ICD-10: C82.40

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, specifically from B-cells. The ICD-10 code C82.40 refers to Follicular lymphoma grade IIIb, unspecified site, which is a specific classification within the broader category of follicular lymphomas.

Clinical Description of Follicular Lymphoma Grade IIIb

Overview

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. It is typically indolent, meaning it progresses slowly, but grade IIIb indicates a more aggressive form of the disease. This grade is part of the World Health Organization (WHO) classification, which categorizes lymphomas based on histological features and clinical behavior.

Grade IIIb Characteristics

• Histological Features: Follicular lymphoma is graded based on the number of large cells (centroblasts) present in the tissue. Grade IIIb is defined by the presence of more than 15 centroblasts per high-power field, indicating a higher proliferation rate and a more aggressive clinical course compared to grades I and II.
• Clinical Behavior: Patients with grade IIIb follicular lymphoma may experience more rapid disease progression and a higher likelihood of transformation to a more aggressive form of lymphoma, such as diffuse large B-cell lymphoma (DLBCL) [5].

Symptoms

Common symptoms of follicular lymphoma may include:
- Swollen lymph nodes, often painless
- Fever
- Night sweats
- Unexplained weight loss
- Fatigue

These symptoms can vary based on the extent of the disease and the specific sites affected.

Diagnosis

Diagnosis typically involves:
- Biopsy: A tissue sample from an affected lymph node is examined histologically to confirm the presence of follicular lymphoma and to determine the grade.
- Imaging Studies: CT scans, PET scans, or MRI may be used to assess the extent of the disease and to identify any affected sites.
- Blood Tests: These may help evaluate overall health and detect any abnormalities associated with lymphoma.

Treatment Options

Treatment for follicular lymphoma grade IIIb may include:
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab) to enhance effectiveness.
- Radiation Therapy: May be used in localized cases or as palliative care.
- Targeted Therapies: Newer treatments, such as CAR T-cell therapy, may be considered for relapsed or refractory cases.
- Watchful Waiting: In some cases, especially if the disease is asymptomatic, a "watch and wait" approach may be adopted.

Conclusion

ICD-10 code C82.40 designates follicular lymphoma grade IIIb, unspecified site, highlighting a more aggressive form of this type of lymphoma. Understanding the clinical characteristics, symptoms, diagnostic methods, and treatment options is crucial for effective management and care of patients diagnosed with this condition. As research continues, new therapies and treatment protocols are being developed to improve outcomes for individuals with follicular lymphoma.

Follicular lymphoma grade IIIb, classified under ICD-10 code C82.40, 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 originates from B-lymphocytes. Grade IIIb indicates a more aggressive form of follicular lymphoma, where the cancer cells exhibit a higher proliferation rate compared to lower grades. This grade is often associated with a more advanced stage at diagnosis and a poorer prognosis.

Signs and Symptoms

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

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the neck, armpits, or groin. Patients may notice enlarged lymph nodes during routine examinations or while feeling for lumps.

• B Symptoms: These are systemic symptoms that may indicate more advanced disease and 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 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.

• Abdominal Symptoms: If lymph nodes in the abdomen are involved, patients may experience abdominal pain, fullness, or discomfort due to organ compression.

• Skin Symptoms: In some cases, patients may develop skin lesions or rashes, although this is less common.

Patient Characteristics

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

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. However, it can occur in younger individuals as well.

• Gender: There is a slight male predominance in the incidence of follicular lymphoma, although it affects both genders.

• Comorbidities: Patients may have other health conditions that can complicate treatment, such as cardiovascular disease or diabetes.

• Family History: A family history of lymphomas or other hematological malignancies may be present, suggesting a potential genetic predisposition.

• Ethnicity: While follicular lymphoma can affect individuals of any ethnicity, some studies suggest variations in incidence rates among different populations.

Conclusion

Follicular lymphoma grade IIIb (ICD-10 code C82.40) presents with a range of clinical signs and symptoms, primarily characterized by lymphadenopathy and systemic B symptoms. Understanding these presentations, along with patient demographics and characteristics, is essential for timely diagnosis and effective management. Early recognition of symptoms and appropriate diagnostic workup can significantly impact treatment outcomes and patient quality of life.

Follicular lymphoma grade IIIb, classified under ICD-10 code C82.40, is a subtype of non-Hodgkin lymphoma characterized by specific histological features. Understanding its alternative names and related terms can enhance clarity in medical documentation and communication. Below are the alternative names and related terms associated with this condition.

Alternative Names for Follicular Lymphoma Grade IIIb

1. Follicular Lymphoma, Grade 3b: This is the most direct alternative name, emphasizing the grade of the lymphoma.
2. Follicular Lymphoma, High-Grade: Since grade IIIb is considered high-grade, this term is often used in clinical settings.
3. Follicular Lymphoma, Grade 3: This term may be used interchangeably with grade IIIb, although it is essential to specify the subtype when necessary.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): Follicular lymphoma is a type of non-Hodgkin lymphoma, and this broader term encompasses various lymphoma subtypes.
2. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, which refers to lymphomas originating from B lymphocytes.
3. Lymphoproliferative Disorders: This term encompasses a range of conditions, including follicular lymphoma, where there is an abnormal proliferation of lymphocytes.
4. Lymphoma, Follicular Type: This term may be used to describe the general category of follicular lymphomas, including grade IIIb.
5. C82.4: The specific ICD-10 code for follicular lymphoma grade IIIb, which can be referenced in medical coding and billing.

Clinical Context

Follicular lymphoma grade IIIb is characterized by a more aggressive clinical course compared to lower grades of follicular lymphoma. It is essential for healthcare providers to accurately document and communicate the specific grade and type of lymphoma to ensure appropriate treatment and management strategies are employed.

In summary, understanding the alternative names and related terms for ICD-10 code C82.40 can facilitate better communication among healthcare professionals and improve patient care outcomes. If you need further details or specific information regarding treatment or management, feel free to ask!

Follicular lymphoma, particularly grade IIIb, is a subtype of non-Hodgkin lymphoma characterized by specific histological features and clinical behavior. The diagnosis of follicular lymphoma, including grade IIIb, involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria and considerations used in the diagnosis of follicular lymphoma grade IIIb, which corresponds to the ICD-10 code C82.40.

Clinical Evaluation

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

2. Physical Examination: A thorough physical examination is essential to assess lymph node involvement and any splenomegaly or hepatomegaly.

Imaging Studies

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

2. PET Scans: Positron emission tomography (PET) scans may be utilized to assess metabolic activity in lymph nodes and to help stage the disease.

Histopathological Examination

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node or tissue. The biopsy specimen is examined microscopically.

2. Histological Classification: Follicular lymphoma is classified based on the World Health Organization (WHO) classification system. Grade IIIb is characterized by:
   - High-grade features: More than 50% of the neoplastic follicles are composed of large cells (centroblasts).
   - Immunophenotyping: The neoplastic cells typically express CD10, CD19, CD20, and BCL2, while lacking CD5.

3. Cytogenetic Analysis: The presence of the t(14;18) chromosomal translocation, which results in the overexpression of the BCL2 gene, is a common finding in follicular lymphoma and can aid in diagnosis.

Staging

1. Ann Arbor Staging System: The Ann Arbor classification is used to stage the lymphoma, which is crucial for determining treatment options. Staging considers the number of lymph node regions involved and whether the disease has spread to other organs.

2. Prognostic Factors: Factors such as the International Prognostic Index (IPI) may be used to assess prognosis based on age, stage, performance status, and serum lactate dehydrogenase (LDH) levels.

Conclusion

The diagnosis of follicular lymphoma grade IIIb (ICD-10 code C82.40) is a multifaceted process that requires careful clinical assessment, imaging studies, and 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 IIIb, is a subtype of non-Hodgkin lymphoma characterized by its aggressive nature and specific treatment requirements. The ICD-10 code C82.40 refers to follicular lymphoma grade IIIb at an unspecified site. Understanding the standard treatment approaches for this condition is crucial for effective management.

Overview of Follicular Lymphoma Grade IIIb

Follicular lymphoma is classified into different grades based on the histological features observed under a microscope. Grade IIIb is the most aggressive form of follicular lymphoma, with a higher proliferation index and a tendency to transform into more aggressive forms of lymphoma. This grade is often associated with a poorer prognosis compared to lower-grade follicular lymphomas[1].

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains a cornerstone of treatment for grade IIIb follicular lymphoma. The most commonly used regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used in combination with monoclonal antibodies like Rituximab (R-CHOP) to enhance efficacy[2].
• Rituximab: This monoclonal antibody targets CD20 on B-cells and is frequently used in combination with chemotherapy. Rituximab can be administered as a single agent in cases of relapse or when chemotherapy is not suitable[3].

2. Targeted Therapy

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

• PI3K Inhibitors: Drugs like Copanlisib (Aliqopa) are used for patients who have relapsed or are refractory to other treatments. These agents target specific pathways involved in cancer cell survival and proliferation[4].
• Bruton’s Tyrosine Kinase (BTK) Inhibitors: Ibrutinib is another targeted therapy that has shown promise in treating follicular lymphoma, particularly in cases that are resistant to standard therapies[5].

3. Radiation Therapy

Radiation therapy may be employed in specific scenarios, particularly for localized disease or as a palliative measure to relieve symptoms. It is less commonly used as a primary treatment for advanced-stage follicular lymphoma but can be effective in localized areas[6].

4. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, especially those with grade IIIb, autologous stem cell transplantation may be considered. This approach is typically reserved for younger patients or those with a good performance status, as it involves high-dose chemotherapy followed by the reinfusion of the patient’s own stem cells[7].

5. Clinical Trials

Participation in clinical trials can provide access to novel therapies and treatment strategies that are not yet widely available. Patients with follicular lymphoma, particularly those with grade IIIb, are encouraged to discuss clinical trial options with their healthcare providers[8].

Conclusion

The management of follicular lymphoma grade IIIb (ICD-10 code C82.40) involves a multifaceted approach that includes chemotherapy, targeted therapies, radiation, and potentially stem cell transplantation. The choice of treatment is influenced by various factors, including the patient's overall health, disease stage, and response to previous therapies. Ongoing research and clinical trials continue to shape the landscape of treatment options, offering hope for improved outcomes in this challenging subtype of lymphoma. For personalized treatment plans, patients should consult with their oncologists to determine the most appropriate strategy based on their specific circumstances.