagnosis and effective management. Clinicians should remain vigilant for the classic symptoms of lymphoma, particularly in at-risk populations, to facilitate early intervention and improve patient outcomes. Regular follow-ups and monitoring are essential for managing this indolent yet potentially aggressive form of lymphoma.

ICD-10 code C82.23 refers specifically to "Follicular lymphoma grade III, unspecified, intra-abdominal 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, Unspecified: This term emphasizes the unspecified nature of the lymphoma's characteristics in this particular code.

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. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in lymphoma cases, including follicular lymphoma.
4. Intra-abdominal Lymph Nodes: This specifies the location of the affected lymph nodes, which is crucial for diagnosis and treatment planning.
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, often requiring more intensive treatment strategies. The involvement of intra-abdominal lymph nodes can complicate the clinical picture, necessitating careful evaluation and management.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.23 is essential for accurate diagnosis, treatment planning, and communication among healthcare professionals. This knowledge aids in ensuring that patients receive appropriate care tailored to the specific characteristics of their lymphoma. If you need further details or specific information regarding treatment options or prognosis, feel free to ask!