ICD-10: C82.54

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.54, is a subtype of non-Hodgkin lymphoma (NHL) that primarily affects the lymph nodes, particularly in the axilla (armpit) and upper limb regions. This lymphoma is characterized by the proliferation of B-lymphocytes, which are a type of white blood cell involved in the immune response.

Clinical Description

Definition and Characteristics

Diffuse follicle center lymphoma is a type of follicular lymphoma that presents with a diffuse pattern of growth. Unlike other forms of follicular lymphoma that may exhibit a more nodular or localized growth pattern, DFCL tends to infiltrate lymphoid tissues more extensively. This can lead to a more aggressive clinical course and may require different treatment approaches compared to other indolent lymphomas.

Epidemiology

DFCL is relatively rare compared to other types of non-Hodgkin lymphoma. It typically occurs in adults, with a higher incidence in individuals over the age of 60. The exact etiology remains unclear, but factors such as genetic predisposition, environmental exposures, and immune system status may play a role in its development.

Symptoms

Patients with DFCL may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the axillary region.
- B symptoms: These may include fever, night sweats, and unexplained weight loss.
- Fatigue: Generalized tiredness and lack of energy.
- Pain or discomfort: This may occur in the affected lymph nodes or surrounding areas.

Diagnosis

Diagnosis of DFCL typically involves:
- Physical examination: Assessment of lymph node enlargement.
- Imaging studies: CT scans or PET scans to evaluate the extent of disease.
- Biopsy: A definitive diagnosis is made through histological examination of lymph node tissue, which reveals the characteristic diffuse infiltration of follicle center cells.

Staging

Staging of diffuse follicle center lymphoma follows the Ann Arbor classification system, which considers the number of lymph node regions involved and the presence of systemic symptoms. This staging is crucial for determining the appropriate treatment strategy.

Treatment Options

Chemotherapy

The primary treatment for DFCL often involves chemotherapy regimens, which may include:
- R-CHOP: A combination of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.
- Other regimens: Depending on the patient's specific condition and response to initial treatment.

Targeted Therapy

Recent advancements have introduced targeted therapies, such as:
- Monoclonal antibodies: Rituximab is commonly used to target CD20-positive B-cells.
- Novel agents: Newer drugs like epcoritamab and mosunetuzumab are being explored for their efficacy in treating various forms of B-cell lymphomas, including DFCL.

Radiation Therapy

In some cases, localized radiation therapy may be employed, particularly if the disease is confined to a limited area or if there is a need to alleviate symptoms from bulky disease.

Prognosis

The prognosis for patients with diffuse follicle center lymphoma can vary significantly based on several factors, including the stage at diagnosis, the patient's overall health, and response to treatment. Generally, the prognosis is more favorable for patients diagnosed at an early stage, while advanced disease may require more aggressive treatment and may have a poorer outcome.

Conclusion

ICD-10 code C82.54 encapsulates the clinical complexities of diffuse follicle center lymphoma affecting the lymph nodes of the axilla and upper limb. Understanding the characteristics, symptoms, and treatment options for this lymphoma subtype is essential for effective management and improved patient outcomes. As research continues, new therapies and treatment strategies are likely to emerge, offering hope for better management of this challenging condition.

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.54, is a subtype of non-Hodgkin lymphoma characterized by the proliferation of B-lymphocytes in the follicle center of lymph nodes. This condition primarily affects the lymph nodes in the axilla (armpit) and upper limb, leading to a range of clinical presentations, signs, symptoms, and patient characteristics.

Clinical Presentation

General Overview

DFCL typically presents as a painless swelling of lymph nodes, which may be detected during a physical examination or imaging studies. The disease can manifest in various stages, influencing the extent of symptoms and overall patient health.

Signs and Symptoms

1. Lymphadenopathy: The most common sign is the enlargement of lymph nodes, particularly in the axillary region and upper limbs. Patients may notice lumps or swelling in these areas.
2. Systemic Symptoms: Patients may experience systemic symptoms such as:
   - Fever: Often low-grade, but can be persistent.
   - Night Sweats: Profuse sweating during the night, which can disrupt sleep.
   - Weight Loss: Unintentional weight loss over a short period, often exceeding 10% of body weight.
3. Fatigue: A common complaint among patients, often due to the body's response to the lymphoma.
4. Pruritus: Some patients report itching, which may not be associated with any rash.
5. Abdominal Symptoms: In cases where lymph nodes in the abdomen are involved, patients may experience abdominal pain or discomfort.

Patient Characteristics

1. Age: DFCL can occur in adults of any age but is more commonly diagnosed in middle-aged individuals, typically between 40 and 70 years old.
2. Gender: There is a slight male predominance in the incidence of non-Hodgkin lymphomas, including DFCL.
3. Comorbidities: Patients may have underlying health conditions, such as autoimmune diseases or previous infections, which can influence the presentation and management of the lymphoma.
4. Immunocompromised Status: Individuals with compromised immune systems, such as those with HIV/AIDS or those undergoing immunosuppressive therapy, may be at higher risk for developing lymphomas, including DFCL.

Diagnosis and Evaluation

Diagnosis of DFCL typically involves a combination of clinical evaluation, imaging studies (such as CT scans), and histopathological examination of lymph node biopsies. Immunophenotyping and genetic studies may also be performed to confirm the diagnosis and assess the specific characteristics of the lymphoma.

Imaging Studies

• CT Scans: Useful for assessing the extent of lymphadenopathy and any involvement of surrounding tissues.
• PET Scans: May be employed to evaluate metabolic activity of the lymphoma and detect any additional sites of disease.

Biopsy

A lymph node biopsy is essential for definitive diagnosis, allowing for histological examination and immunophenotyping to confirm the presence of follicle center lymphoma.

Conclusion

Diffuse follicle center lymphoma, particularly affecting the lymph nodes of the axilla and upper limb, presents with characteristic signs and symptoms, including lymphadenopathy, systemic symptoms, and fatigue. Understanding the clinical presentation and patient characteristics is crucial for timely diagnosis and effective management. Early recognition and intervention can significantly impact patient outcomes, emphasizing the importance of awareness among healthcare providers regarding this lymphoma subtype.

ICD-10 code C82.54 refers specifically to "Diffuse follicle center lymphoma, lymph nodes of axilla and upper limb." This classification falls under 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: This term is often used interchangeably with diffuse follicle center lymphoma, although it can refer to a broader category of follicular lymphomas.
2. Diffuse Large B-Cell Lymphoma (DLBCL): While not identical, DLBCL can sometimes be confused with follicle center lymphomas due to overlapping characteristics in histology and clinical presentation.
3. B-Cell Lymphoma: This is a general term that includes various types of lymphomas originating from B lymphocytes, including diffuse follicle center lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): C82.54 is a subtype of non-Hodgkin lymphoma, which is a diverse group of blood cancers that includes all lymphomas except Hodgkin's lymphoma.
2. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with diffuse follicle center lymphoma.
3. Lymphoma: A general term for cancers that affect the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
4. Stage II Lymphoma: If the lymphoma is localized to the lymph nodes of the axilla and upper limb, it may be classified as stage II, which is relevant for treatment planning and prognosis.

Clinical Context

Diffuse follicle center lymphoma is characterized by the proliferation of B-cells in the lymph nodes, particularly affecting the axillary and upper limb regions. Understanding the alternative names and related terms is crucial for healthcare professionals when diagnosing and coding for treatment, as well as for research and clinical trials.

In summary, while C82.54 specifically denotes diffuse follicle center lymphoma in the lymph nodes of the axilla and upper limb, it is important to recognize its relationship to broader categories of lymphoma and related clinical terms. This understanding aids in accurate diagnosis, treatment planning, and communication among healthcare providers.

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.54, is a subtype of non-Hodgkin lymphoma that primarily affects the lymph nodes, particularly in the axilla and upper limb regions. The diagnosis of DFCL involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosis:

Clinical Presentation

1. Symptoms: Patients may present with painless lymphadenopathy, which is the enlargement of lymph nodes. Symptoms can also include fatigue, weight loss, fever, and night sweats, although these are more common in aggressive forms of lymphoma.

2. Physical Examination: A thorough physical examination is essential to identify swollen lymph nodes, particularly in the axillary and upper limb areas, as well as any other lymphatic regions.

Imaging Studies

1. Ultrasound: This imaging technique can help assess the size and characteristics of lymph nodes. It is often used as an initial evaluation tool.

2. CT Scans: A computed tomography (CT) scan of the chest, abdomen, and pelvis is typically performed to evaluate the extent of lymphadenopathy and to check for any involvement of other organs.

3. PET Scans: Positron emission tomography (PET) scans may be utilized to assess metabolic activity in lymph nodes and to help differentiate between benign and malignant processes.

Histopathological Examination

1. Biopsy: A definitive diagnosis of DFCL requires a biopsy of the affected lymph node. This can be done through excisional biopsy, core needle biopsy, or fine-needle aspiration.

2. Immunohistochemistry: The biopsy specimen is analyzed using immunohistochemical staining to identify specific markers. DFCL typically expresses B-cell markers such as CD19, CD20, and CD10, while showing a lack of markers associated with more aggressive lymphomas.

3. Genetic Studies: Cytogenetic analysis may be performed to identify chromosomal abnormalities, such as the presence of the BCL2 gene rearrangement, which is often associated with follicular lymphomas.

Diagnostic Criteria Summary

• Lymphadenopathy: Presence of enlarged lymph nodes in the axilla and upper limb.
• Histological Features: Confirmation of diffuse follicle center lymphoma through biopsy and immunohistochemical profiling.
• Imaging Findings: Evidence of lymph node involvement through ultrasound, CT, or PET scans.
• Exclusion of Other Conditions: Rule out other types of lymphomas or benign conditions that may mimic DFCL.

Conclusion

The diagnosis of diffuse follicle center lymphoma (ICD-10 code C82.54) is a multifaceted process that relies on clinical evaluation, imaging studies, and histopathological confirmation. Accurate diagnosis is crucial for determining the appropriate treatment plan and prognosis for the patient. If you have further questions or need more specific information, feel free to ask!

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.54, is a subtype of non-Hodgkin lymphoma (NHL) that primarily affects the lymph nodes, particularly in the axilla and upper limb regions. Understanding the standard treatment approaches for this condition is crucial for effective management and patient outcomes.

Overview of Diffuse Follicle Center Lymphoma

DFCL is characterized by the proliferation of B-cells in the follicle centers of lymph nodes. It is typically indolent but can transform into a more aggressive form. The treatment strategy often depends on various factors, including the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma.

Standard Treatment Approaches

1. Observation (Watchful Waiting)

In cases where the lymphoma is asymptomatic and not causing significant health issues, a strategy of observation may be employed. This approach involves regular monitoring without immediate treatment, allowing for intervention only if the disease progresses or symptoms develop.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for DFCL, especially in symptomatic cases or advanced stages. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for aggressive forms of lymphoma but can also be effective in treating indolent lymphomas like DFCL.
• R-CHOP: The addition of Rituximab (a monoclonal antibody targeting CD20 on B-cells) to the CHOP regimen has significantly improved outcomes for patients with NHL, including DFCL. Rituximab enhances the effectiveness of chemotherapy and is commonly used in treatment protocols.

3. Radiation Therapy

Radiation therapy may be utilized in localized cases, particularly when the lymphoma is confined to a specific area, such as the axilla or upper limb. It can be effective in reducing tumor burden and alleviating symptoms.

4. Targeted Therapy

Recent advancements in targeted therapies have provided new options for patients with DFCL. These include:

• Bruton’s Tyrosine Kinase Inhibitors (BTK Inhibitors): Such as Ibrutinib, which has shown efficacy in various B-cell malignancies.
• PI3K Inhibitors: Like Copanlisib (Aliqopa®), which is specifically indicated for relapsed follicular lymphoma and may be applicable in certain cases of DFCL.

5. Stem Cell Transplantation

For patients with relapsed or refractory DFCL, autologous stem cell transplantation may be considered. This approach involves harvesting the patient's stem cells, administering high-dose chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function.

6. Clinical Trials

Participation in clinical trials may be an option for patients seeking access to novel therapies and treatment strategies that are not yet widely available. These trials often explore new combinations of existing treatments or entirely new agents.

Conclusion

The treatment of diffuse follicle center lymphoma, particularly in the lymph nodes of the axilla and upper limb, is multifaceted and tailored to the individual patient. Standard approaches include observation, chemotherapy (with or without targeted therapies), radiation, and potentially stem cell transplantation for more advanced cases. As research continues to evolve, new therapies and combinations are likely to enhance the management of this lymphoma subtype, improving patient outcomes and quality of life. For patients diagnosed with DFCL, discussing treatment options with a healthcare provider specializing in hematology or oncology is essential for developing an effective treatment plan.