ICD-10: C82.28

Clinical Description of ICD-10 Code C82.28

ICD-10 Code C82.28 refers specifically to Follicular lymphoma grade III, unspecified, affecting the lymph nodes of multiple sites. Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, particularly from B-lymphocytes, which are a type of white blood cell. This condition is characterized by the proliferation of abnormal lymphoid follicles, leading to the formation of tumors in lymph nodes and other lymphatic tissues.

Characteristics of Follicular Lymphoma

1. Grade III Classification:
   - Follicular lymphoma is graded based on the number of large cells present in the tumor. Grade III indicates a higher proportion of large cells, which correlates with a more aggressive disease course compared to lower grades (I and II). This grade is further divided into IIIA and IIIB, with IIIA having a predominance of small cells and IIIB being predominantly large cells[3].

2. Clinical Presentation:
   - Patients with follicular lymphoma may present with painless lymphadenopathy, which is the swelling of lymph nodes. Symptoms can also include fever, night sweats, weight loss, and fatigue, although many patients may be asymptomatic at diagnosis[3].

3. Multiple Sites Involvement:
   - The designation "lymph nodes of multiple sites" indicates that the lymphoma is not confined to a single lymph node region but is disseminated across various lymphatic areas. This can complicate treatment and prognosis, as widespread disease may require more aggressive therapeutic approaches[1].

Diagnosis and Staging

• Diagnosis: Diagnosis typically involves a combination of physical examination, imaging studies (such as CT scans or PET scans), and biopsy of affected lymph nodes to confirm the presence of malignant follicular cells. Immunohistochemical staining is often used to identify specific markers associated with follicular lymphoma[2].

• Staging: The Ann Arbor staging system is commonly used to determine the extent of the disease, which is crucial for treatment planning. Staging considers the number of lymph node regions involved, whether the disease has spread to other organs, and the presence of systemic symptoms[1].

Treatment Options

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

• Chemotherapy: Often used in combination with immunotherapy, particularly for advanced stages.
• Immunotherapy: Agents like rituximab are frequently employed to target CD20-positive B-cells.
• Radiation Therapy: May be used for localized disease or as palliative care.
• Stem Cell Transplantation: Considered for younger patients or those with aggressive disease not responding to initial treatments[2][3].

Conclusion

ICD-10 code C82.28 encapsulates a specific and complex form of follicular lymphoma that necessitates careful clinical evaluation and management. Understanding the characteristics, diagnosis, and treatment options for this condition is essential for healthcare providers to deliver effective care and improve patient outcomes. As research continues, advancements in targeted therapies and personalized medicine may further enhance treatment strategies for patients with follicular lymphoma.

Follicular lymphoma, particularly classified under ICD-10 code C82.28, refers to a specific type of non-Hodgkin lymphoma that is characterized by the proliferation of follicle center (germinal center) B-cells. This subtype is noted for its indolent nature but can transform into a more aggressive form, particularly when classified as grade III. 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 hematological malignancy that typically arises in the lymph nodes but can also affect other sites. Grade III follicular lymphoma is characterized by a higher proliferation index and a more aggressive clinical course compared to lower-grade variants. The designation "unspecified" indicates that the specific characteristics of the lymphoma have not been detailed, but it still falls under the broader category of follicular lymphomas.

Common Patient Characteristics

• Age: Follicular lymphoma predominantly affects 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.
• Ethnicity: The condition is observed across various ethnic groups, but incidence rates may vary.

Signs and Symptoms

Lymphadenopathy

• Swollen Lymph Nodes: Patients often present with painless swelling of lymph nodes, which may be localized or involve multiple sites. Common areas include the neck, axilla, and groin.
• Multiple Sites: As indicated by the ICD-10 code, lymphadenopathy can occur in multiple lymph node regions, which is a hallmark of advanced disease.

Systemic Symptoms

• B Symptoms: Patients may experience systemic symptoms such as:
• Fever: Unexplained fevers that may be intermittent.
• Night Sweats: Profuse sweating during the night that can disrupt sleep.
• Weight Loss: Unintentional weight loss exceeding 10% of body weight over six months.

Other Symptoms

• Fatigue: A common complaint among patients, often due to the disease burden or anemia.
• Abdominal Symptoms: If the lymphoma involves abdominal lymph nodes, patients may experience abdominal pain, fullness, or discomfort.
• Splenomegaly: Enlargement of the spleen may occur, leading to discomfort or a feeling of fullness.

Diagnosis and Evaluation

Diagnostic Imaging

• CT Scans: Imaging studies such as CT scans of the chest, abdomen, and pelvis are often utilized to assess the extent of lymphadenopathy and any organ involvement.
• PET Scans: Positron emission tomography (PET) scans may be used to evaluate metabolic activity of the lymph nodes and to help stage the disease.

Laboratory Tests

• Blood Tests: Routine blood tests may reveal anemia, elevated lactate dehydrogenase (LDH), and other abnormalities indicative of lymphoma.
• Biopsy: A definitive diagnosis is made through lymph node biopsy, which reveals the characteristic follicular architecture and grade of the lymphoma.

Conclusion

Follicular lymphoma grade III, unspecified, affecting multiple lymph node sites, presents with a range of clinical features that include painless lymphadenopathy, systemic B symptoms, and potential abdominal discomfort. Understanding the patient characteristics and clinical presentation is crucial for timely diagnosis and management. Given the indolent nature of follicular lymphoma, early detection and appropriate treatment can significantly impact patient outcomes. Regular follow-up and monitoring are essential to manage the disease effectively and address any transformation to a more aggressive form.

ICD-10 code C82.28 refers specifically to "Follicular lymphoma grade III, unspecified, lymph nodes of multiple sites." 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: 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 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 follicular lymphoma.
3. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
4. 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.
5. Stage IV Lymphoma: If the lymphoma has spread to multiple lymph nodes, it may be classified as stage IV, although this is not specific to grade III.

Clinical Context

Follicular lymphoma grade III is characterized by a higher proliferation of cancer cells and a more aggressive clinical course compared to lower-grade follicular lymphomas. It is essential for healthcare providers to accurately diagnose and classify this condition to determine the appropriate treatment strategy.

In summary, while ICD-10 code C82.28 specifically identifies follicular lymphoma grade III affecting multiple lymph nodes, it is associated with various alternative names and related terms that reflect its classification within the broader context of lymphatic cancers. Understanding these terms can aid in better communication among healthcare professionals and enhance patient education regarding their diagnosis.

Follicular lymphoma, particularly grade III, is a subtype of non-Hodgkin lymphoma characterized by specific diagnostic criteria. The ICD-10 code C82.28 refers to follicular lymphoma grade III that is unspecified and affects lymph nodes at multiple sites. Here’s a detailed overview of the criteria used for diagnosis:

Diagnostic Criteria for Follicular Lymphoma Grade III

1. Clinical Presentation

• Symptoms: Patients may present with painless lymphadenopathy, which is the swelling of lymph nodes. Other symptoms can include fever, night sweats, and weight loss, commonly referred to as "B symptoms."
• Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes, particularly in the cervical, axillary, and inguinal regions.

2. Histopathological Examination

• Biopsy: A lymph node biopsy is crucial for diagnosis. The tissue sample is examined microscopically to identify the presence of neoplastic follicle structures.
• Grading: Follicular lymphoma is graded based on the number of large cells (centroblasts) present. Grade III is characterized by a predominance of large cells, with more than 15 centroblasts per high-power field (HPF) in the biopsy sample.

3. Immunophenotyping

• Immunohistochemistry: This technique is used to identify specific markers on the lymphoma cells. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2 proteins. The presence of these markers supports the diagnosis.
• BCL2 Gene Rearrangement: The detection of BCL2 gene rearrangement is a hallmark of follicular lymphoma and can be assessed through techniques such as fluorescence in situ hybridization (FISH).

4. Staging and Imaging Studies

• Imaging: CT scans, PET scans, or MRI may be utilized to assess the extent of the disease and to identify lymph nodes involved at multiple sites.
• Ann Arbor Staging: This classification system helps determine the stage of lymphoma based on the number of lymph node regions involved and whether the disease has spread to other organs.

5. Exclusion of Other Conditions

• Differential Diagnosis: It is essential to rule out other types of lymphomas and reactive lymphadenopathy. Conditions such as chronic lymphocytic leukemia (CLL) or other non-Hodgkin lymphomas may present similarly.

6. Laboratory Tests

• Blood Tests: Complete blood counts (CBC) and other laboratory tests may be performed to assess overall health and to check for anemia or other abnormalities that could indicate lymphoma.

Conclusion

The diagnosis of follicular lymphoma grade III, unspecified, affecting multiple lymph node sites (ICD-10 code C82.28) involves a combination of clinical evaluation, histopathological examination, immunophenotyping, imaging studies, and exclusion of other conditions. Accurate diagnosis is critical for determining the appropriate treatment plan and prognosis for the patient. 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 potential for transformation into a more aggressive form. The ICD-10 code C82.28 specifically refers to follicular lymphoma grade III that is unspecified and affects lymph nodes at multiple sites. Here’s an 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 treatment approach often depends on the stage of the disease, the patient's overall health, and specific characteristics of the 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 therapy.

2. Chemotherapy

For symptomatic patients or those with rapidly progressing disease, chemotherapy is a common treatment option. The most frequently used regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for aggressive forms of lymphoma.
• R-CHOP: This is a variation of the CHOP regimen that includes Rituximab, a monoclonal antibody that targets CD20 on B-cells, enhancing the effectiveness of chemotherapy.

3. Immunotherapy

Rituximab is a cornerstone in the treatment of follicular lymphoma. It can be used alone or in combination with chemotherapy. In cases of relapsed or refractory disease, other monoclonal antibodies or newer agents like Obinutuzumab may be considered.

4. Radiation Therapy

Radiation therapy may be used in localized cases or as a palliative measure to relieve symptoms. It is particularly effective for patients with limited-stage disease or those with localized lymphadenopathy.

5. Targeted Therapy

Targeted therapies, such as PI3K inhibitors (e.g., Copanlisib) and BTK inhibitors, are emerging options for patients with relapsed or refractory follicular lymphoma. These therapies specifically target pathways involved in the survival and proliferation of lymphoma cells.

6. 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 it involves multiple lymph node sites, is multifaceted and tailored to the individual patient. The choice of therapy depends on various factors, including the disease's aggressiveness, the patient's overall health, and their preferences. Ongoing research continues to refine these approaches, with a focus on improving outcomes and minimizing side effects. Regular follow-up and monitoring are essential to adapt the treatment plan as needed and to manage any potential complications.