ICD-10: C82.33

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that arises from B-lymphocytes and is characterized by its indolent nature, although it can transform into a more aggressive form. The specific ICD-10 code C82.33 refers to Follicular lymphoma grade IIIa, particularly affecting the intra-abdominal lymph nodes. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Follicular Lymphoma Grade IIIa

Definition and Classification

Follicular lymphoma is classified into several grades based on histological features, with grade IIIa being one of the more aggressive forms. The grading system is determined by the number of large cells present in the tumor, with grade IIIa indicating a higher proportion of large cells compared to lower grades. This classification is crucial for determining prognosis and treatment strategies.

Pathophysiology

Follicular lymphoma originates from the germinal center B-cells in lymphoid tissue. The disease is characterized by the proliferation of neoplastic follicle-like structures, which can disrupt normal lymph node architecture. In grade IIIa, there is a significant presence of large cell transformation, which can lead to a more aggressive clinical course compared to lower-grade follicular lymphomas.

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the abdomen, neck, or groin.
- B-symptoms: These include fever, night sweats, and unexplained weight loss.
- Abdominal discomfort: Due to enlarged intra-abdominal lymph nodes, patients may experience pain or fullness in the abdomen.

Diagnosis

Diagnosis typically involves:
- Imaging Studies: CT scans or PET scans to assess the extent of lymphadenopathy and any organ involvement.
- Biopsy: A lymph node biopsy is essential for histological examination to confirm the diagnosis and grade of lymphoma.
- Immunophenotyping: This helps in identifying the specific type of lymphoma and its characteristics.

Treatment Options

Treatment for follicular lymphoma grade IIIa may include:
- Chemotherapy: Often combined with immunotherapy, such as monoclonal antibodies (e.g., rituximab).
- Radiation Therapy: May be used in localized disease.
- Targeted Therapy: Newer agents like copanlisib (Aliqopa) and other targeted therapies are being explored for their efficacy in treating follicular lymphoma.

Prognosis

The prognosis for patients with follicular lymphoma grade IIIa can vary significantly based on several factors, including the extent of disease at diagnosis, response to treatment, and the presence of any transformation to a more aggressive form of lymphoma. Generally, the prognosis is poorer than for lower-grade follicular lymphomas due to the higher grade and associated aggressive behavior.

Conclusion

ICD-10 code C82.33 specifically identifies Follicular lymphoma grade IIIa affecting the intra-abdominal lymph nodes, highlighting the need for careful diagnosis and management due to its aggressive nature. Understanding the clinical features, diagnostic criteria, and treatment options is essential for healthcare providers in managing this condition effectively. Regular follow-up and monitoring are crucial for assessing treatment response and managing any potential complications associated with the disease.

Follicular lymphoma grade IIIa, classified under ICD-10 code C82.33, is a subtype of non-Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. Understanding these aspects is crucial for diagnosis and management.

Clinical Presentation

Follicular lymphoma is a type of indolent (slow-growing) lymphoma that primarily affects the lymphatic system. Grade IIIa indicates a more aggressive form of follicular lymphoma, where the cancer cells are more proliferative compared to lower grades. The clinical presentation often includes:

• Lymphadenopathy: Patients typically present with enlarged lymph nodes, which may be painless. In grade IIIa, lymphadenopathy can be more pronounced and may involve intra-abdominal lymph nodes, leading to abdominal discomfort or distension.
• B Symptoms: These include fever, night sweats, and unexplained weight loss. The presence of B symptoms can indicate a more aggressive disease course and may be more common in higher-grade lymphomas like grade IIIa[1].

Signs and Symptoms

The signs and symptoms of follicular lymphoma grade IIIa can vary widely among patients but often include:

• Abdominal Pain or Discomfort: Due to the involvement of intra-abdominal lymph nodes, patients may experience pain or a feeling of fullness in the abdomen[1].
• Fatigue: A common symptom in many cancer patients, fatigue can be significant and debilitating in those with lymphoma[1].
• Anemia: Patients may present with signs of anemia, such as pallor or fatigue, due to bone marrow involvement or chronic disease[1].
• Pruritus: Some patients report itching, which can be a systemic symptom associated with lymphoma[1].
• Splenomegaly: Enlargement of the spleen may occur, leading to additional abdominal discomfort or fullness[1].

Patient Characteristics

Certain characteristics may be associated with patients diagnosed with follicular lymphoma grade IIIa:

• Age: Follicular lymphoma is more commonly diagnosed in older adults, typically between the ages of 60 and 70. However, it can occur in younger individuals as well[1].
• Gender: There is a slight male predominance in the incidence of follicular lymphoma, although it affects both genders[1].
• Comorbidities: Patients may have other health conditions that can complicate treatment, such as cardiovascular disease or diabetes, which are more prevalent in older populations[1].
• Family History: A family history of lymphoproliferative disorders may increase the risk of developing follicular lymphoma[1].

Conclusion

Follicular lymphoma grade IIIa, particularly when involving intra-abdominal lymph nodes, presents with a range of clinical features that can significantly impact patient quality of life. Recognizing the signs and symptoms, along with understanding patient demographics, is essential for timely diagnosis and effective management. Clinicians should remain vigilant for B symptoms and consider the overall health status of the patient when planning treatment strategies. Further research and clinical trials continue to enhance our understanding of this complex disease and its management options.

Follicular lymphoma grade IIIa, classified under ICD-10 code C82.33, is a subtype of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This specific grade indicates a more aggressive form of the disease compared to lower grades of follicular lymphoma. Below are alternative names and related terms associated with this condition.

Alternative Names

1. Follicular Lymphoma, Grade IIIa: This is the most direct alternative name, emphasizing the grade of the lymphoma.
2. Follicular Lymphoma, High-Grade: This term is often used to denote the more aggressive nature of grade IIIa compared to lower grades.
3. Follicular Lymphoma with Diffuse Large B-cell Lymphoma (DLBCL): In some cases, grade IIIa can be associated with transformation to DLBCL, which is a more aggressive form of lymphoma.

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: Since follicular lymphoma arises from B-cells, this term is often used in broader discussions of lymphomas.
3. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
4. Lymphoma Staging: The process of determining the extent of the disease, which is crucial for treatment planning.
5. Bone Marrow Involvement: In advanced cases, follicular lymphoma may involve the bone marrow, which can affect prognosis and treatment options.

Clinical Context

Follicular lymphoma grade IIIa is significant in clinical practice due to its implications for treatment and prognosis. It is essential for healthcare providers to recognize the terminology associated with this condition to ensure accurate diagnosis, coding, and treatment planning.

In summary, understanding the alternative names and related terms for ICD-10 code C82.33 is crucial for healthcare professionals involved in the diagnosis and management of patients with follicular lymphoma. This knowledge aids in effective communication and documentation within clinical settings.

The diagnosis of Follicular Lymphoma Grade IIIa, particularly when it involves intra-abdominal lymph nodes, is guided by a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria and considerations used in the diagnosis of this specific condition, which corresponds to the ICD-10 code C82.33.

Clinical Presentation

1. Symptoms: Patients may present with nonspecific symptoms such as:
   - Lymphadenopathy (swelling of lymph nodes)
   - Abdominal pain or discomfort
   - Unexplained weight loss
   - Fever and night sweats

2. Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes, particularly in the abdomen, which may indicate the presence of lymphoma.

Imaging Studies

1. CT Scans: Computed Tomography (CT) scans of the abdomen and pelvis are commonly used to visualize lymphadenopathy and assess the extent of disease involvement in intra-abdominal lymph nodes.

2. PET Scans: Positron Emission Tomography (PET) scans may be utilized to evaluate metabolic activity in lymph nodes and help differentiate between benign and malignant processes.

Histopathological Criteria

1. Biopsy: A definitive diagnosis of Follicular Lymphoma requires a biopsy of the affected lymph node. The biopsy can be performed via:
   - Excisional biopsy
   - Core needle biopsy

2. Microscopic Examination: The histopathological examination will reveal:
   - Follicular architecture with neoplastic proliferation of follicle center (germinal center) B-cells.
   - The presence of a high number of centroblasts, which is characteristic of Grade IIIa lymphoma.

3. Immunophenotyping: Immunohistochemical staining is performed to confirm the diagnosis, typically showing:
   - Positive staining for CD10, CD19, CD20, and BCL2.
   - Negative staining for CD5, which helps differentiate it from other types of lymphoma.

Molecular and Genetic Testing

1. Genetic Markers: The presence of the t(14;18) chromosomal translocation, which results in the BCL2 gene rearrangement, is a hallmark of follicular lymphoma and can be assessed through molecular testing.

2. Minimal Residual Disease (MRD): In some cases, testing for minimal residual disease may be performed to assess treatment response and disease status.

Staging

1. Ann Arbor Staging System: The staging of Follicular Lymphoma is crucial for treatment planning and is based on the Ann Arbor classification, which considers the number of lymph node regions involved and the presence of systemic symptoms.

2. Intra-abdominal Involvement: Specifically for C82.33, the diagnosis indicates that the lymphoma is present in intra-abdominal lymph nodes, which may influence treatment decisions.

Conclusion

The diagnosis of Follicular Lymphoma Grade IIIa, particularly involving intra-abdominal lymph nodes, is a multifaceted process that integrates clinical findings, imaging studies, histopathological evaluation, and genetic testing. Accurate diagnosis is essential for determining the appropriate treatment strategy and prognosis for the patient. If you have further questions or need more specific information, feel free to ask!

Follicular lymphoma, particularly grade IIIa, is a subtype of non-Hodgkin lymphoma characterized by its indolent nature and specific treatment considerations. The ICD-10 code C82.33 refers to follicular lymphoma located in intra-abdominal lymph nodes. Here’s a detailed overview of the standard treatment approaches for this condition.

Overview of Follicular Lymphoma Grade IIIa

Follicular lymphoma is classified into different grades based on histological features, with grade IIIa indicating a more aggressive form compared to lower grades. This subtype is characterized by a higher proliferation index and may require more intensive treatment strategies. The presence of intra-abdominal lymph nodes can complicate the clinical picture, necessitating a tailored approach to therapy.

Standard Treatment Approaches

1. Watchful Waiting

In cases where the disease 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 become a standard approach, significantly improving outcomes for patients with follicular lymphoma[1].

3. Targeted Therapy

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

• Rituximab: This monoclonal antibody targets CD20 on B-cells and is often used in combination with chemotherapy. It can also be used as a single agent in relapsed cases.
• Obinutuzumab (Gazyva): Another anti-CD20 monoclonal antibody that may be used in combination with chemotherapy or as maintenance therapy after initial treatment[2].

4. Radiation Therapy

Radiation therapy may be considered in specific scenarios, particularly for localized disease or in cases where there is a significant mass effect from lymphadenopathy. It can be used as a curative approach in early-stage disease or palliatively to relieve symptoms in advanced cases[3].

5. 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, as it involves high-dose chemotherapy followed by the infusion of the patient’s own stem cells[4].

6. Clinical Trials

Participation in clinical trials may provide access to novel therapies and combinations that are not yet widely available. Patients are encouraged to discuss this option with their healthcare providers, as ongoing research may lead to improved outcomes.

Conclusion

The treatment of follicular lymphoma grade IIIa, particularly when involving intra-abdominal lymph nodes, requires a comprehensive approach tailored to the individual patient’s condition, symptoms, and overall health. Standard treatments include chemotherapy, targeted therapies, and potentially radiation or stem cell transplantation, depending on the disease's aggressiveness and the patient's response to initial therapies. Regular follow-up and monitoring are essential to adapt the treatment plan as needed and to manage any complications that may arise during the course of the disease.

For the most current treatment protocols and clinical guidelines, consulting with a hematologist or oncologist specializing in lymphomas is recommended.