ICD-10: C82.48

Clinical Description of Follicular Lymphoma Grade IIIb (ICD-10 Code C82.48)

Overview of Follicular Lymphoma
Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, specifically from B-cells. It is characterized by the proliferation of follicle center (germinal center) B-cells and is generally considered an indolent (slow-growing) form of lymphoma. However, the grade of the lymphoma can significantly influence its behavior and treatment approach.

Grade IIIb Classification
Follicular lymphoma is graded based on the number of large cells present in the tissue sample. Grade IIIb indicates a higher proportion of large cells, which can lead to a more aggressive disease course compared to lower grades. This grade is associated with a higher likelihood of transformation to a more aggressive form of lymphoma, such as diffuse large B-cell lymphoma (DLBCL) [1].

ICD-10 Code C82.48

Specifics of C82.48
The ICD-10 code C82.48 specifically refers to "Follicular lymphoma grade IIIb, lymph nodes of multiple sites." This classification indicates that the lymphoma is not only present but also involves multiple lymph node regions, which can complicate treatment and prognosis. The designation of multiple sites suggests a more systemic involvement of the disease, which may require more intensive therapeutic strategies [2][3].

Clinical Features

Symptoms
Patients with follicular lymphoma may present with a variety of symptoms, including:
- Painless swelling of lymph nodes, often in the neck, armpits, or groin.
- Fever, night sweats, and unexplained weight loss (B symptoms).
- Fatigue and weakness.
- Abdominal discomfort or swelling if lymph nodes in the abdomen are involved.

Diagnosis
Diagnosis typically involves:
- Physical Examination: Assessment of lymph node enlargement.
- Imaging Studies: CT scans or PET scans to evaluate the extent of lymph node involvement.
- Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, which is then examined histologically to determine the grade of the lymphoma.
- Immunophenotyping: Flow cytometry and cell marker studies (e.g., CD10, CD19, CD20) are used to characterize the lymphoma cells [4][5].

Treatment Options

Therapeutic Approaches
Treatment for follicular lymphoma grade IIIb may include:
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab) to enhance efficacy.
- Radiation Therapy: May be used for localized disease or as palliative care.
- Targeted Therapy: Newer agents, such as Bruton’s tyrosine kinase inhibitors, may be considered.
- Stem Cell Transplantation: In select cases, especially for relapsed or refractory disease, autologous or allogeneic stem cell transplantation may be an option [6][7].

Prognosis

The prognosis for patients with follicular lymphoma grade IIIb can vary significantly based on several factors, including the extent of disease, patient age, overall health, and response to initial treatment. The International Prognostic Index (IPI) is often used to help predict outcomes based on clinical features [8].

Conclusion

ICD-10 code C82.48 encapsulates a specific and clinically significant diagnosis of follicular lymphoma grade IIIb affecting multiple lymph node sites. Understanding the clinical characteristics, diagnostic criteria, and treatment options is crucial for effective management of this lymphoma subtype. Continuous advancements in treatment strategies and research are essential for improving patient outcomes in this challenging disease landscape.

References
1. Non-Hodgkin Lymphoma Overview.
2. ICD-10-CM Code for Follicular Lymphoma Grade IIIb.
3. Follicular Lymphoma Classification and Treatment.
4. Diagnostic Criteria for Lymphoma.
5. Immunophenotyping in Lymphoma Diagnosis.
6. Treatment Options for Follicular Lymphoma.
7. Stem Cell Transplantation in Lymphoma.
8. Prognostic Factors in Follicular Lymphoma.

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The specific ICD-10 code C82.48 refers to follicular lymphoma grade IIIb, which indicates a more aggressive form of this disease. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Signs and Symptoms

Patients with follicular lymphoma grade IIIb may present with a variety of symptoms, which can vary significantly among individuals. Common signs and symptoms include:

• Lymphadenopathy: The most prominent feature is the enlargement of lymph nodes, which may be painless and can occur in multiple sites throughout the body, including the neck, armpits, and groin[12][13].
• 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[12][13].
• Fatigue: Patients often report a general sense of tiredness or lack of energy, which can be debilitating.
• Abdominal Symptoms: Involvement of abdominal lymph nodes may lead to symptoms such as abdominal pain, fullness, or discomfort, and in some cases, splenomegaly (enlargement of the spleen) or hepatomegaly (enlargement of the liver) may occur[12][13].

Patient Characteristics

Follicular lymphoma typically affects adults, with the following characteristics often observed in patients diagnosed with grade IIIb:

• Age: The median age at diagnosis is usually in the 60s, but it can occur in younger adults as well[12][13].
• Gender: There is a slight male predominance in the incidence of follicular lymphoma, although it can affect both genders[12][13].
• History of Autoimmune Disorders: Some patients may have a history of autoimmune diseases, which has been associated with an increased risk of developing lymphomas[12][13].
• Family History: A family history of lymphoma or other hematological malignancies may be present in some patients, suggesting a potential genetic predisposition[12][13].

Diagnosis and Staging

Diagnosis of follicular lymphoma grade IIIb typically involves a combination of clinical evaluation, imaging studies (such as CT scans), and histopathological examination of lymph node biopsies. The grading of follicular lymphoma is based on the number of large cells (centroblasts) present in the tissue sample, with grade IIIb indicating a higher proportion of these cells, which correlates with a more aggressive disease course[12][13].

Prognosis

The prognosis for patients with follicular lymphoma grade IIIb is generally poorer compared to lower-grade forms of the disease. The International Prognostic Index (IPI) is often used to assess prognosis based on factors such as age, stage, performance status, and serum lactate dehydrogenase (LDH) levels[12][13].

Conclusion

Follicular lymphoma grade IIIb, classified under ICD-10 code C82.48, presents with distinctive clinical features, including lymphadenopathy and systemic B symptoms. Understanding the signs, symptoms, and patient characteristics is essential for timely diagnosis and effective management. Given its aggressive nature, early intervention and appropriate treatment strategies are critical for improving patient outcomes. Regular follow-up and monitoring are also important to manage potential relapses or complications associated with this lymphoma subtype.

ICD-10 code C82.48 refers specifically to Follicular lymphoma grade IIIb, which is a subtype of non-Hodgkin lymphoma characterized by the proliferation of malignant B-cells in the lymph nodes. This particular grade indicates a more aggressive form of the disease. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Follicular Lymphoma, Grade IIIb: This is the most direct alternative name, emphasizing the specific 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, Diffuse: In some contexts, particularly when discussing histological features, it may be referred to as diffuse follicular lymphoma due to the spread of the malignant cells.

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. Lymphadenopathy: This term describes the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
4. Lymphoma Staging: Related to the classification of the disease's progression, which can impact treatment decisions.
5. Lymphoma Treatment Protocols: Refers to the various treatment regimens that may be employed for managing follicular lymphoma, including chemotherapy and immunotherapy.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.48 is crucial for healthcare professionals involved in diagnosis, treatment planning, and coding for insurance purposes. These terms help in accurately communicating the specifics of the condition and ensuring appropriate management strategies are employed. If you need further details on treatment options or prognosis related to this diagnosis, feel free to ask!

The diagnosis of Follicular Lymphoma Grade IIIb, classified under ICD-10 code C82.48, involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosis:

Clinical Presentation

• Symptoms: Patients may present with painless lymphadenopathy, which is the swelling of lymph nodes. Other symptoms can include fever, night sweats, and unexplained weight loss, often referred to as "B symptoms."
• Physical Examination: A thorough physical examination is conducted to assess the extent of lymphadenopathy and to check for splenomegaly (enlargement of the spleen) or hepatomegaly (enlargement of the liver).

Imaging Studies

• CT Scans: Computed Tomography (CT) scans of the chest, abdomen, and pelvis are commonly used to evaluate the extent of lymph node involvement and to identify any extranodal disease.
• PET Scans: Positron Emission Tomography (PET) scans may be utilized to assess metabolic activity in lymph nodes and to help differentiate between active disease and scar tissue.

Histopathological Examination

• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes. This can be an excisional biopsy, where an entire lymph node is removed, or a core needle biopsy.
• Microscopic Analysis: The biopsy specimen is examined microscopically to identify the characteristic follicular architecture and the presence of neoplastic (cancerous) cells. In Grade IIIb, there is a predominance of large cells, which distinguishes it from lower grades of follicular lymphoma.
• Immunophenotyping: Immunohistochemical staining is performed to identify specific markers on the lymphoma cells, such as CD10, CD19, CD20, and BCL2, which are indicative of follicular lymphoma.

Staging

• Ann Arbor Staging System: The disease is staged using the Ann Arbor classification, which considers the number of lymph node regions involved and whether the disease has spread to extranodal sites. This staging is crucial for determining the prognosis and treatment approach.

Molecular and Genetic Testing

• Genetic Markers: Testing for specific genetic abnormalities, such as the BCL2 gene rearrangement, can provide additional information about the lymphoma's behavior and prognosis.

Conclusion

The diagnosis of Follicular Lymphoma Grade IIIb (ICD-10 code C82.48) is a multifaceted process that requires careful clinical assessment, imaging studies, and histopathological confirmation. The integration of these diagnostic criteria helps ensure accurate diagnosis and appropriate treatment planning for patients.

Follicular lymphoma grade IIIb, classified under ICD-10 code C82.48, is a subtype of non-Hodgkin lymphoma characterized by a more aggressive behavior compared to lower-grade follicular lymphomas. The treatment approaches for this condition typically involve a combination of chemotherapy, immunotherapy, and sometimes stem cell transplantation, depending on the patient's specific circumstances, including age, overall health, and disease stage.

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains a cornerstone in the treatment of follicular lymphoma grade IIIb. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for aggressive lymphomas and can be combined with other therapies.
• 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[1].

2. Immunotherapy

Immunotherapy has become increasingly important in treating follicular lymphoma:

• Rituximab: As mentioned, Rituximab is frequently used in combination with chemotherapy. It can also be used as a single-agent therapy in relapsed cases.
• Obinutuzumab (Gazyva): This is another monoclonal antibody that may be used, particularly in combination with chemotherapy for newly diagnosed patients[2].

3. Targeted Therapy

Targeted therapies are designed to attack specific cancer cell characteristics:

• Idelalisib: This is an oral medication that inhibits the PI3K pathway, which is often activated in lymphoma cells. It is typically used in relapsed or refractory cases.
• Venetoclax: This drug targets the BCL-2 protein, which helps cancer cells survive. It is used in combination with other agents for patients with specific genetic markers[3].

4. Stem Cell Transplantation

For eligible patients, particularly those with high-risk features or relapsed disease, stem cell transplantation may be considered:

• Autologous Stem Cell Transplant (ASCT): This involves harvesting the patient’s own stem cells, followed by high-dose chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function.
• Allogeneic Stem Cell Transplant: This may be an option for some patients, particularly younger individuals with aggressive disease, but it carries higher risks and is less commonly used[4].

5. Radiation Therapy

While not a primary treatment for advanced follicular lymphoma, radiation therapy may be used in specific situations, such as localized disease or to alleviate symptoms from bulky lymphadenopathy.

Conclusion

The treatment of follicular lymphoma grade IIIb (ICD-10 code C82.48) is multifaceted and tailored to the individual patient. The combination of chemotherapy, immunotherapy, and potential stem cell transplantation offers a comprehensive approach to managing this aggressive form of lymphoma. Ongoing clinical trials continue to explore new therapies and combinations, aiming to improve outcomes for patients diagnosed with this challenging disease. Regular follow-up and monitoring are essential to assess treatment response and manage any potential side effects effectively[5].

For patients and healthcare providers, staying informed about the latest treatment options and clinical guidelines is crucial in navigating the complexities of follicular lymphoma management.