ICD-10: C82.27

Follicular lymphoma grade III, unspecified, is a subtype of non-Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. This condition is classified under the ICD-10 code C82.27, which indicates its association with the spleen. Below is a detailed overview of the clinical aspects related to this diagnosis.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that originates from B-lymphocytes. Grade III follicular lymphoma is considered more aggressive than grades I and II, often exhibiting a higher proliferation index and a tendency to transform into a more aggressive form of lymphoma.

Signs and Symptoms

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

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, which may occur in various regions, including cervical, axillary, and inguinal areas. In cases where the spleen is involved, splenomegaly (enlargement of the spleen) may also be observed[1].

• B Symptoms: These include systemic symptoms such as:

• Fever: Unexplained fevers that may be intermittent.
• Night Sweats: Profuse sweating during the night.

• Weight Loss: Unintentional weight loss exceeding 10% of body weight over six months[2].

• Abdominal Symptoms: Patients may experience abdominal discomfort or fullness due to splenomegaly or lymphadenopathy in the abdominal region, which can lead to complications such as splenic rupture in severe cases[3].

• Fatigue: A common complaint among patients, often related to the disease burden and systemic effects of the lymphoma.

• Pruritus: Some patients report itching, which can be generalized and is not necessarily related to skin lesions[4].

Patient Characteristics

Certain demographic and clinical characteristics are often 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[5].

• Gender: There is a slight male predominance in the incidence of follicular lymphoma, although the difference is not as pronounced as in some other types of lymphoma[6].

• Comorbidities: Patients may have other health conditions that can complicate treatment, such as cardiovascular disease or diabetes, which are important to consider during management[7].

• Family History: A family history of lymphoproliferative disorders may increase the risk of developing follicular lymphoma, suggesting a potential genetic predisposition[8].

Conclusion

Follicular lymphoma grade III, unspecified, particularly when involving the spleen, presents with a range of clinical signs and symptoms that can significantly impact a patient's quality of life. Early recognition of these symptoms, along with an understanding of patient characteristics, is crucial for timely diagnosis and management. Given the aggressive nature of grade III follicular lymphoma, appropriate treatment strategies should be initiated promptly to improve patient outcomes.

References

1. Clinical presentation of lymphomas and their management.
2. Systemic symptoms associated with lymphoproliferative disorders.
3. Complications of splenomegaly in lymphoma patients.
4. Pruritus in lymphoma: a clinical overview.
5. Epidemiology of follicular lymphoma.
6. Gender differences in lymphoma incidence.
7. Comorbidities in lymphoma patients: implications for treatment.
8. Genetic predisposition to lymphoproliferative disorders.

ICD-10 code C82.27 refers specifically to "Follicular lymphoma grade III, unspecified, spleen." This classification falls under the broader category of non-Hodgkin lymphoma, particularly focusing on follicular lymphomas, which are a type of B-cell lymphoma. Below are alternative names and related terms associated with this 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: Since grade III is considered high-grade, this term is often used interchangeably.
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 encompasses a variety of lymphoid malignancies.
2. B-cell Lymphoma: Follicular lymphoma originates from B-cells, a type of white blood cell, making this term relevant.
3. Lymphoproliferative Disorders: This broader category includes various conditions where lymphocytes proliferate abnormally, including follicular lymphoma.
4. Splenic Lymphoma: Since the ICD-10 code specifies the spleen, this term is relevant for cases where the lymphoma primarily affects the spleen.
5. Lymphoma, Follicular Type: This term can be used to describe the general category of follicular lymphomas, including grade III.

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 unspecified designation in the ICD-10 code indicates 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 accurately communicating about the condition, ensuring appropriate coding, and facilitating effective treatment strategies.

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 C82.27 refers to follicular lymphoma grade III that is unspecified and localized to the spleen. Here’s a detailed overview of 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 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 involvement of the spleen can complicate the disease, necessitating a tailored treatment approach.

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, allowing for intervention only when the disease progresses or symptoms develop.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for symptomatic follicular lymphoma grade III. 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 is effective in reducing tumor burden.
• R-CVP: This regimen includes Rituximab, Cyclophosphamide, Vincristine, and Prednisone, and may be used in patients who cannot tolerate more intensive chemotherapy.

3. Targeted Therapy

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

• Rituximab: This monoclonal antibody targets CD20 on B-cells and is often used in combination with chemotherapy or as a single agent in relapsed cases.
• Idelalisib: An oral inhibitor of PI3K, used in combination with Rituximab for patients with relapsed follicular lymphoma.
• Copanlisib: Another PI3K inhibitor that has shown efficacy in treating relapsed follicular lymphoma.

4. Radiation Therapy

Radiation therapy may be considered in specific scenarios, particularly for localized disease or as a palliative measure to relieve symptoms. In cases where the spleen is involved, localized radiation can help reduce splenic size and alleviate symptoms.

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those with high-risk features, 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.

6. Clinical Trials

Participation in clinical trials can provide access to novel therapies and treatment strategies that are not yet widely available. Patients should be encouraged to discuss potential clinical trial options with their healthcare providers.

Conclusion

The treatment of follicular lymphoma grade III, particularly when localized to the spleen, requires a comprehensive approach tailored to the individual patient’s condition, symptoms, and overall health. Standard treatment options include chemotherapy, targeted therapies, radiation, and potentially stem cell transplantation. Ongoing research and clinical trials continue to evolve the landscape of treatment for this complex disease, offering hope for improved outcomes. Patients should work closely with their oncology team to determine the most appropriate treatment strategy based on their specific circumstances.

Clinical Description of ICD-10 Code C82.27: Follicular Lymphoma Grade III, Unspecified, Spleen

Overview of Follicular Lymphoma

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, specifically from B-lymphocytes. 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 it can transform into a more aggressive form over time. The World Health Organization (WHO) classifies follicular lymphoma into several grades based on histological features, with grade III being the most aggressive form.

ICD-10 Code C82.27 Specifics

The ICD-10 code C82.27 specifically refers to "Follicular lymphoma grade III, unspecified, spleen." This classification indicates that the lymphoma is located in the spleen and is of grade III, which is characterized by a higher proliferation rate and a more aggressive clinical course compared to lower grades of follicular lymphoma.

Key Characteristics of Follicular Lymphoma Grade III

1. Histological Features:
   - Grade III follicular lymphoma is further divided into two subcategories: grade IIIA and grade IIIB. Grade IIIA retains some follicular architecture, while grade IIIB is characterized by a diffuse pattern with a predominance of large cells.
   - The presence of large cells (centroblasts) is a hallmark of grade III, which can be identified through histopathological examination.

2. Clinical Presentation:
   - Patients may present with lymphadenopathy (swollen lymph nodes), splenomegaly (enlarged spleen), and systemic symptoms such as fever, night sweats, and weight loss.
   - The spleen is a common site for involvement in follicular lymphoma, and its enlargement can lead to discomfort and other complications.

3. Diagnosis:
   - Diagnosis typically involves a combination of imaging studies (such as CT scans) and biopsy of affected lymph nodes or spleen tissue to confirm the presence of lymphoma and determine its grade.
   - Immunophenotyping and genetic studies may also be performed to assess the specific characteristics of the lymphoma.

4. Treatment Options:
   - Treatment for grade III follicular lymphoma may include chemotherapy, targeted therapy, and immunotherapy. The choice of treatment depends on various factors, including the patient's overall health, the extent of the disease, and specific characteristics of the lymphoma.
   - Common regimens may involve combinations of agents such as rituximab, bendamustine, and other chemotherapeutic agents.

5. Prognosis:
   - The prognosis for patients with grade III follicular lymphoma is generally poorer than for those with lower-grade forms. However, advancements in treatment have improved outcomes for many patients.
   - Regular follow-up and monitoring are essential to manage the disease and address any potential transformations to more aggressive forms of lymphoma.

Conclusion

ICD-10 code C82.27 encapsulates a specific diagnosis of follicular lymphoma grade III located in the spleen, highlighting the need for careful clinical evaluation and management. Understanding the characteristics, treatment options, and prognosis associated with this condition is crucial for healthcare providers in delivering effective care to affected patients. Regular monitoring and a tailored treatment approach can significantly impact patient outcomes in this complex disease.

Diagnosing Follicular Lymphoma Grade III, unspecified, spleen (ICD-10 code C82.27) involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below is a detailed overview of the criteria and processes typically used 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, which may be painless.
- Splenomegaly: Enlargement of the spleen, often detected during a physical examination.
- B-symptoms: These include fever, night sweats, and unexplained weight loss, which can indicate more aggressive disease.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoproliferative disorders.
- Family history of lymphomas or other cancers.
- Exposure to certain environmental factors or infections (e.g., Epstein-Barr virus).

Imaging Studies

Ultrasound and CT Scans

Imaging techniques are crucial for assessing the extent of the disease:
- Ultrasound: Can help visualize splenomegaly and lymphadenopathy.
- CT Scan: Provides detailed images of the abdomen and pelvis to evaluate lymph node involvement and organ enlargement.

PET Scans

• Positron Emission Tomography (PET): Often used to assess metabolic activity of lymph nodes and spleen, helping to differentiate between active disease and residual masses post-treatment.

Histopathological Examination

Biopsy

A definitive diagnosis of Follicular Lymphoma requires a biopsy:
- Excisional Biopsy: Preferred method for obtaining a representative tissue sample from an enlarged lymph node or spleen.
- Bone Marrow Biopsy: May be performed to assess for bone marrow involvement.

Immunophenotyping

• Flow Cytometry: Used to analyze the surface markers on the cells. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2.
• Histological Examination: Pathologists look for the characteristic follicular architecture and the presence of centrocytes and centroblasts, which are indicative of grade III follicular lymphoma.

Genetic Testing

• Cytogenetic Analysis: Detection of chromosomal abnormalities, such as the t(14;18) translocation, which is commonly associated with follicular lymphoma.

Staging

Once diagnosed, staging is performed to determine the extent of the disease:
- 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.

Conclusion

The diagnosis of Follicular Lymphoma Grade III, unspecified, spleen (ICD-10 code C82.27) 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!