ICD-10: C82.24

ICD-10 code C82.24 refers to Follicular lymphoma grade III, unspecified, specifically affecting the lymph nodes of the axilla and upper limb. This classification falls under the broader category of non-Hodgkin lymphoma, which encompasses a variety of lymphoid malignancies.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that originates from B-lymphocytes, specifically from the follicle center (germinal center) of lymph nodes. It is characterized by the proliferation of neoplastic follicle-like structures. The disease is typically classified into different grades based on histological features, with grade III indicating a more aggressive form of the disease compared to grades I and II.

Grade III Characteristics

• Histological Features: Follicular lymphoma grade III is further divided into IIIA and IIIB, with IIIA showing a predominance of follicular structures and IIIB exhibiting a diffuse pattern. Grade III is characterized by a higher number of large cells (centroblasts) in the follicles, which correlates with a more aggressive clinical course.
• Symptoms: Patients may present with painless lymphadenopathy, which can occur in various regions, including the axilla (armpit) and upper limb. Other symptoms may include fever, night sweats, weight loss, and fatigue, although many patients may be asymptomatic at diagnosis.

Specifics of C82.24

Affected Areas

The designation of lymph nodes of the axilla and upper limb indicates that the lymphoma is localized to these specific regions. This localization can influence treatment decisions and prognosis.

Diagnosis

Diagnosis typically involves:
- Imaging Studies: CT scans or PET scans to assess the extent of lymphadenopathy.
- Biopsy: A lymph node biopsy is essential for histological confirmation and grading of the lymphoma.
- Immunophenotyping: Flow cytometry and immunohistochemistry are used to identify specific markers (e.g., CD10, BCL2) that characterize follicular lymphoma.

Treatment Options

Treatment for follicular lymphoma grade III may include:
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab) for more aggressive disease.
- Radiation Therapy: May be used for localized disease.
- Targeted Therapy: Newer agents targeting specific pathways involved in lymphoma growth are also being explored.

Prognosis

The prognosis for patients with follicular lymphoma grade III can vary significantly based on factors such as age, overall health, and response to initial treatment. Generally, grade III has a poorer prognosis compared to lower-grade follicular lymphomas, necessitating more aggressive treatment approaches.

Conclusion

ICD-10 code C82.24 captures a specific and clinically significant diagnosis of follicular lymphoma grade III affecting the lymph nodes of the axilla and upper limb. Understanding the clinical characteristics, diagnostic criteria, and treatment options is crucial for effective management of this lymphoma subtype. Regular follow-up and monitoring are essential to assess treatment response and manage any potential complications associated with the disease.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. The ICD-10 code C82.24 specifically refers to follicular lymphoma grade III that is unspecified and located in the lymph nodes of the axilla (armpit) and upper limb. Below is a detailed overview of the clinical aspects associated with this condition.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that arises from B-lymphocytes. 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 axillary region and upper limbs. Patients may notice enlarged lymph nodes during self-examination or routine medical check-ups.
• 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 a general sense of tiredness or lack of energy, which can be debilitating.
• Pruritus: Some patients may experience itching, which is not necessarily related to skin lesions.
• Abdominal Symptoms: In cases where lymph nodes in the abdomen are involved, patients may experience abdominal pain or discomfort.

Patient Characteristics

Certain demographic and clinical characteristics are commonly 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, such as autoimmune diseases or previous cancers, which can complicate the clinical picture.
• Family History: A family history of lymphoproliferative disorders may be noted in some patients, suggesting a potential genetic predisposition.

Diagnosis and Staging

Diagnosis of follicular lymphoma grade III involves a combination of clinical evaluation, imaging studies (such as CT scans), and histopathological examination of lymph node biopsies. The staging of the disease is crucial for determining the appropriate treatment approach and is typically classified using the Ann Arbor staging system.

Imaging Studies

• CT Scans: These are often used to assess the extent of lymphadenopathy and to evaluate for any involvement of other organs.
• PET Scans: Positron emission tomography may be utilized to assess metabolic activity of the lymphoma and to help in staging.

Histopathological Examination

A biopsy of the affected lymph nodes is essential for confirming the diagnosis. The histological examination will reveal the characteristic follicular architecture and the presence of large cell components, which are indicative of grade III follicular lymphoma.

Conclusion

Follicular lymphoma grade III, particularly in the axillary and upper limb lymph nodes, presents with a range of clinical signs and symptoms, including lymphadenopathy, systemic B symptoms, and fatigue. Understanding the patient characteristics and the clinical presentation is vital for timely diagnosis and management. Early detection and appropriate treatment can significantly impact patient outcomes, making awareness of these clinical features essential for healthcare providers.

ICD-10 code C82.24 refers specifically to "Follicular lymphoma grade III, unspecified, lymph nodes of axilla and upper limb." This classification falls under the broader category of non-Hodgkin lymphoma, particularly follicular lymphoma, which is a type of cancer that originates in the lymphatic system.

Alternative Names and Related Terms

1. Follicular Lymphoma: This is the general term for the type of lymphoma that C82.24 represents. It is characterized by the proliferation of follicle center (germinal center) B-cells.

2. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of non-Hodgkin lymphoma, which encompasses a diverse group of blood cancers that include all lymphomas except Hodgkin's lymphoma.

3. Grade III Follicular Lymphoma: This term specifies the aggressiveness of the lymphoma, indicating that it is a higher-grade variant, which typically has a worse prognosis compared to lower-grade follicular lymphomas.

4. Lymphoma of the Axilla: This term refers to the specific anatomical location of the lymph nodes affected by the lymphoma, which is the axillary region (armpit area).

5. Lymphoma of the Upper Limb: Similar to the above, this term indicates the involvement of lymph nodes in the upper limb, which may include nodes in the shoulder and arm regions.

6. B-cell Follicular Lymphoma: This term emphasizes the B-cell origin of the lymphoma, as follicular lymphoma arises from B-lymphocytes.

7. Follicular Lymphoma, Unspecified: This term may be used when the specific characteristics of the lymphoma are not detailed, which aligns with the "unspecified" designation in the ICD-10 code.

Related Terms in Medical Context

• Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with lymphoma.
• Lymphoma Staging: Related to the classification of the extent of the disease, which can influence treatment decisions.
• Chemotherapy and Immunotherapy: Common treatment modalities for follicular lymphoma, especially in higher grades.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.24 is crucial for accurate diagnosis, treatment planning, and communication among healthcare professionals. These terms help in categorizing the disease and understanding its implications for patient care. If you need further details on treatment options or prognosis related to this condition, feel free to ask!

Diagnosing Follicular Lymphoma, particularly grade III as specified by the ICD-10 code C82.24, involves a comprehensive evaluation that includes clinical assessment, imaging studies, and histopathological examination. 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, particularly in the axillary and upper limb regions.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more aggressive disease.
- Fatigue: Generalized fatigue is common among patients.

Physical Examination

A thorough physical examination is essential to identify:
- Enlarged lymph nodes in the axilla and upper limbs.
- Splenomegaly or hepatomegaly, which may indicate systemic involvement.

Imaging Studies

Radiological Assessment

Imaging techniques are crucial for staging and assessing the extent of the disease:
- CT Scans: Chest, abdomen, and pelvis CT scans help visualize lymph node involvement and any organomegaly.
- PET Scans: Positron Emission Tomography (PET) scans can assess metabolic activity in lymph nodes, helping to differentiate between active disease and benign conditions.

Histopathological Examination

Biopsy

A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node:
- Excisional Biopsy: Preferred for obtaining a representative tissue sample.
- Core Needle Biopsy: May be used if excisional biopsy is not feasible.

Microscopic Evaluation

The histopathological examination focuses on:
- Follicular Architecture: The presence of neoplastic follicles is characteristic of follicular lymphoma.
- Cell Type: The identification of centrocytes and centroblasts is crucial. Grade III follicular lymphoma is characterized by a higher proportion of centroblasts.
- Immunophenotyping: Flow cytometry or immunohistochemistry is used to confirm the presence of B-cell markers (e.g., CD19, CD20) and to assess the proliferation index (Ki-67).

Molecular and Genetic Testing

Genetic Markers

• t(14;18) Translocation: Detection of this chromosomal abnormality is common in follicular lymphoma and is often assessed through fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR).

Staging and Grading

Ann Arbor Staging System

The Ann Arbor system is used to stage lymphoma based on the number of lymph node regions involved and the presence of systemic symptoms.

Grading

Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF):
- Grade I: 0-5 centroblasts per HPF.
- Grade II: 6-15 centroblasts per HPF.
- Grade III: More than 15 centroblasts per HPF, which may be further classified into IIIA (predominantly follicular) and IIIB (predominantly diffuse).

Conclusion

The diagnosis of follicular lymphoma grade III, unspecified, in the lymph nodes of the axilla and upper limb (ICD-10 code C82.24) is a multifaceted process that combines clinical evaluation, imaging studies, histopathological analysis, and genetic testing. Each component plays a critical role in confirming the diagnosis and determining the appropriate treatment strategy. 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 C82.24 refers to follicular lymphoma grade III that is unspecified and located in the lymph nodes of the axilla and upper limb. Understanding the standard treatment approaches for this condition is crucial for effective management.

Overview of Follicular Lymphoma Grade III

Follicular lymphoma 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 features. The disease typically presents with painless lymphadenopathy, and in this case, it specifically affects the lymph nodes in the axilla and upper limb.

Standard Treatment Approaches

1. Initial Assessment and Staging

Before initiating treatment, a thorough assessment is essential. This includes:
- Imaging Studies: CT scans or PET scans to determine the extent of the disease.
- Biopsy: Confirming the diagnosis and grading through lymph node biopsy.
- Laboratory Tests: Blood tests to evaluate overall health and organ function.

2. Watchful Waiting

In cases where the lymphoma is asymptomatic and not causing significant health issues, a strategy known as "watchful waiting" may be employed. This involves regular monitoring without immediate treatment, particularly in older patients or those with comorbidities.

3. Chemotherapy

For symptomatic patients or those with rapidly progressing disease, chemotherapy is often the first-line treatment. Common regimens include:
- R-CHOP: A combination of Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. This regimen is effective for many patients with aggressive forms of follicular lymphoma.
- R-CVP: Rituximab combined with Cyclophosphamide, Vincristine, and Prednisone may be used, especially in patients who cannot tolerate more intensive chemotherapy.

4. Targeted Therapy

Targeted therapies have emerged as significant options for treating follicular lymphoma:
- Rituximab: A monoclonal antibody targeting CD20, often used in combination with chemotherapy.
- Idelalisib: An oral inhibitor of PI3K, used in relapsed or refractory cases.
- Copanlisib: Another PI3K inhibitor that has shown efficacy in treating follicular lymphoma.

5. Radiation Therapy

Radiation therapy may be considered in specific situations, such as localized disease or for palliative care to relieve symptoms. It is particularly effective for localized lymphadenopathy.

6. Stem Cell Transplantation

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

7. Clinical Trials

Participation in clinical trials may provide access to new therapies and treatment strategies. Patients should be informed about ongoing studies that may be relevant to their condition.

Conclusion

The management of follicular lymphoma grade III, particularly in the axilla and upper limb, requires a tailored approach based on the individual patient's condition, overall health, and preferences. Standard treatment options include chemotherapy, targeted therapies, and, in some cases, radiation therapy or stem cell transplantation. Continuous advancements in treatment strategies and ongoing clinical trials offer hope for improved outcomes in patients with this challenging lymphoma subtype. Regular follow-up and monitoring are essential to adapt the treatment plan as needed and to manage any potential side effects effectively.