ICD-10: C82.56

Clinical Description of ICD-10 Code C82.56

ICD-10 Code C82.56 refers specifically to Diffuse Follicle Center Lymphoma (DFCL) that is localized in the intrapelvic lymph nodes. This classification falls under the broader category of follicular lymphomas, which are a type of non-Hodgkin lymphoma (NHL) characterized by the proliferation of B-lymphocytes in the follicle centers of lymphoid tissue.

Characteristics of Diffuse Follicle Center Lymphoma

1. Pathophysiology:
   - DFCL is a subtype of follicular lymphoma, which is typically indolent but can transform into a more aggressive form. It arises from the germinal center B-cells and is marked by the presence of specific genetic alterations, such as the t(14;18) translocation, which leads to the overexpression of the BCL2 protein, inhibiting apoptosis and allowing for the survival of malignant cells[1].

2. Clinical Presentation:
   - Patients with DFCL may present with painless lymphadenopathy, which can occur in various regions, including the intrapelvic area. Symptoms may also include systemic manifestations such as fever, night sweats, and weight loss, particularly if the disease progresses or transforms into a more aggressive form[2].

3. Diagnosis:
   - Diagnosis typically involves a combination of imaging studies (such as CT scans or PET scans) and histopathological examination of lymph node biopsies. Flow cytometry and immunohistochemistry are crucial for identifying the characteristic markers of B-cell lymphomas, including CD10, BCL6, and BCL2[3].

4. Staging:
   - The staging of lymphoma is essential for determining the appropriate treatment approach. The Ann Arbor staging system is commonly used, which considers the number of lymph node regions involved and the presence of systemic symptoms[4].

5. Treatment Options:
   - Treatment for DFCL may include watchful waiting for asymptomatic patients, chemotherapy, immunotherapy (such as monoclonal antibodies like rituximab), and, in some cases, stem cell transplantation. The choice of treatment often depends on the stage of the disease, the patient's overall health, and the presence of symptoms[5].

Conclusion

ICD-10 code C82.56 is a critical classification for healthcare providers dealing with patients diagnosed with Diffuse Follicle Center Lymphoma affecting the intrapelvic lymph nodes. Understanding the clinical characteristics, diagnostic criteria, and treatment options is essential for effective management and improved patient outcomes. As with all lymphomas, early detection and appropriate intervention are key to enhancing prognosis and quality of life for affected individuals.

[1] Article - Billing and Coding: Allogeneic Hematopoietic Cell ...
[2] NON-HODGKIN LYMPHOMA Includes Follicular, ...
[3] 88182 Cell marker study 88184 Flowcytometry 88182 Cell marker study 88184 Flowcytometry
[4] CMS Manual System
[5] Medical Policy: - Breyanzi® (lisocabtagene maraleucel)

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.56, is a subtype of follicular lymphoma characterized by the proliferation of neoplastic B-cells in the lymphatic system. This condition primarily affects the intrapelvic lymph nodes, which can lead to a variety of clinical presentations, signs, and symptoms. Understanding these aspects is crucial for diagnosis and management.

Clinical Presentation

Patient Characteristics

Patients with diffuse follicle center lymphoma often present with the following characteristics:

• Age: DFCL typically occurs in adults, with a higher incidence in individuals aged 50 and older.
• Gender: There is a slight male predominance in cases of follicular lymphoma, including DFCL.
• Comorbidities: Patients may have a history of autoimmune diseases or other malignancies, which can influence the clinical course and treatment options.

Signs and Symptoms

The clinical manifestations of DFCL can vary widely, but common signs and symptoms include:

• Lymphadenopathy: Patients often present with painless swelling of lymph nodes, particularly in the pelvic region. This can lead to abdominal or pelvic discomfort due to the enlargement of intrapelvic lymph nodes.
• B Symptoms: These include systemic symptoms such as:
• Fever: Unexplained fevers may occur.
• Night Sweats: Patients may experience drenching night sweats.
• Weight Loss: Unintentional weight loss is common and can be significant.
• Abdominal Symptoms: Due to the involvement of intrapelvic lymph nodes, patients may report:
• Abdominal Pain: Discomfort or pain in the lower abdomen.
• Bloating: A sensation of fullness or bloating may be present.
• Changes in Bowel Habits: This can include constipation or diarrhea, depending on the extent of lymph node involvement.
• Fatigue: A general sense of tiredness or lack of energy is frequently reported.

Diagnostic Considerations

Diagnosis of DFCL typically involves a combination of clinical evaluation, imaging studies, and histopathological examination. Key diagnostic tools include:

• Imaging Studies: CT scans or PET scans are often utilized to assess lymph node involvement and the extent of disease.
• Biopsy: A lymph node biopsy is essential for confirming the diagnosis, allowing for histological examination to identify the characteristic follicular architecture and B-cell markers.

Conclusion

Diffuse follicle center lymphoma, particularly when involving intrapelvic lymph nodes, presents with a range of clinical features that can significantly impact patient quality of life. Early recognition of symptoms such as lymphadenopathy, systemic B symptoms, and abdominal discomfort is crucial for timely diagnosis and management. Given the complexity of this lymphoma subtype, a multidisciplinary approach involving oncologists, radiologists, and pathologists is often necessary to ensure optimal patient care and treatment outcomes.

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.56, is a subtype of non-Hodgkin lymphoma that primarily affects the follicle center of lymphoid tissue. This specific code refers to cases where the lymphoma is localized in the intrapelvic lymph nodes. Below are alternative names and related terms associated with this condition.

Alternative Names

1. Follicular Lymphoma: This is a broader term that encompasses various subtypes of lymphomas originating from follicle center cells, including diffuse follicle center lymphoma.
2. Diffuse Large B-Cell Lymphoma (DLBCL): While not identical, DLBCL can sometimes be confused with follicular lymphomas due to overlapping characteristics, particularly in aggressive forms.
3. B-Cell Lymphoma: A general term for lymphomas that originate from B lymphocytes, which includes follicular lymphomas.
4. Non-Hodgkin Lymphoma (NHL): This is a broader category that includes all types of lymphomas except Hodgkin lymphoma, under which diffuse follicle center lymphoma falls.

Related Terms

1. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with diffuse follicle center lymphoma.
2. Lymphoma Staging: The process of determining the extent of lymphoma spread, which is crucial for treatment planning.
3. Bone Marrow Involvement: In some cases, diffuse follicle center lymphoma may involve the bone marrow, which can affect prognosis and treatment.
4. Immunophenotyping: A laboratory process used to identify the specific types of cells in a lymphoma, which can help in diagnosing and classifying the lymphoma subtype.
5. Chemotherapy and Targeted Therapy: Common treatment modalities for diffuse follicle center lymphoma, often involving agents that target B-cell markers.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.56 is essential for healthcare professionals involved in the diagnosis and treatment of diffuse follicle center lymphoma. This knowledge aids in effective communication and enhances the accuracy of medical records and treatment plans. If you need further information on treatment options or prognosis related to this condition, feel free to ask!

Diffuse follicle center lymphoma (DFCL), classified under ICD-10 code C82.56, is a subtype of non-Hodgkin lymphoma characterized by the proliferation of B-lymphocytes in the follicle center of lymph nodes. The diagnosis of DFCL, particularly when it involves intrapelvic lymph nodes, relies on 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 nonspecific symptoms such as:
   - Lymphadenopathy (swelling of lymph nodes)
   - Fever
   - Night sweats
   - Unexplained weight loss
   - Fatigue

2. Physical Examination: A thorough physical examination may reveal enlarged lymph nodes, particularly in the cervical, axillary, or inguinal regions, and potentially in the pelvic area.

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 benign and malignant processes.

Histopathological Criteria

1. Biopsy: A definitive diagnosis of DFCL requires a biopsy of the affected lymph node. The biopsy can be performed via:
   - Excisional biopsy (removal of an entire lymph node)
   - Core needle biopsy (removal of a small cylinder of tissue)

2. Microscopic Examination: Pathological examination of the biopsy specimen typically reveals:
   - A diffuse pattern of growth with a predominance of follicle center (germinal center) B-cells.
   - The presence of characteristic cellular features, such as large atypical lymphoid cells.

3. Immunophenotyping: Flow cytometry or immunohistochemistry is used to analyze the surface markers on the lymphocytes. DFCL typically expresses:
   - CD19, CD20, and CD10 (B-cell markers)
   - BCL-2 protein, which is often overexpressed in follicular lymphomas.

4. Genetic Studies: Cytogenetic analysis may reveal chromosomal translocations, such as t(14;18), which is commonly associated with follicular lymphomas.

Staging

The Ann Arbor staging system is often used to determine the extent of the disease, which is crucial for treatment planning. Staging involves assessing whether the lymphoma is localized (stage I or II) or disseminated (stage III or IV).

Conclusion

The diagnosis of diffuse follicle center lymphoma, particularly in the context of intrapelvic lymph nodes, is a multifaceted process that integrates clinical findings, imaging studies, and histopathological evaluation. 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!

Diffuse follicle center lymphoma, classified under ICD-10 code C82.56, is a subtype of non-Hodgkin lymphoma (NHL) that primarily affects the follicle center of lymphoid tissue. This condition can manifest in various lymph node regions, including the intrapelvic lymph nodes. The treatment approaches for this type of lymphoma typically involve a combination of therapies tailored to the individual patient's condition, stage of the disease, and overall health.

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains a cornerstone of treatment for diffuse follicle center lymphoma. Common 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 many patients with aggressive forms of NHL, including diffuse follicle center lymphoma[1].
• Other Regimens: Depending on the patient's specific circumstances, alternative chemotherapy regimens may be considered, especially if the lymphoma is resistant to initial treatments or if the patient has specific health considerations.

2. Targeted Therapy

Targeted therapies have become increasingly important in the management of lymphomas. For diffuse follicle center lymphoma, options may include:

• Rituximab: This monoclonal antibody targets CD20, a protein found on the surface of B-cells, including malignant cells in follicle center lymphoma. It can be used alone or in combination with chemotherapy[2].
• Newer Agents: Medications such as Lunsumio™ (mosunetuzumab-axgb) are being explored for their efficacy in treating follicle center lymphoma. This drug is a bispecific T-cell engager that targets both CD20 and CD3, potentially enhancing the immune response against the lymphoma cells[3].

3. Radiation Therapy

Radiation therapy may be employed in specific scenarios, particularly for localized disease or as a consolidation treatment after chemotherapy. It can help reduce the size of lymph nodes and eliminate residual disease[4].

4. Stem Cell Transplantation

For patients with relapsed or refractory diffuse follicle center lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be considered. This approach allows for the administration of higher doses of chemotherapy than would be tolerable without the support of stem cell rescue[5].

5. Clinical Trials

Participation in clinical trials can provide access to cutting-edge therapies and novel treatment combinations. Patients are encouraged to discuss the possibility of enrolling in clinical trials with their healthcare providers, as these studies may offer additional options beyond standard treatments[6].

Conclusion

The treatment of diffuse follicle center lymphoma, particularly when involving intrapelvic lymph nodes, is multifaceted and should be personalized based on the patient's specific clinical scenario. A combination of chemotherapy, targeted therapies, radiation, and potentially stem cell transplantation forms the basis of management strategies. Ongoing research and clinical trials continue to evolve the landscape of treatment options, providing hope for improved outcomes in patients with this type of lymphoma. It is essential for patients to work closely with their oncology team to determine the most appropriate treatment plan tailored to their needs.