ICD-10: C82.38

ICD-10 code C82.38 refers specifically to Follicular lymphoma grade IIIa, which is a subtype of non-Hodgkin lymphoma (NHL) characterized by the proliferation of follicle center (germinal center) B-cells. This particular grade of follicular lymphoma is notable for its aggressive nature compared to lower grades and is classified under the broader category of follicular lymphomas.

Clinical Description

Definition and Characteristics

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that arises from B-lymphocytes in the lymph nodes. Grade IIIa indicates a more aggressive form of this lymphoma, where there is a higher proportion of large cells (centroblasts) present in the tumor. Specifically, grade IIIa is defined by the presence of 6 to 15 centroblasts per high-power field (HPF) in histological examination, which distinguishes it from lower grades (I and II) that have fewer large cells.

Symptoms

Patients with follicular lymphoma may present with:
- Lymphadenopathy: Swelling of lymph nodes, which can occur in multiple sites throughout the body.
- B symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more advanced disease.
- Fatigue: Generalized tiredness is common among patients.
- Abdominal discomfort: If lymph nodes in the abdomen are involved, patients may experience discomfort or fullness.

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: Flow cytometry or immunohistochemistry is used to identify specific cell markers that characterize follicular lymphoma.
- Imaging studies: CT scans or PET scans may be utilized to assess the extent of lymph node involvement and to check for any extranodal disease.

Treatment Options

Treatment for follicular lymphoma grade IIIa may include:
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab) to enhance efficacy.
- Radiation therapy: May be used in localized disease or as palliative care.
- Targeted therapies: Newer agents, such as PI3K inhibitors, may be considered based on the patient's specific disease characteristics and overall health.

Prognosis

The prognosis for patients with follicular lymphoma grade IIIa can vary significantly based on several factors, including the extent of disease at diagnosis, the patient's age, and overall health. Generally, grade IIIa is associated with a more aggressive clinical course compared to lower-grade follicular lymphomas, necessitating a more intensive treatment approach.

Conclusion

ICD-10 code C82.38 encapsulates a specific and clinically significant diagnosis of follicular lymphoma grade IIIa, characterized by its aggressive nature and the involvement of multiple lymph node sites. Understanding the clinical presentation, diagnostic criteria, and treatment options is crucial for effective management and improving patient outcomes in this challenging lymphoma subtype.

Follicular lymphoma, particularly classified under ICD-10 code C82.38, refers to a specific subtype of non-Hodgkin lymphoma 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 in cases classified as grade IIIa. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Overview of Follicular Lymphoma Grade IIIa

Follicular lymphoma is categorized into grades based on the histological examination of the lymph nodes. Grade IIIa indicates a higher proliferation of neoplastic cells compared to lower grades, which can lead to more aggressive behavior. Patients with grade IIIa follicular lymphoma often present with lymphadenopathy, which can be widespread, affecting multiple lymph node sites.

Signs and Symptoms

1. Lymphadenopathy:
   - The most common clinical sign is the presence of enlarged lymph nodes, which may be painless and can occur in multiple regions, including cervical, axillary, and inguinal areas. Patients may notice swelling in these regions without accompanying pain.

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 that can soak through clothing and bedding.
   • Weight Loss: Unintentional weight loss exceeding 10% of body weight over six months.

3. Fatigue:
   - A common complaint among patients, often due to the body's response to the malignancy and the metabolic demands of the tumor.

4. Abdominal Symptoms:
   - In cases where lymph nodes in the abdomen are involved, patients may experience abdominal discomfort, fullness, or pain due to lymphadenopathy or splenomegaly.

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

Patient Characteristics

• Age:

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

• Gender:

• There is a slight male predominance in the incidence of follicular lymphoma.

• Comorbidities:

• Patients may have other health conditions, including autoimmune diseases or prior history of other malignancies, which can influence treatment decisions and prognosis.

• Family History:

• A family history of lymphoproliferative disorders may be noted in some patients, suggesting a potential genetic predisposition.

Conclusion

Follicular lymphoma grade IIIa, particularly affecting multiple lymph node sites, presents with a range of clinical signs and symptoms primarily centered around lymphadenopathy and systemic manifestations. Understanding these characteristics is crucial for timely diagnosis and management. If you suspect a patient may have this condition, a thorough clinical evaluation, including imaging and biopsy, is essential for confirmation and to guide treatment options.

ICD-10 code C82.38 specifically refers to Follicular lymphoma grade IIIa, which is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This particular grade indicates a more aggressive form of the disease, and it is important to understand the alternative names and related terms associated with this diagnosis for accurate coding and communication in clinical settings.

Alternative Names for Follicular Lymphoma Grade IIIa

1. Follicular Lymphoma, Grade 3a: This is the most direct alternative name, often used interchangeably with the ICD-10 code designation.
2. Follicular Lymphoma, High-Grade: Since grade IIIa is considered high-grade, this term may be used in clinical discussions.
3. Follicular Lymphoma, B-cell Type: This emphasizes the B-cell origin of the lymphoma, which is relevant in the context of hematological malignancies.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a subtype of non-Hodgkin lymphoma, and this broader term encompasses various types of lymphomas that do not fall under Hodgkin lymphoma.
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 patients with follicular lymphoma.
4. B-cell Neoplasm: Follicular lymphoma is classified as a B-cell neoplasm, indicating its origin from B-lymphocytes.
5. Stage IIIC Follicular Lymphoma: While not a direct synonym, this term may be used in staging discussions, as it indicates advanced disease with multiple lymph node involvement.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in the diagnosis, treatment, and coding of follicular lymphoma. Accurate terminology ensures effective communication among medical teams and aids in the proper documentation for billing and insurance purposes.

In summary, the ICD-10 code C82.38 for Follicular lymphoma grade IIIa is associated with several alternative names and related terms that reflect its classification and clinical implications. Familiarity with these terms enhances clarity in medical records and discussions surrounding patient care.

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 grade IIIa, involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosis, particularly relevant to the ICD-10 code C82.38, which pertains to follicular lymphoma grade IIIa affecting lymph nodes at multiple sites.

Clinical Evaluation

1. Symptoms: Patients may present with symptoms such as painless lymphadenopathy, fever, night sweats, and weight loss. These systemic symptoms, often referred to as "B symptoms," can indicate a more aggressive disease course.

2. Physical Examination: A thorough physical examination is essential to identify lymphadenopathy in multiple regions, including cervical, axillary, and inguinal lymph nodes.

Imaging Studies

1. CT Scans: Computed tomography (CT) scans of the chest, abdomen, and pelvis are commonly used to assess the extent of lymphadenopathy and to identify any organ involvement.

2. PET Scans: Positron emission tomography (PET) scans may be utilized to evaluate metabolic activity in lymph nodes and to differentiate between active disease and residual masses post-treatment.

Histopathological Examination

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node. The biopsy can be performed via excisional, incisional, or fine-needle aspiration methods.

2. Histological Features: The histopathological examination will reveal:
   - Follicular Architecture: The presence of neoplastic follicles that disrupt normal lymph node architecture.
   - Cell Type: The neoplastic cells are typically small to medium-sized B-lymphoid cells, with grade IIIa indicating a higher proportion of larger cells (centroblasts).
   - Immunophenotyping: Immunohistochemical staining is performed to confirm the B-cell lineage (positive for CD19, CD20, and CD10) and to assess the proliferation index using Ki-67, which is often elevated in grade IIIa.

3. Genetic Studies: Cytogenetic analysis may reveal chromosomal translocations, such as t(14;18), which is commonly associated with follicular lymphoma.

Staging

1. Ann Arbor Staging System: The staging of follicular lymphoma is crucial for treatment planning and prognosis. The Ann Arbor system classifies lymphoma based on the number of lymph node regions involved and whether there is extranodal involvement.

2. Multiple Sites: For ICD-10 code C82.38, the diagnosis specifies involvement of lymph nodes at multiple sites, indicating a more advanced stage of the disease.

Conclusion

The diagnosis of follicular lymphoma grade IIIa (ICD-10 code C82.38) involves a comprehensive approach that includes clinical assessment, imaging studies, and detailed histopathological evaluation. The combination of these criteria helps to ensure an accurate diagnosis, which 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 the potential for transformation into a more aggressive form. The ICD-10 code C82.38 specifically refers to follicular lymphoma grade IIIa affecting lymph nodes at multiple sites. 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.

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, allowing for intervention only when symptoms develop or the disease progresses.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for follicular lymphoma, especially in symptomatic cases. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for more aggressive presentations or when the disease transforms.
• R-CHOP: The addition of Rituximab (a monoclonal antibody) to the CHOP regimen has significantly improved outcomes. Rituximab targets CD20-positive B cells, which are prevalent in follicular lymphoma.

3. Immunotherapy

Rituximab is a key component in the treatment of follicular lymphoma. It can be used alone or in combination with chemotherapy. Other monoclonal antibodies, such as Obinutuzumab, may also be considered.

4. Radiation Therapy

Radiation therapy can be effective, particularly for localized disease or as a palliative measure to relieve symptoms. It may be used in conjunction with chemotherapy or as a standalone treatment in certain cases.

5. Targeted Therapies

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

• Idelalisib: An oral inhibitor of the PI3K pathway, used in relapsed or refractory cases.
• Copanlisib: Another PI3K inhibitor, indicated for patients who have received at least two prior therapies.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, autologous stem cell transplantation may be considered, particularly after achieving a complete response to initial therapy. This approach is more common in younger patients or those with high-risk features.

7. Clinical Trials

Participation in clinical trials may provide access to novel therapies and treatment strategies that are not yet widely available. Patients are encouraged to discuss this option with their healthcare providers.

Conclusion

The management of follicular lymphoma grade IIIa involves a combination of observation, chemotherapy, immunotherapy, radiation, and potentially targeted therapies or stem cell transplantation. The choice of treatment is highly individualized, taking into account the patient's specific circumstances and preferences. Ongoing research and clinical trials continue to evolve the landscape of treatment options, offering hope for improved outcomes in patients with this condition. For the most effective management, patients should work closely with their oncology team to determine the best approach tailored to their needs.