ICD-10: C82.45

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 depending on the grade. The ICD-10 code C82.45 specifically refers to follicular lymphoma grade IIIb located in the lymph nodes of the inguinal region and lower limb.

Clinical Description of Follicular Lymphoma Grade IIIb

Definition and Classification

Follicular lymphoma is classified into several grades based on histological features observed under a microscope. Grade IIIb is the most aggressive form of follicular lymphoma, characterized by a predominance of large cells (large cell transformation) within the follicular architecture. This grade is associated with a higher proliferation index and a more aggressive clinical course compared to lower grades (I and II) of follicular lymphoma.

Symptoms

Patients with follicular lymphoma may present with:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the inguinal region (groin) and lower limbs, which is common in grade IIIb cases.
- B-symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more advanced disease.
- Fatigue: Generalized tiredness is often reported by 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. The presence of large cells in the follicular structure is indicative of grade IIIb.
- Immunophenotyping: This process helps to identify the specific type of lymphoma cells, often showing positivity for B-cell markers such as CD19, CD20, and CD10.
- Imaging Studies: CT scans or PET scans may be used to assess the extent of disease and involvement of lymph nodes.

Staging

The staging of follicular lymphoma is crucial for treatment planning and prognosis. The Ann Arbor staging system is commonly used, which considers the number of lymph node regions involved and whether the disease has spread to other organs.

Treatment Options

Treatment for follicular lymphoma grade IIIb may include:
- Chemotherapy: Regimens such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) are commonly used.
- Targeted Therapy: Agents like ibrutinib or venetoclax may be considered, especially in relapsed cases.
- Radiation Therapy: This may be used for localized disease or as palliative care.
- Stem Cell Transplantation: In some cases, especially for younger patients or those with aggressive disease, autologous or allogeneic stem cell transplantation may be an option.

Prognosis

The prognosis for patients with follicular lymphoma grade IIIb is generally poorer than for those with lower-grade forms. Factors influencing prognosis include the patient's age, overall health, the extent of disease at diagnosis, and response to initial treatment.

Conclusion

ICD-10 code C82.45 identifies follicular lymphoma grade IIIb affecting the lymph nodes of the inguinal region and lower limb. This condition requires careful diagnosis and management due to its aggressive nature. Understanding the clinical features, treatment options, and prognosis is essential for effective patient care and outcomes.

Follicular lymphoma, particularly grade IIIb, is a subtype of non-Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. The ICD-10 code C82.45 specifically refers to follicular lymphoma grade IIIb located in the lymph nodes of the inguinal region and lower limb. Below is a detailed overview of 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 IIIb being the most aggressive form within this category. This grade is characterized by a higher proliferation of neoplastic cells and a more aggressive clinical course compared to lower grades.

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 inguinal region (groin) and lower limbs. Patients may notice enlarged lymph nodes that can be palpable during a 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.
• Abdominal Symptoms: If lymph nodes in the abdomen are involved, patients may experience abdominal pain or discomfort, early satiety, or changes in bowel habits.

Patient Characteristics

Certain demographic and clinical characteristics are commonly 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. 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, such as autoimmune diseases or prior infections, which can influence the clinical course and treatment options.
• Family History: A family history of lymphoproliferative disorders may be noted in some patients, suggesting a potential genetic predisposition.

Diagnosis and Staging

Diagnosis of follicular lymphoma grade IIIb involves a combination of clinical evaluation, imaging studies (such as CT scans), and histopathological examination of lymph node biopsies. The staging of the disease is crucial for determining the appropriate treatment approach and prognosis.

Imaging Studies

• CT Scans: These are often used to assess the extent of lymphadenopathy and any involvement of other organs.
• PET Scans: Positron emission tomography may be utilized to evaluate metabolic activity of the lymphoma and to help in staging.

Histopathological Examination

• Biopsy: A lymph node biopsy is essential for confirming the diagnosis. The histological examination will reveal the characteristic follicular architecture and the presence of a high number of large cells, which is indicative of grade IIIb.

Conclusion

Follicular lymphoma grade IIIb, particularly affecting the lymph nodes of the inguinal region and lower limb, presents with distinct clinical features, including lymphadenopathy, systemic B symptoms, and fatigue. Understanding the signs, symptoms, and patient characteristics associated with this condition is crucial for timely diagnosis and effective management. Early intervention can significantly impact the prognosis and quality of life for affected individuals.

ICD-10 code C82.45 specifically refers to Follicular lymphoma grade IIIb, which is a subtype 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 IIIb

1. Follicular Lymphoma, Grade 3b: This is a direct alternative name that emphasizes the grade of the lymphoma.
2. Follicular Lymphoma, High-Grade: Grade IIIb is often considered high-grade due to its aggressive nature compared to lower grades of follicular lymphoma.
3. Non-Hodgkin Lymphoma, Follicular Type, Grade IIIb: This term places the lymphoma within the broader category of non-Hodgkin lymphomas, specifying its follicular nature and grade.

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 subtypes, distinguishing it from Hodgkin lymphoma.
3. Lymphadenopathy: Refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
4. Inguinal Lymph Nodes: Specific lymph nodes located in the groin area, which are affected in this particular diagnosis.
5. Lower Limb Lymphadenopathy: This term describes the involvement of lymph nodes in the lower extremities, relevant to the location specified in C82.45.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. Grade IIIb indicates a more aggressive form of the disease, often requiring different treatment approaches compared to lower-grade follicular lymphomas. The involvement of lymph nodes in the inguinal region and lower limb can lead to specific clinical symptoms, including swelling and discomfort in these areas.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.45 is crucial for healthcare professionals involved in the diagnosis, treatment, and documentation of follicular lymphoma. This knowledge aids in effective communication and ensures accurate coding for medical billing and reporting purposes. If you need further details or specific information regarding treatment options or prognosis, feel free to ask!

Follicular lymphoma, particularly grade IIIb, 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 C82.45, which pertains to follicular lymphoma grade IIIb located in the lymph nodes of the inguinal region and lower limb, involves several criteria and diagnostic steps.

Diagnostic Criteria for Follicular Lymphoma Grade IIIb

1. Histological Examination

• Tissue Biopsy: A definitive diagnosis of follicular lymphoma is made through a biopsy of the affected lymph nodes. The histological examination reveals a predominance of follicle-like structures composed of neoplastic follicle center (germinal center) cells.
• Grade Assessment: Follicular lymphoma is graded based on the number of centroblasts per high-power field (HPF). Grade IIIb is characterized by the presence of more than 15 centroblasts per HPF, indicating a more aggressive form of the disease compared to grades I and II[1].

2. Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers on the lymphoma cells. Follicular lymphoma typically expresses CD19, CD20, CD10, and BCL2, while lacking CD5. The presence of these markers helps confirm the diagnosis[1][2].

3. Cytogenetic Analysis

• Chromosomal Abnormalities: The most common genetic alteration in follicular lymphoma is the t(14;18)(q32;q21) translocation, which results in the overexpression of the BCL2 gene. Detection of this translocation can be performed using fluorescence in situ hybridization (FISH) or polymerase chain reaction (PCR) techniques[2].

4. Clinical Evaluation

• Symptoms and Physical Examination: Patients may present with painless lymphadenopathy, which can be localized to the inguinal region and lower limbs. Systemic symptoms such as fever, night sweats, and weight loss may also be assessed to determine the disease stage and overall prognosis[1].
• Staging: The Ann Arbor staging system is commonly used to classify the extent of lymphoma. This includes imaging studies such as CT scans or PET scans to evaluate the involvement of lymph nodes and any extranodal sites[2].

5. Laboratory Tests

• Blood Tests: Complete blood counts (CBC) and other laboratory tests may be performed to assess overall health and organ function. Elevated lactate dehydrogenase (LDH) levels can indicate a more aggressive disease[1].

Conclusion

The diagnosis of follicular lymphoma grade IIIb, particularly in the inguinal region and lower limb, requires a comprehensive approach that includes histological examination, immunophenotyping, cytogenetic analysis, clinical evaluation, and laboratory tests. Each of these components plays a crucial role in confirming the diagnosis and determining the appropriate treatment strategy. 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 C82.45 refers to follicular lymphoma located in the lymph nodes of the inguinal region and lower limb. 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 histological features, with grade IIIb being the most aggressive form. This grade is characterized by a predominance of large cells, which can lead to a more rapid progression of the disease compared to lower-grade follicular lymphomas. The involvement of lymph nodes in the inguinal region and lower limb can complicate treatment and necessitate a tailored approach.

Standard Treatment Approaches

1. Chemotherapy

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

• R-CHOP: This regimen combines Rituximab (a monoclonal antibody) with Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. R-CHOP is often the first-line treatment for aggressive lymphomas, including grade IIIb follicular lymphoma, due to its effectiveness in reducing tumor burden and improving survival rates[1].

• R-CVP: This regimen includes Rituximab, Cyclophosphamide, Vincristine, and Prednisone, and may be considered for patients who are not candidates for more intensive chemotherapy[2].

2. Targeted Therapy

Targeted therapies have emerged as significant options for treating follicular lymphoma. Notable agents include:

• Rituximab: This monoclonal antibody targets CD20 on B-cells and is often used in combination with chemotherapy or as a standalone treatment in relapsed cases[3].

• Obinutuzumab (Gazyva): Another anti-CD20 monoclonal antibody that may be used in combination with chemotherapy for patients with advanced disease[4].

• Copanlisib (Aliqopa): A PI3K inhibitor that is approved for the treatment of relapsed follicular lymphoma and may be considered in cases where traditional chemotherapy is not effective[5].

3. Radiation Therapy

Radiation therapy can be an effective treatment modality, particularly for localized disease. In cases where the lymphoma is confined to specific lymph nodes, such as those in the inguinal region, localized radiation may be employed either as a primary treatment or as a consolidation therapy following chemotherapy[6].

4. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be considered. This approach is typically reserved for younger patients or those with significant disease burden who have not responded adequately to initial therapies[7].

5. Clinical Trials

Participation in clinical trials may provide access to novel therapies and treatment strategies that are not yet widely available. Patients with grade IIIb follicular lymphoma are encouraged to discuss clinical trial options with their healthcare providers, as these studies may offer promising new treatments[8].

Conclusion

The management of follicular lymphoma grade IIIb, particularly in the inguinal region and lower limb, requires a comprehensive approach that may include chemotherapy, targeted therapies, radiation, and potentially stem cell transplantation. Given the aggressive nature of this lymphoma subtype, early intervention and a multidisciplinary treatment strategy are essential for optimizing patient outcomes. Patients should work closely with their oncologists to determine the most appropriate treatment plan based on their individual circumstances and disease characteristics.

References

1. Non-Hodgkin Lymphoma Treatment Guidelines.
2. Chemotherapy Regimens for Lymphoma.
3. Rituximab in Follicular Lymphoma.
4. Obinutuzumab for Advanced Follicular Lymphoma.
5. Copanlisib in Relapsed Follicular Lymphoma.
6. Radiation Therapy in Lymphoma Treatment.
7. Stem Cell Transplantation for Lymphoma.
8. Clinical Trials for Follicular Lymphoma.