ICD-10: C82.35

ICD-10 code C82.35 specifically refers to Follicular lymphoma grade IIIa located in the lymph nodes of the inguinal region and lower limb. This classification is part of the broader category of non-Hodgkin lymphomas, which are a diverse group of blood cancers that originate in the lymphatic system.

Clinical Description of Follicular Lymphoma Grade IIIa

Overview

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that arises from B-lymphocytes, specifically from the follicle center cells. It is characterized by the proliferation of neoplastic follicle-like structures in lymphoid tissue. Grade IIIa indicates a higher level of malignancy compared to lower grades, with a more aggressive clinical course.

Pathophysiology

In follicular lymphoma, the cancerous cells typically exhibit a specific genetic alteration, often involving the BCL2 gene, which leads to the overexpression of the BCL2 protein. This protein inhibits apoptosis (programmed cell death), allowing the malignant cells to survive longer than normal cells. The grade IIIa designation indicates that the lymphoma has a higher number of large cells (centroblasts) compared to lower grades, which can influence treatment decisions and prognosis.

Symptoms

Patients with follicular lymphoma may present with:
- Painless lymphadenopathy: Swelling of lymph nodes, particularly in the inguinal region (groin) and lower limbs.
- B symptoms: These may include fever, night sweats, and unexplained weight loss, which can indicate more advanced disease.
- Fatigue: General tiredness and lack of energy are common complaints.

Diagnosis

Diagnosis typically involves:
- Histopathological examination: A biopsy of the affected lymph nodes is essential for confirming the diagnosis and determining the grade of the lymphoma.
- Immunophenotyping: This process helps identify the specific type of lymphoma by analyzing the surface markers on the cancer cells.
- Imaging studies: CT scans or PET scans may be used to assess the extent of the disease and involvement of lymph nodes.

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 for localized disease.
- Targeted therapies: Newer agents like copanlisib (Aliqopa) and mosunetuzumab-axgb are being explored for their efficacy in treating follicular lymphoma.

Prognosis

The prognosis for patients with follicular lymphoma can vary significantly based on several factors, including the stage of the disease at diagnosis, the patient's overall health, and the specific characteristics of the lymphoma. Grade IIIa is associated with a more aggressive course compared to lower grades, which may necessitate more intensive treatment strategies.

Conclusion

ICD-10 code C82.35 encapsulates a specific and clinically significant diagnosis of follicular lymphoma grade IIIa affecting the lymph nodes in the inguinal region and lower limb. Understanding the clinical features, diagnostic criteria, and treatment options is crucial for effective management and improving patient outcomes in this complex disease. Regular follow-up and monitoring are essential to address any potential progression or complications associated with this type of lymphoma.

Follicular lymphoma, particularly classified under ICD-10 code C82.35, refers to a specific subtype of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This type of lymphoma is typically indolent but can transform into a more aggressive form. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with follicular lymphoma grade IIIa, particularly affecting the lymph nodes of the inguinal region and lower limb.

Clinical Presentation

Signs and Symptoms

1. Lymphadenopathy:
   - The most common presentation is painless swelling of lymph nodes, particularly in the inguinal region and lower limbs. Patients may notice enlarged lymph nodes that can be felt under the skin.

2. B Symptoms:
   - Patients may experience systemic symptoms known as "B symptoms," which include:

   • Fever: Unexplained fevers that may be intermittent.
   • Night Sweats: Profuse sweating during the night, often soaking bedclothes.
   • Weight Loss: Unintentional weight loss exceeding 10% of body weight over six months.

3. Fatigue:
   - A common complaint among patients, often due to the disease's impact on overall health and energy levels.

4. Abdominal Symptoms:
   - In some cases, if lymph nodes in the abdomen are involved, patients may experience abdominal pain or discomfort, early satiety, or changes in bowel habits.

5. Skin Manifestations:
   - Rarely, patients may develop skin lesions or rashes associated with lymphoma.

Patient Characteristics

1. Age:
   - Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is less common in younger individuals.

2. Gender:
   - There is a slight male predominance in the incidence of follicular lymphoma.

3. Comorbidities:
   - Patients may have other health conditions, including autoimmune diseases or previous cancers, which can influence treatment options and prognosis.

4. Family History:
   - A family history of lymphoproliferative disorders may be noted in some patients, suggesting a potential genetic predisposition.

5. Ethnicity:
   - While follicular lymphoma can affect individuals of any ethnicity, some studies suggest variations in incidence rates among different ethnic groups.

Diagnosis and Evaluation

Diagnosis of follicular lymphoma grade IIIa typically involves:
- Histopathological Examination: A biopsy of the affected lymph nodes is essential for confirming the diagnosis. The histological grading is based on the number of centroblasts per high-power field, with grade IIIa indicating a higher number of these cells.
- Imaging Studies: CT scans or PET scans may be utilized to assess the extent of lymphadenopathy and any potential extranodal involvement.
- Laboratory Tests: Blood tests may be performed to evaluate overall health and organ function, as well as to check for markers associated with lymphoma.

Conclusion

Follicular lymphoma grade IIIa, particularly affecting the inguinal region and lower limbs, presents with characteristic signs and symptoms, including lymphadenopathy and systemic B symptoms. Understanding the clinical presentation and patient characteristics is crucial for timely diagnosis and management. If you suspect follicular lymphoma or have concerns about symptoms, it is essential to consult a healthcare professional for appropriate evaluation and treatment options.

ICD-10 code C82.35 refers specifically to Follicular lymphoma grade IIIa, which is a type of non-Hodgkin lymphoma primarily affecting the lymph nodes in the inguinal region and lower limb. Understanding alternative names and related terms for this condition can enhance clarity in medical documentation and communication. Below are some relevant terms and alternative names associated with this diagnosis.

Alternative Names for Follicular Lymphoma Grade IIIa

1. Follicular Lymphoma, Grade 3A: This is a direct alternative name that specifies the grade of the lymphoma.
2. Follicular Lymphoma, Stage IIIA: While "stage" and "grade" are not synonymous, some may use "stage" informally to refer to the severity of the disease.
3. Non-Hodgkin Lymphoma, Follicular Type: This broader term encompasses all grades of follicular lymphoma, including grade IIIa.
4. Lymphoma, Follicular, Grade IIIa: A variation in phrasing that maintains the same meaning.

Related Terms

1. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes various types, including Hodgkin and non-Hodgkin lymphomas.
2. Non-Hodgkin Lymphoma (NHL): A category of lymphomas that includes follicular lymphoma and other types, distinguishing it from Hodgkin lymphoma.
3. Lymphadenopathy: Refers to the enlargement of lymph nodes, which is a common symptom in lymphoma cases.
4. Lymphoma Classification: Refers to the system used to categorize lymphomas based on histological features, which includes follicular lymphoma.
5. B-cell Lymphoma: Follicular lymphoma is a type of B-cell lymphoma, indicating the origin of the cancer cells.

Clinical Context

Follicular lymphoma is characterized by its indolent nature, often presenting with painless lymphadenopathy. Grade IIIa indicates a more aggressive form of follicular lymphoma, which may require different treatment approaches compared to lower-grade forms. Understanding these terms is crucial for healthcare professionals when discussing diagnosis, treatment options, and patient management strategies.

In summary, the ICD-10 code C82.35 is associated with several alternative names and related terms that reflect its classification and clinical implications. These terms are essential for accurate communication in medical settings and for ensuring that patients receive appropriate care based on their specific diagnosis.

Follicular lymphoma, particularly grade IIIa, is a subtype of non-Hodgkin lymphoma characterized by specific histological features and clinical presentations. The diagnosis of follicular lymphoma, including the specific ICD-10 code C82.35, which pertains to follicular lymphoma grade IIIa located in the lymph nodes of the inguinal region and lower limb, involves several criteria that encompass clinical evaluation, imaging studies, and histopathological examination.

Diagnostic Criteria for Follicular Lymphoma Grade IIIa

1. Clinical Evaluation

• Symptoms: Patients may present with painless lymphadenopathy, which is often the first sign. Systemic symptoms such as fever, night sweats, and weight loss may also be present, although they are less common in early-stage disease.
• Physical Examination: A thorough physical examination is essential to assess lymph node involvement, particularly in the inguinal region and lower limbs, as indicated by the ICD-10 code.

2. Imaging Studies

• CT Scans: Computed tomography (CT) scans of the abdomen, pelvis, and chest are typically performed to evaluate the extent of lymphadenopathy and to rule out other causes of lymph node enlargement.
• PET Scans: Positron emission tomography (PET) scans may be utilized to assess metabolic activity in lymph nodes and to help stage the disease.

3. Histopathological Examination

• Biopsy: A definitive diagnosis requires a biopsy of the affected lymph node. This can be done through excisional biopsy or fine-needle aspiration.
• Microscopic Analysis: The biopsy specimen is examined microscopically for the presence of neoplastic follicle structures. In grade IIIa follicular lymphoma, there is a predominance of large cells (centroblasts) within the follicles, with a higher number of these cells compared to grade I and II.
• Immunophenotyping: Immunohistochemical staining is performed to confirm the diagnosis. Follicular lymphoma typically expresses CD10, BCL2, and BCL6, while lacking markers such as CD5 and CD23, which are more characteristic of chronic lymphocytic leukemia.

4. Cytogenetic and Molecular Studies

• Genetic Testing: The presence of the t(14;18) chromosomal translocation, which results in the overexpression of the BCL2 gene, is a hallmark of follicular lymphoma. This can be assessed through fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR) techniques.

5. Staging

• Ann Arbor Staging System: The disease is staged according to the Ann Arbor classification, which considers the number of lymph node regions involved and the presence of systemic symptoms. For C82.35, the involvement of inguinal lymph nodes and lower limbs suggests at least stage II disease.

Conclusion

The diagnosis of follicular lymphoma grade IIIa, particularly in the inguinal region and lower limb, is a multifaceted process that requires careful clinical assessment, imaging studies, histopathological evaluation, and potentially genetic 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 regarding treatment options or management strategies, feel free to ask!

Follicular lymphoma grade IIIa, classified under ICD-10 code C82.35, is a subtype of non-Hodgkin lymphoma characterized by its indolent nature and specific histological features. The treatment approaches for this condition are multifaceted and depend on various factors, including the patient's overall health, the extent of the disease, and specific clinical characteristics. Below is a detailed overview of standard treatment strategies for this lymphoma subtype.

Overview of Follicular Lymphoma Grade IIIa

Follicular lymphoma is a type of B-cell non-Hodgkin lymphoma that typically presents with painless lymphadenopathy. Grade IIIa indicates a higher proliferation of malignant cells compared to lower grades, which can influence treatment decisions. The involvement of lymph nodes in the inguinal region and lower limb suggests localized disease, which may affect the choice of therapy.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For patients with asymptomatic follicular lymphoma, especially those with early-stage disease, a strategy of watchful waiting may be employed. This approach involves regular monitoring without immediate treatment, as many patients may not require intervention until symptoms develop or the disease progresses.

2. Chemotherapy

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

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for more aggressive forms of lymphoma.
• R-CHOP: The addition of Rituximab (a monoclonal antibody targeting CD20) to the CHOP regimen has significantly improved outcomes for patients with follicular lymphoma, including those with grade IIIa.

3. Immunotherapy

Immunotherapy has become increasingly important in the treatment of follicular lymphoma:

• Rituximab: This monoclonal antibody is commonly used in combination with chemotherapy or as a single agent for maintenance therapy after initial treatment.
• Obinutuzumab: Another anti-CD20 monoclonal antibody that may be used in combination with chemotherapy for newly diagnosed patients.

4. Radiation Therapy

Radiation therapy can be effective, particularly for localized disease. It may be used in the following scenarios:

• Localized Disease: For patients with limited-stage disease, involved-field radiation therapy can be curative.
• Palliative Care: Radiation may also be used to relieve symptoms in cases of bulky disease or painful lymphadenopathy.

5. Targeted Therapy

Recent advancements have introduced targeted therapies that focus on specific pathways involved in lymphoma cell survival:

• PI3K Inhibitors: Drugs like Copanlisib (Aliqopa) have shown efficacy in treating relapsed follicular lymphoma.
• BCL-2 Inhibitors: Venetoclax is another targeted therapy that may be considered, particularly in cases resistant to standard therapies.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, autologous stem cell transplantation may be considered, especially after achieving a complete response to initial therapy. This approach is typically reserved for younger patients or those with more aggressive disease.

Conclusion

The treatment of follicular lymphoma grade IIIa, particularly in the inguinal region and lower limb, is tailored to the individual patient based on disease characteristics and overall health. A combination of chemotherapy, immunotherapy, and targeted therapies, along with radiation when appropriate, forms the basis of management. Ongoing clinical trials and research continue to refine these approaches, aiming to improve outcomes and minimize treatment-related toxicity. Regular follow-up and monitoring are essential to adapt treatment strategies as the disease evolves.