ICD-10: C82.36

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. It is generally considered an indolent (slow-growing) form of lymphoma, but it can vary in aggressiveness. The ICD-10 code C82.36 specifically refers to Follicular lymphoma grade IIIa located in the intrapelvic lymph nodes.

Clinical Description of Follicular Lymphoma Grade IIIa

Definition and Classification

Follicular lymphoma is classified into several grades based on the histological examination of the lymph node tissue. Grade IIIa indicates a more aggressive form of follicular lymphoma, where there is a predominance of large cells, but it still retains some characteristics of the follicular pattern. This grade is part of the World Health Organization (WHO) classification of lymphomas, which categorizes lymphomas based on their cellular characteristics and behavior.

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, which may be painless.
- B-symptoms: These include fever, night sweats, and unexplained weight loss.
- Fatigue: Generalized tiredness that does not improve with rest.
- Abdominal discomfort: Particularly if lymph nodes in the abdomen or pelvis are involved.

Diagnosis

Diagnosis typically involves:
- Imaging Studies: CT scans or PET scans to assess the extent of lymphadenopathy and involvement of other organs.
- Biopsy: A lymph node biopsy is essential for histological confirmation of follicular lymphoma and grading.
- Immunophenotyping: Flow cytometry or immunohistochemistry to identify specific markers on the lymphoma cells.

Treatment Options

Treatment for follicular lymphoma grade IIIa may include:
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab).
- Radiation Therapy: May be used for localized disease.
- Targeted Therapy: Newer agents that specifically target lymphoma cells.
- Watchful Waiting: In some cases, especially if the disease is asymptomatic, a "watch and wait" approach may be adopted.

Prognosis

The prognosis for patients with follicular lymphoma grade IIIa can vary significantly based on several factors, including the patient's age, overall health, and response to treatment. Generally, grade IIIa is associated with a more aggressive course than lower grades, but advancements in treatment have improved outcomes.

ICD-10 Code C82.36 Specifics

The ICD-10 code C82.36 is used for billing and coding purposes in healthcare settings. It specifically denotes:
- C82: Follicular lymphoma
- .36: Indicates the specific involvement of intrapelvic lymph nodes, which can have implications for treatment and prognosis.

Importance of Accurate Coding

Accurate coding is crucial for appropriate treatment planning, insurance reimbursement, and epidemiological tracking of lymphoma cases. It ensures that healthcare providers can effectively communicate about the patient's condition and treatment needs.

In summary, follicular lymphoma grade IIIa, particularly when involving intrapelvic lymph nodes, represents a significant clinical challenge that requires careful diagnosis and management. The use of the ICD-10 code C82.36 facilitates the systematic approach to treatment and research in this area.

Diagnosing Follicular Lymphoma, particularly grade IIIa, involves a combination of clinical evaluation, imaging studies, and histopathological examination. The ICD-10 code C82.36 specifically refers to this subtype of lymphoma located in the intrapelvic lymph nodes. Below is a detailed overview of the criteria used for diagnosis.

Clinical Presentation

Symptoms

Patients with follicular lymphoma may present with:
- Lymphadenopathy: Swelling of lymph nodes, which may be painless.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which can indicate more aggressive disease.
- Abdominal Symptoms: Due to the involvement of intrapelvic lymph nodes, patients may experience abdominal discomfort or fullness.

Diagnostic Criteria

1. Histopathological Examination

The definitive diagnosis of follicular lymphoma is made through a biopsy of the affected lymph nodes. The following criteria are typically assessed:
- Histological Grade: Follicular lymphoma is classified into grades I, II, and III based on the number of centroblasts per high-power field. Grade IIIa is characterized by:
- Presence of Centroblasts: More than 15 centroblasts per high-power field, but less than 50% of the neoplastic follicles.
- Follicular Architecture: The architecture is disrupted, with a predominance of larger cells.

2. Immunophenotyping

Immunohistochemical staining is performed to confirm the diagnosis:
- B-cell Markers: The neoplastic cells typically express CD19, CD20, and CD10.
- BCL2 Protein: The presence of BCL2 protein is a hallmark of follicular lymphoma, indicating the cells' ability to evade apoptosis.

3. Cytogenetic Analysis

• t(14;18) Translocation: This genetic alteration is commonly found in follicular lymphoma and involves the BCL2 gene, contributing to the pathogenesis of the disease.

4. Imaging Studies

Imaging techniques are crucial for staging and assessing the extent of the disease:
- CT Scans: Used to evaluate lymphadenopathy and organ involvement, particularly in the abdomen and pelvis.
- PET Scans: May be utilized to assess metabolic activity of lymph nodes and detect any extranodal disease.

5. Staging

The Ann Arbor staging system is often used to classify the extent of lymphoma:
- Stage I: Involvement of a single lymph node region.
- Stage II: Involvement of two or more lymph node regions on the same side of the diaphragm.
- Stage III: Involvement of lymph nodes on both sides of the diaphragm.
- Stage IV: Disseminated involvement of one or more extranodal organs.

Conclusion

The diagnosis of Follicular Lymphoma grade IIIa, particularly in the context of intrapelvic lymph nodes, relies on a combination of clinical evaluation, histopathological findings, immunophenotyping, cytogenetic analysis, and imaging studies. 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 histological features. The ICD-10 code C82.36 refers to follicular lymphoma located in the intrapelvic lymph nodes. Treatment approaches for this condition typically involve a combination of chemotherapy, immunotherapy, and sometimes radiation therapy, depending on the stage of the disease, the patient's overall health, and specific clinical factors.

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 follicular lymphoma can often remain stable for extended periods.

2. Chemotherapy

Chemotherapy is a cornerstone of treatment for symptomatic 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: 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

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

• Rituximab (Rituxan): This monoclonal antibody is commonly used in combination with chemotherapy. It can also be used as a single agent in cases of relapse or when chemotherapy is not appropriate.
• Obinutuzumab (Gazyva): Another monoclonal antibody that may be used in combination with chemotherapy or as a maintenance therapy after initial treatment.

4. Radiation Therapy

Radiation therapy may be considered in specific situations, particularly for localized disease or to alleviate symptoms caused by enlarged lymph nodes. It is often used in conjunction with other treatments.

5. Targeted Therapy

Targeted therapies, such as copanlisib (Aliqopa) and idelalisib, are options for patients who have relapsed or are refractory to standard treatments. These drugs target specific pathways involved in the growth and survival of cancer cells.

6. Stem Cell Transplantation

For patients with relapsed or refractory 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 IIIa, particularly in the intrapelvic lymph nodes, is multifaceted and tailored to the individual patient. The choice of treatment depends on various factors, including the extent of the disease, patient health, and response to previous therapies. Ongoing clinical trials and advancements in targeted therapies continue to evolve the landscape of treatment options for this condition, offering hope for improved outcomes. Regular follow-up and monitoring are essential to manage the disease effectively and adjust treatment as necessary.

Follicular lymphoma, particularly grade IIIa, is a subtype of non-Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. The ICD-10 code C82.36 specifically refers to follicular lymphoma grade IIIa located in the intrapelvic lymph nodes. Below is a detailed overview of the clinical aspects associated with this condition.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that arises from B-lymphocytes. It is classified into different grades based on histological features, with grade IIIa indicating a more aggressive form compared to lower grades. The presence of the disease in intrapelvic lymph nodes can lead to specific clinical manifestations.

Signs and Symptoms

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

• Lymphadenopathy: Swelling of lymph nodes is common, particularly in the pelvic region. Patients may notice enlarged lymph nodes in the groin or abdomen.
• Abdominal Pain or Discomfort: Due to the involvement of intrapelvic lymph nodes, patients may experience pain or a feeling of fullness in the lower abdomen.
• B Symptoms: These include fever, night sweats, and unexplained weight loss, which are indicative of systemic involvement and can occur in more aggressive forms of lymphoma.
• Fatigue: A common symptom in many cancer patients, fatigue can be pronounced in those with lymphoma due to the disease's metabolic demands and potential anemia.
• Anemia: Patients may present with signs of anemia, such as pallor or fatigue, due to bone marrow involvement or chronic disease.
• Itching: Some patients report pruritus (itching), which can be associated with lymphoma.

Patient Characteristics

Certain demographic and clinical characteristics are often observed in patients diagnosed with follicular lymphoma grade IIIa:

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is relatively rare in younger individuals.
• Gender: There is a slight male predominance in the incidence of follicular lymphoma.
• Comorbidities: Patients may have other health conditions that can complicate treatment, such as cardiovascular disease or diabetes.
• Family History: A family history of lymphoproliferative disorders may be noted in some patients, suggesting a potential genetic predisposition.

Diagnosis and Evaluation

Diagnosis of follicular lymphoma grade IIIa involves a combination of clinical evaluation, imaging studies, and histopathological examination:

• Imaging Studies: CT scans or PET scans are often utilized to assess the extent of lymphadenopathy and to evaluate the involvement of intrapelvic lymph nodes.
• 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.
• Laboratory Tests: Blood tests may reveal abnormalities such as anemia or elevated lactate dehydrogenase (LDH) levels, which can indicate a more aggressive disease.

Conclusion

Follicular lymphoma grade IIIa, particularly when involving intrapelvic lymph nodes, presents with a range of clinical signs and symptoms that can significantly impact a patient's quality of life. Understanding these characteristics is crucial for timely diagnosis and effective management. If you suspect symptoms related to this condition, it is essential to consult a healthcare professional for appropriate evaluation and treatment options.

ICD-10 code C82.36 specifically refers to Follicular lymphoma grade IIIa located in the intrapelvic lymph nodes. This classification is part of 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 IIIa

1. Follicular Lymphoma, Grade 3A: This is a direct alternative name that maintains the same meaning as C82.36.
2. Follicular Lymphoma, High-Grade: Since grade IIIa is considered a high-grade lymphoma, this term is often used interchangeably.
3. Follicular Lymphoma, Aggressive Type: This term reflects the more aggressive nature of grade IIIa compared to lower grades of follicular lymphoma.

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 both Hodgkin and non-Hodgkin lymphomas.
3. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in lymphoma cases, including follicular lymphoma.
4. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, as it originates from B-lymphocytes.
5. Stage IV Lymphoma: If the disease has spread beyond the lymph nodes to other organs, it may be classified as stage IV, although this is not specific to grade IIIa.

Clinical Context

Follicular lymphoma grade IIIa is characterized by a higher proliferation of cancer cells compared to lower grades, which can influence treatment decisions and prognosis. The involvement of intrapelvic lymph nodes indicates a specific location of the disease, which can be critical for staging and therapeutic approaches.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.36 is essential for healthcare professionals involved in the diagnosis and treatment of lymphoma. This knowledge aids in effective communication and documentation within clinical settings. If you need further information on treatment options or management strategies for follicular lymphoma, feel free to ask!