ICD-10: C82.46

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10-CM code C82.46 specifically refers to Follicular lymphoma grade IIIb located in the intrapelvic lymph nodes. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Follicular Lymphoma Grade IIIb

Definition and Classification

Follicular lymphoma is classified into several grades based on histological features, with grade IIIb being the most aggressive form. This classification is part of the broader category of non-Hodgkin lymphomas, which includes various types of lymphoid tissue malignancies. Grade IIIb follicular lymphoma is characterized by a predominance of large cells, which can lead to a more aggressive clinical course compared to lower-grade forms.

Pathophysiology

Follicular lymphoma arises from B-lymphocytes in the germinal centers of lymphoid follicles. The transformation to grade IIIb indicates a higher proliferation index and a greater number of large cells, which can lead to more rapid disease progression and a poorer prognosis. The presence of the disease in the intrapelvic lymph nodes suggests that the lymphoma has spread beyond its original site, which can complicate treatment and management.

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the neck, armpits, or groin.
- Abdominal discomfort: Due to enlarged lymph nodes in the abdominal or pelvic region.
- B symptoms: Such as fever, night sweats, and unexplained weight loss, which may indicate more advanced disease.

Diagnosis

Diagnosis typically involves:
- Imaging studies: CT scans or PET scans to assess the extent of lymph node involvement and any potential organ involvement.
- Biopsy: A tissue sample from the affected lymph nodes is examined histologically to confirm the diagnosis and grade of the lymphoma.
- Immunophenotyping: Flow cytometry or immunohistochemistry may be used to identify specific cell markers associated with follicular lymphoma.

Treatment Options

Treatment for follicular lymphoma grade IIIb may include:
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab) to target B-cells.
- Radiation therapy: May be used for localized disease or to alleviate symptoms.
- Stem cell transplant: In some cases, particularly for younger patients or those with aggressive disease, an allogeneic stem cell transplant may be considered.

Prognosis

The prognosis for patients with follicular lymphoma grade IIIb is generally poorer than for lower-grade forms due to its aggressive nature. 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 C82.46 identifies follicular lymphoma grade IIIb specifically affecting the intrapelvic lymph nodes, highlighting the need for careful diagnosis and management due to its aggressive characteristics. Understanding the clinical features, diagnostic methods, and treatment options is crucial for healthcare providers in delivering effective care for patients with this condition. Regular follow-up and monitoring are essential to manage potential complications and assess treatment response.

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 C82.46 refers to follicular lymphoma grade IIIb located in the intrapelvic lymph nodes. Here’s a detailed overview of the standard treatment approaches for this condition.

Overview of Follicular Lymphoma Grade IIIb

Follicular lymphoma is classified into grades based on the histological features observed under a microscope. Grade IIIb is the most aggressive form, with a higher proliferation index and a tendency to transform into more aggressive types of lymphoma. This grade often requires more intensive treatment strategies compared to lower-grade follicular lymphomas.

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[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[1].

2. Targeted Therapy

Targeted therapies have become increasingly important in the treatment of follicular lymphoma. Notable options include:

• Rituximab: This monoclonal antibody targets CD20 on B-cells and is often used in combination with chemotherapy or as a standalone treatment in certain cases[1][2].
• PI3K Inhibitors: Drugs like Copanlisib (Aliqopa) are used for relapsed or refractory follicular lymphoma and may be considered in specific scenarios[2][3].

3. Radiation Therapy

Radiation therapy can be an effective treatment for localized disease, particularly in cases where the lymphoma is confined to specific lymph node regions, such as the intrapelvic lymph nodes. It may be used:

• As a primary treatment in localized cases.
• As a consolidation therapy following chemotherapy to eliminate residual disease[1].

4. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, particularly those with grade IIIb, hematopoietic stem cell transplantation (HCT) may be considered. This approach is typically reserved for younger patients or those with significant comorbidities who can tolerate the procedure[1][2].

5. 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, as ongoing research may lead to improved outcomes[1].

Conclusion

The treatment of follicular lymphoma grade IIIb, particularly in the context of intrapelvic lymph nodes, involves a multifaceted approach that includes chemotherapy, targeted therapies, radiation, and potentially stem cell transplantation. The choice of treatment is highly individualized, taking into account the patient's overall health, disease characteristics, and preferences. Continuous advancements in research and clinical trials are essential for improving treatment outcomes for this aggressive form of lymphoma. For the most effective management, patients should work closely with their oncology team to determine the best course of action tailored to their specific situation.

Follicular lymphoma grade IIIb, classified under ICD-10 code C82.46, is a subtype of non-Hodgkin lymphoma characterized by specific clinical presentations, signs, symptoms, and patient characteristics. Understanding these aspects is crucial for accurate 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 this lymphoma, where there is a predominance of large cells. The clinical presentation can vary significantly among patients, but several common features are noted:

• Lymphadenopathy: Patients often present with painless swelling of lymph nodes, particularly in the neck, axilla, or groin. In the case of C82.46, there is a specific involvement of intrapelvic lymph nodes, which may lead to abdominal or pelvic discomfort.
• B Symptoms: These include fever, night sweats, and unexplained weight loss. The presence of these symptoms can indicate a more advanced disease stage and may suggest systemic involvement.
• Abdominal Symptoms: Due to the involvement of intrapelvic lymph nodes, patients may experience abdominal pain, fullness, or changes in bowel habits, such as constipation or diarrhea, depending on the extent of lymph node enlargement and its effect on surrounding structures.

Signs and Symptoms

The signs and symptoms associated with follicular lymphoma grade IIIb can be categorized as follows:

Local Symptoms

• Painless Lymphadenopathy: Enlargement of lymph nodes in the pelvic region may be palpable during a physical examination.
• Abdominal Distension: Due to lymph node enlargement, patients may experience a sensation of fullness or pressure in the abdomen.

Systemic Symptoms

• Fever: Intermittent fevers may occur, often without an identifiable infection.
• Night Sweats: Patients may report excessive sweating during the night.
• Weight Loss: Unintentional weight loss is common and can be significant.

Other Symptoms

• Fatigue: A general sense of tiredness or lack of energy is frequently reported.
• Itching: Some patients may experience pruritus, which can be distressing.

Patient Characteristics

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

• Age: This type of lymphoma is more commonly diagnosed in adults, particularly those over the age of 60.
• 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.

Conclusion

Follicular lymphoma grade IIIb, particularly with intrapelvic lymph node involvement (ICD-10 code C82.46), presents with a range of clinical features that can significantly impact patient quality of life. Recognizing the signs and symptoms, along with understanding patient characteristics, is essential for timely diagnosis and effective management. Clinicians should remain vigilant for both local and systemic manifestations of the disease to provide comprehensive care.

ICD-10 code C82.46 specifically refers to Follicular lymphoma grade IIIb 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

1. Follicular Lymphoma, Grade IIIb: This is the primary name for the condition, indicating a more aggressive form of follicular lymphoma.
2. Follicular Lymphoma, High-Grade: Grade IIIb is often considered high-grade due to its aggressive nature compared to lower grades.
3. Follicular Lymphoma, Advanced Stage: This term may be used when the lymphoma has progressed significantly, particularly when it involves intrapelvic lymph nodes.

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. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in lymphoma cases.
3. Lymphoma: A general term for cancers that originate in the lymphatic system, including both Hodgkin and non-Hodgkin lymphomas.
4. B-cell Lymphoma: Follicular lymphoma is classified as a B-cell lymphoma, as it arises from B-lymphocytes.
5. Stage IV Lymphoma: If the disease has spread to the intrapelvic lymph nodes, it may be classified as stage IV, indicating advanced disease.

Clinical Context

Follicular lymphoma grade IIIb is characterized by a higher proliferation rate of cancer cells, which can lead to more aggressive symptoms and a different treatment approach compared to lower-grade follicular lymphomas. The involvement of intrapelvic lymph nodes can also influence the staging and management of the disease.

Understanding these alternative names and related terms can be crucial for healthcare professionals when discussing diagnosis, treatment options, and patient management strategies. If you need further details on treatment protocols or prognosis related to this condition, 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 grade IIIb, involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria and considerations used for diagnosing follicular lymphoma grade IIIb, specifically in the context of intrapelvic lymph nodes, which corresponds to the ICD-10 code C82.46.

Clinical Presentation

1. Symptoms: Patients may present with symptoms such as:
   - Painless lymphadenopathy (swelling of lymph nodes)
   - B symptoms (fever, night sweats, weight loss)
   - Abdominal discomfort or fullness due to lymph node enlargement in the pelvic region.

2. Physical Examination: A thorough physical examination may reveal enlarged lymph nodes in the neck, axilla, or groin, as well as abdominal or pelvic masses.

Imaging Studies

1. CT Scans: Computed tomography (CT) scans of the abdomen and pelvis are crucial for identifying enlarged lymph nodes and assessing the extent of disease involvement in the intrapelvic region.

2. PET Scans: Positron emission tomography (PET) scans can help evaluate metabolic activity in lymph nodes, distinguishing between active lymphoma and benign conditions.

Histopathological Criteria

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node. The histological examination typically shows:
   - A nodular pattern of follicular architecture.
   - A predominance of follicle center (germinal center) cells.
   - The presence of large cells, which is characteristic of grade IIIb.

2. Immunophenotyping: Flow cytometry or immunohistochemistry is used to identify specific markers:
   - Positive for CD10, CD19, CD20, and BCL2.
   - Negative for CD5, which helps differentiate follicular lymphoma from other types of lymphoma.

3. Grading: Follicular lymphoma is graded based on the number of large cells (centroblasts) per high-power field (HPF):
   - Grade IIIa: 5 or fewer centroblasts per HPF.
   - Grade IIIb: More than 5 centroblasts per HPF, indicating a more aggressive disease.

Staging

1. Ann Arbor Staging System: The staging of follicular lymphoma follows the Ann Arbor classification, which considers the number of lymph node regions involved and the presence of systemic symptoms. In the case of intrapelvic lymph nodes, the disease may be classified as stage II if it is confined to one side of the diaphragm.

2. Bone Marrow Biopsy: A bone marrow biopsy may be performed to assess for bone marrow involvement, which can influence treatment decisions and prognosis.

Conclusion

The diagnosis of follicular lymphoma grade IIIb, particularly in the context of intrapelvic lymph nodes (ICD-10 code C82.46), relies on a combination of clinical evaluation, imaging studies, and histopathological findings. 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!