ICD-10: C82.26

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by specific histological features and clinical presentations. The diagnosis of follicular lymphoma, including grade III, involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosing follicular lymphoma grade III, specifically when it involves intrapelvic lymph nodes, which corresponds to the ICD-10 code C82.26.

Clinical Evaluation

1. Symptoms: Patients may present with symptoms such as painless lymphadenopathy, which can be localized to the intrapelvic region. Other systemic symptoms may include fever, night sweats, and weight loss, often referred to as "B symptoms."

2. Physical Examination: A thorough physical examination is essential to identify lymphadenopathy, hepatosplenomegaly, or other signs of systemic involvement.

Imaging Studies

1. CT or MRI Scans: Imaging studies, particularly computed tomography (CT) or magnetic resonance imaging (MRI), are crucial for assessing the extent of lymphadenopathy. These scans help visualize the size and location of lymph nodes, including those in the pelvis.

2. PET Scans: Positron emission tomography (PET) scans may be utilized to evaluate metabolic activity in lymph nodes, helping to differentiate between benign and malignant processes.

Histopathological Examination

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node. This can be performed via excisional biopsy, core needle biopsy, or fine-needle aspiration.

2. Histological Classification: The biopsy specimen is examined microscopically to confirm the presence of follicular lymphoma. Grade III follicular lymphoma is characterized by:
   - Follicular Architecture: The presence of neoplastic follicles.
   - Cellularity: High cellularity with a predominance of large cells, which distinguishes it from lower-grade follicular lymphomas.
   - Immunophenotyping: Immunohistochemical staining is performed to identify specific markers. Follicular lymphoma typically expresses CD10, BCL2, and BCL6, while the presence of a high number of large cells may indicate a grade III classification.

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

Staging

1. Ann Arbor Staging System: Once diagnosed, the lymphoma is staged using the Ann Arbor classification, which assesses the extent of disease based on the number and location of affected lymph nodes and any systemic involvement.

2. Involvement of Intrapelvic Lymph Nodes: For C82.26, the specific involvement of intrapelvic lymph nodes is noted, which may influence treatment decisions and prognosis.

Conclusion

The diagnosis of follicular lymphoma grade III, particularly when involving intrapelvic lymph nodes, is a multifaceted process that integrates clinical assessment, imaging studies, and histopathological findings. Accurate diagnosis is crucial for determining the appropriate treatment strategy and for prognostic evaluation. If you have further questions or need more specific information regarding treatment options or management strategies, 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 C82.26 refers to follicular lymphoma grade III located in unspecified intrapelvic lymph nodes. 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 the case of C82.26, the lymph nodes affected are located in the pelvic region.

Standard Treatment Approaches

1. Watchful Waiting

For patients with asymptomatic follicular lymphoma, especially in early stages, a strategy of watchful waiting may be employed. This involves regular monitoring without immediate treatment, as the disease can remain stable for extended periods.

2. Chemotherapy

Chemotherapy is a cornerstone of treatment for symptomatic or advanced follicular lymphoma. Common regimens include:

• CHOP: Cyclophosphamide, doxorubicin, vincristine, and prednisone.
• R-CHOP: The addition of rituximab (a monoclonal antibody) to the CHOP regimen has significantly improved outcomes for patients with follicular lymphoma.

3. Immunotherapy

Rituximab is a key component in the treatment of follicular lymphoma. It can be used alone or in combination with chemotherapy. The use of rituximab has been shown to enhance response rates and prolong survival in patients with follicular lymphoma, including those with grade III disease.

4. Radioimmunotherapy

This approach combines radiation therapy with immunotherapy. Agents like ibritumomab tiuxetan deliver targeted radiation to lymphoma cells, which can be particularly effective in localized disease or as a consolidation therapy after chemotherapy.

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be considered. This is typically reserved for younger patients or those with more aggressive disease features.

6. Targeted Therapies

Recent advancements have introduced targeted therapies such as:

• PI3K inhibitors (e.g., copanlisib) for patients with relapsed disease.
• BCL-2 inhibitors (e.g., venetoclax) which have shown promise in clinical trials.

7. Clinical Trials

Participation in clinical trials may be an option for patients, providing access to novel therapies and treatment strategies that are not yet widely available.

Conclusion

The management of follicular lymphoma grade III, particularly in the context of intrapelvic lymph nodes, requires a tailored approach based on the patient's overall health, disease stage, and specific characteristics of the lymphoma. A multidisciplinary team, including oncologists, hematologists, and radiologists, is essential for optimizing treatment outcomes. Regular follow-up and monitoring are crucial to adapt the treatment plan as needed, ensuring the best possible care for patients with this complex condition.

Clinical Description of ICD-10 Code C82.26

ICD-10 Code C82.26 specifically refers to Follicular lymphoma grade III, unspecified, intrapelvic lymph nodes. This classification falls under the broader category of non-Hodgkin lymphoma, which encompasses a variety of lymphoid malignancies characterized by the proliferation of lymphocytes. Follicular lymphoma is one of the most common types of non-Hodgkin lymphoma and is typically indolent, meaning it often progresses slowly.

Characteristics of Follicular Lymphoma

1. Histological Features:
   - Follicular lymphoma is characterized by the presence of neoplastic follicles in lymphoid tissue. In grade III, there is a higher degree of cellularity and a predominance of large cells, which can indicate a more aggressive disease compared to lower grades[1].
   - The lymphoma is classified based on the World Health Organization (WHO) classification, which includes grades I to III, with grade III being further divided into IIIA and IIIB based on the proportion of large cells present[2].

2. Clinical Presentation:
   - Patients with follicular lymphoma may present with painless lymphadenopathy, which can occur in various regions, including the intrapelvic area. Symptoms may also include fever, night sweats, and weight loss, although many patients remain asymptomatic for extended periods[3].
   - The involvement of intrapelvic lymph nodes can lead to abdominal discomfort or other gastrointestinal symptoms, depending on the extent of lymph node enlargement and its impact on surrounding structures[4].

3. Diagnosis:
   - Diagnosis typically involves a combination of imaging studies (such as CT scans or PET scans) and biopsy of affected lymph nodes. Histopathological examination is crucial for confirming the diagnosis and determining the grade of the lymphoma[5].
   - Immunophenotyping and genetic studies, including the detection of the t(14;18) translocation, are often performed to further characterize the lymphoma and guide treatment decisions[6].

Treatment Options

The management of follicular lymphoma, particularly grade III, can vary based on the stage of the disease, the presence of symptoms, and the patient's overall health. Treatment options may include:

• Chemotherapy: Often used in combination with immunotherapy, particularly for advanced-stage disease or symptomatic patients.
• Radiation Therapy: May be employed for localized disease or to alleviate symptoms from bulky lymphadenopathy.
• Targeted Therapy: Agents such as rituximab, a monoclonal antibody targeting CD20, are commonly used in treatment regimens[7].
• Watchful Waiting: In asymptomatic patients with low tumor burden, a strategy of active surveillance may be adopted, delaying treatment until necessary[8].

Conclusion

ICD-10 code C82.26 denotes a specific diagnosis of follicular lymphoma grade III affecting the intrapelvic lymph nodes. Understanding the clinical characteristics, diagnostic criteria, and treatment options is essential for effective management of this condition. As with all lymphomas, early detection and tailored treatment strategies are crucial for improving patient outcomes and quality of life. For further information or specific case management, consultation with a hematologist or oncologist is recommended.

[1] Source on histological features of follicular lymphoma.
[2] WHO classification reference for lymphoma grading.
[3] Clinical presentation details for follicular lymphoma.
[4] Symptoms related to intrapelvic lymph node involvement.
[5] Diagnostic methods for follicular lymphoma.
[6] Importance of immunophenotyping in lymphoma diagnosis.
[7] Overview of treatment options for follicular lymphoma.
[8] Active surveillance strategy in asymptomatic cases.

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 C82.26 specifically refers to follicular lymphoma grade III that is unspecified and involves intrapelvic lymph nodes. 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 originates from B-lymphocytes. It is classified into different grades based on histological features, with grade III being more aggressive than grades I and II. The involvement of intrapelvic lymph nodes indicates that the lymphoma has spread to lymphatic tissues located in the pelvic region.

Signs and Symptoms

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

• Lymphadenopathy: Swelling of lymph nodes is one of the most common signs. In this case, patients may have enlarged lymph nodes in the pelvic area, which can be palpable during a physical examination.
• B Symptoms: These are systemic symptoms that may 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.
• Abdominal Discomfort: Patients may experience discomfort or pain in the lower abdomen due to the enlargement of lymph nodes in the pelvic region.
• Fatigue: A common symptom in many cancer patients, fatigue can be significant and debilitating.
• Anemia: Some patients may present with anemia, which can lead to additional symptoms such as weakness and pallor.

Patient Characteristics

Certain characteristics may be associated with 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.
• History of Autoimmune Disorders: Some patients may have a history of autoimmune diseases, which have been associated with an increased risk of developing lymphomas.
• Family History: A family history of lymphoproliferative disorders may be noted in some patients, suggesting a genetic predisposition.

Diagnostic Considerations

Diagnosis of follicular lymphoma grade III involves a combination of clinical evaluation, imaging studies (such as CT scans or PET scans), and histopathological examination of lymph node biopsies. The histological grading is crucial as it influences treatment decisions and prognosis.

Conclusion

Follicular lymphoma grade III, particularly when involving intrapelvic lymph nodes, presents with a range of clinical signs and symptoms that can significantly impact a patient's quality of life. Understanding these presentations is essential for timely diagnosis and management. Patients typically present with lymphadenopathy, systemic B symptoms, and may exhibit characteristics such as age and gender predisposition. Early recognition and appropriate treatment are vital for improving outcomes in affected individuals.

ICD-10 code C82.26 refers specifically to "Follicular lymphoma grade III, unspecified, intrapelvic 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 more straightforward term that directly describes the lymphoma's grade without specifying the location.
2. Follicular Lymphoma, High-Grade: Since grade III is considered high-grade, this term is often used interchangeably in clinical settings.
3. Follicular Lymphoma, Aggressive Type: This term highlights the more aggressive nature of grade III follicular lymphoma compared to lower grades.

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. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in lymphoma cases, including follicular lymphoma.
3. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
4. Intrapelvic Lymph Nodes: This term specifies the location of the affected lymph nodes, indicating that the lymphoma is present in the pelvic region.

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 designation of "unspecified" in the ICD-10 code suggests that there may not be enough information to classify the lymphoma further, which can be important for treatment planning and prognosis.

Understanding these alternative names and related terms can aid healthcare professionals in communication and documentation, ensuring clarity in diagnosis and treatment strategies.