ICD-10: C82.34

Follicular lymphoma, particularly classified under ICD-10 code C82.34, refers to a specific subtype of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This lymphoma is typically indolent but can transform into a more aggressive form, such as grade IIIa, which is important for clinical management and prognosis. 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 type of non-Hodgkin lymphoma that arises from B-lymphocytes in the lymph nodes. Grade IIIa indicates a higher proliferation rate compared to lower grades, which can lead to more aggressive behavior and a different clinical approach.

Common Signs and Symptoms

Patients with follicular lymphoma grade IIIa may present with a variety of signs and symptoms, including:

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the axillary (armpit) and upper limb regions. Patients may notice enlarged lymph nodes that can be palpable during physical examination.
• 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.

Advanced Symptoms

As the disease progresses, patients may experience more severe symptoms, including:

• Splenomegaly: Enlargement of the spleen, which can lead to abdominal discomfort or fullness.
• Hepatomegaly: Enlargement of the liver may also occur, contributing to abdominal symptoms.
• Cytopenias: Due to bone marrow involvement, patients may develop anemia, thrombocytopenia, or leukopenia, leading to increased susceptibility to infections, bleeding, or fatigue.

Patient Characteristics

Demographics

• Age: Follicular lymphoma typically 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.

Risk Factors

• Family History: A family history of lymphoma or other hematologic malignancies may increase risk.
• Immunosuppression: Patients with compromised immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, are at higher risk.
• Environmental Factors: Exposure to certain chemicals (e.g., pesticides) and previous radiation therapy may also be associated with an increased risk of developing lymphoma.

Comorbidities

Patients may present with various comorbid conditions, which can complicate management. Common comorbidities include cardiovascular diseases, diabetes, and other malignancies.

Conclusion

Follicular lymphoma grade IIIa, particularly affecting the lymph nodes of the axilla and upper limb, presents with a range of clinical features that can significantly impact patient quality of life. Early recognition of symptoms such as lymphadenopathy, B symptoms, and fatigue is crucial for timely diagnosis and treatment. Understanding patient demographics and risk factors can aid healthcare providers in identifying at-risk individuals and implementing appropriate surveillance and management strategies. Regular follow-up and monitoring are essential for managing this indolent yet potentially aggressive lymphoma effectively.

ICD-10 code C82.34 specifically refers to Follicular lymphoma grade IIIa, which is a type of non-Hodgkin lymphoma primarily affecting the lymph nodes in the axilla (armpit) and upper limb. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some alternative names and related terms associated with this diagnosis.

Alternative Names for Follicular Lymphoma Grade IIIa

1. Follicular Lymphoma, Grade 3A: This is a direct alternative name that maintains the same meaning but may be used interchangeably in clinical settings.
2. Follicular Lymphoma, High-Grade: Since grade IIIa is considered a high-grade lymphoma, this term may be used to describe the aggressiveness of the disease.
3. Follicular Lymphoma, Stage IIIA: While "stage" and "grade" are distinct concepts, some may refer to the disease in terms of its stage, particularly in discussions about treatment and prognosis.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of non-Hodgkin lymphoma, so this broader term is often used in discussions about lymphomas.
2. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes various types, including follicular lymphoma.
3. B-cell Lymphoma: Follicular lymphoma arises from B-cells, a type of white blood cell, making this term relevant in the context of its classification.
4. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
5. Lymphoma of the Axilla: This term specifies the location of the lymphoma, which is pertinent for clinical discussions and treatment planning.

Clinical Context

Follicular lymphoma grade IIIa is characterized by a more aggressive behavior compared to lower-grade follicular lymphomas. It is essential for healthcare providers to use precise terminology to ensure accurate diagnosis, treatment planning, and communication among multidisciplinary teams.

In summary, while ICD-10 code C82.34 specifically identifies follicular lymphoma grade IIIa, various alternative names and related terms can be utilized in clinical practice to enhance understanding and communication regarding this condition.

Diagnosing Follicular Lymphoma, particularly grade IIIa, involves a comprehensive evaluation that includes clinical assessment, imaging studies, and histopathological examination. The ICD-10 code C82.34 specifically refers to Follicular Lymphoma grade IIIa located in the lymph nodes of the axilla and upper limb. Below are the key criteria and steps typically used in the diagnosis of this condition.

Clinical Evaluation

Symptoms

Patients may present with:
- Painless swelling of lymph nodes, particularly in the axillary region.
- Systemic symptoms such as fever, night sweats, and unexplained weight loss, which may indicate more advanced disease.

Physical Examination

• A thorough physical examination is conducted to assess lymphadenopathy (swelling of lymph nodes) and to check for any other signs of lymphoma.

Imaging Studies

Radiological Assessment

• CT Scans: Computed tomography scans of the chest, abdomen, and pelvis are often performed to evaluate the extent of lymphadenopathy and to check for any organ involvement.
• PET Scans: Positron emission tomography scans may be utilized to assess metabolic activity in lymph nodes and to help stage the disease.

Histopathological Examination

Biopsy

• A definitive diagnosis of Follicular Lymphoma is made through a biopsy of the affected lymph node. This can be done via:
• Excisional Biopsy: Removal of an entire lymph node for examination.
• Core Needle Biopsy: A less invasive method that removes a small cylinder of tissue.

Microscopic Analysis

• The biopsy sample is examined under a microscope by a pathologist. Key features include:
• Follicular Architecture: The presence of follicle-like structures.
• Cell Type: Identification of neoplastic follicle center (germinal center) B-cells.
• Grade Assessment: Follicular Lymphoma is graded based on the number of large cells (centroblasts) present. Grade IIIa indicates a predominance of large cells but still retains some follicular architecture.

Immunophenotyping

• Immunohistochemical staining is performed to identify specific markers:
• CD10, CD19, CD20, and BCL2: These markers are typically positive in Follicular Lymphoma.
• BCL6: May also be assessed to further characterize the lymphoma.

Molecular Studies

Genetic Testing

• FISH (Fluorescence In Situ Hybridization): This test can identify chromosomal abnormalities, such as the t(14;18) translocation, which is commonly associated with Follicular Lymphoma.

Staging

• Once diagnosed, the disease is staged using the Ann Arbor staging system, which considers the number of lymph node regions involved and any extranodal disease.

Conclusion

The diagnosis of Follicular Lymphoma grade IIIa, particularly in the axilla and upper limb, is a multifaceted process that combines clinical evaluation, imaging studies, histopathological examination, and molecular testing. Accurate diagnosis is crucial 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 C82.34 refers to follicular lymphoma located in the lymph nodes of the axilla and upper limb. 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 involvement of lymph nodes in the axilla and upper limb can influence treatment decisions, particularly regarding the extent of disease and patient symptoms.

Standard Treatment Approaches

1. Watchful Waiting

In cases where the disease is asymptomatic and the patient is in good health, a strategy of watchful waiting may be employed. This approach 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. Immunotherapy

Rituximab, as mentioned, is a cornerstone of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. Other immunotherapeutic agents, such as:

• Obinutuzumab: This is another monoclonal antibody that may be used in combination with chemotherapy for patients with advanced disease.
• Lunsumio™ (mosunetuzumab-axgb): This newer bispecific T-cell engager has shown promise in treating relapsed or refractory follicular lymphoma and may be considered in certain cases[2].

4. Radiation Therapy

Localized radiation therapy may be beneficial for patients with limited-stage disease or those with localized symptoms. It can be used as a primary treatment or as a consolidation therapy following chemotherapy to target residual disease in specific lymph node areas[3].

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those with grade IIIa, autologous stem cell transplantation may be considered. This approach is typically reserved for younger patients or those with a good performance status, as it can offer a chance for long-term remission[4].

6. Targeted Therapy

Targeted therapies, such as copanlisib (Aliqopa®), are also being explored for follicular lymphoma. These agents target specific pathways involved in the growth and survival of lymphoma cells and may be used in relapsed cases[5].

Conclusion

The treatment of follicular lymphoma grade IIIa, particularly in the axilla and upper limb, involves a multifaceted approach tailored to the individual patient’s disease characteristics and overall health. While watchful waiting may be appropriate for asymptomatic patients, those with symptomatic or aggressive disease typically benefit from a combination of chemotherapy, immunotherapy, and possibly radiation. Emerging therapies and clinical trials continue to expand the options available, offering hope for improved outcomes in this challenging disease.

For patients and healthcare providers, it is crucial to discuss the potential benefits and risks of each treatment option, considering the patient's preferences and overall treatment goals. Regular follow-up and monitoring are essential to adapt the treatment plan as needed based on the patient's response and any changes in their condition.

[1] Billing and Coding: Intensity Modulated Radiation Therapy
[2] Lunsumio™ (mosunetuzumab-axgb)
[3] Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma
[4] HCT for Non-Hodgkin Lymphoma
[5] Aliqopa® (copanlisib)

Clinical Description of Follicular Lymphoma Grade IIIa (ICD-10 Code C82.34)

Overview of Follicular Lymphoma
Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates from B-lymphocytes, specifically the follicle center cells. It is characterized by a slow progression and is often diagnosed at an advanced stage. Follicular lymphoma is classified into several grades based on histological features, with grade IIIa being one of the more aggressive forms.

ICD-10 Code C82.34
The ICD-10 code C82.34 specifically refers to follicular lymphoma grade IIIa that affects the lymph nodes of the axilla (armpit area) and upper limb. This classification is crucial for accurate diagnosis, treatment planning, and billing purposes in healthcare settings.

Clinical Features

1. Symptoms
   Patients with follicular lymphoma may present with:
   - Painless swelling of lymph nodes, particularly in the axillary region.
   - Systemic symptoms such as fever, night sweats, and unexplained weight loss.
   - Fatigue and general malaise.

2. Diagnosis
   Diagnosis typically involves:
   - Physical Examination: Assessment of lymphadenopathy in the axillary and upper limb regions.
   - Imaging Studies: CT scans or PET scans to evaluate the extent of lymph node involvement and any potential extranodal disease.
   - Biopsy: A definitive diagnosis is made through a lymph node biopsy, where histological examination reveals the characteristic follicular architecture and the presence of grade IIIa features, such as a high proliferation index.

3. Histological Characteristics
   - Grade IIIa: This grade indicates a higher number of large cells (centroblasts) compared to lower grades, which correlates with a more aggressive clinical course. The presence of at least 15% large cells is a defining feature of grade IIIa follicular lymphoma.

Treatment Options

1. Chemotherapy
   - Common regimens include combinations of chemotherapy agents such as cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) or bendamustine with rituximab.

2. Targeted Therapy
   - Rituximab, a monoclonal antibody targeting CD20 on B-cells, is often used in conjunction with chemotherapy. Newer agents like copanlisib may also be considered for relapsed cases.

3. Radiation Therapy
   - In localized cases, radiation therapy may be employed, particularly if the lymphoma is confined to a specific area, such as the axillary lymph nodes.

4. Stem Cell Transplantation
   - For patients with relapsed or refractory disease, autologous or allogeneic stem cell transplantation may be considered, especially in younger patients with good performance status.

Prognosis

The prognosis for patients with follicular lymphoma grade IIIa can vary significantly based on several factors, including:
- Stage at Diagnosis: Early-stage disease generally has a better prognosis.
- Response to Treatment: Patients who achieve a complete response to initial therapy tend to have improved outcomes.
- Biological Factors: Genetic markers and the presence of certain mutations can influence prognosis and treatment decisions.

Conclusion

ICD-10 code C82.34 encapsulates a specific and clinically significant diagnosis of follicular lymphoma grade IIIa affecting the lymph nodes of the axilla and upper limb. Understanding the clinical features, diagnostic criteria, treatment options, and prognosis is essential for healthcare providers managing patients with this condition. Accurate coding not only facilitates appropriate treatment but also ensures proper reimbursement and resource allocation in healthcare systems.