ICD-10: C82.83

ICD-10 code C82.83 refers to "Other types of follicular lymphoma, intra-abdominal lymph nodes." This classification falls under the broader category of non-Hodgkin lymphoma (NHL), specifically focusing on follicular lymphoma, which is a type of cancer that originates in the lymphatic system.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is a slow-growing (indolent) form of non-Hodgkin lymphoma that arises from B-lymphocytes, a type of white blood cell. It is characterized by the proliferation of follicle center (germinal center) B-cells, which can lead to the formation of lymph node masses. The disease is often diagnosed in its advanced stages, as it may not present with significant symptoms initially.

Intra-Abdominal Involvement

The designation of C82.83 specifically indicates that the lymphoma is located in the intra-abdominal lymph nodes. This can include lymph nodes in various abdominal regions, such as the mesentery, retroperitoneum, and other abdominal structures. The involvement of intra-abdominal lymph nodes can lead to various clinical manifestations, including:

• Abdominal Pain: Patients may experience discomfort or pain due to the enlargement of lymph nodes.
• Bloating and Distension: Enlarged lymph nodes can cause a sensation of fullness or bloating in the abdomen.
• Weight Loss: Unintentional weight loss may occur as a result of the disease.
• Night Sweats and Fever: These systemic symptoms can be indicative of lymphoma and may accompany the disease.

Diagnosis

Diagnosis of follicular lymphoma, including intra-abdominal types, typically involves a combination of:

• Imaging Studies: CT scans or PET scans are often used to visualize lymph node involvement and assess the extent of the disease.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, which allows for histological examination and confirmation of follicular lymphoma.
• Immunophenotyping: This laboratory technique helps to identify specific markers on the lymphoma cells, aiding in the classification and treatment planning.

Treatment Options

The treatment for follicular lymphoma, particularly when it involves intra-abdominal lymph nodes, may vary based on the stage of the disease and the patient's overall health. Common treatment modalities include:

• Watchful Waiting: In cases where the lymphoma is asymptomatic and indolent, a strategy of active surveillance may be employed.
• Chemotherapy: Regimens such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) are commonly used.
• Immunotherapy: Rituximab, a monoclonal antibody, is frequently used either alone or in combination with chemotherapy.
• Radiation Therapy: This may be considered for localized disease or to alleviate symptoms.

Prognosis

The prognosis for patients with follicular lymphoma can vary widely. Factors influencing outcomes include the stage at diagnosis, the presence of symptoms, and the patient's overall health. Follicular lymphoma is generally considered a chronic condition, with many patients living for years with the disease, although it can transform into a more aggressive form of lymphoma.

Conclusion

ICD-10 code C82.83 captures a specific subset of follicular lymphoma characterized by involvement of intra-abdominal lymph nodes. Understanding the clinical presentation, diagnostic approaches, and treatment options is crucial for effective management of this condition. As with all cancers, early detection and tailored treatment strategies are key to improving patient outcomes.

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10 code C82.83 specifically refers to "Other types of follicular lymphoma, intra-abdominal lymph nodes." Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma typically presents as a slow-growing (indolent) lymphoma, often diagnosed in later stages. It is characterized by the presence of neoplastic follicle-like structures in lymphoid tissue. The intra-abdominal variant, as indicated by the ICD-10 code C82.83, suggests that the lymphoma is primarily affecting lymph nodes located in the abdominal cavity.

Signs and Symptoms

Patients with follicular lymphoma, particularly those with intra-abdominal lymph node involvement, may exhibit a range of signs and symptoms, including:

• Lymphadenopathy: Swelling of lymph nodes, which may be palpable in the abdomen or groin. Patients may notice enlarged lymph nodes in the neck, axilla, or abdomen.
• Abdominal Pain or Discomfort: Due to the enlargement of lymph nodes or other abdominal structures, patients may experience pain or a feeling of fullness in the abdomen.
• B Symptoms: These include fever, night sweats, and unexplained weight loss, which can indicate more aggressive disease or transformation to a higher-grade lymphoma.
• Fatigue: Generalized fatigue is common and may be related to the disease itself or anemia.
• Splenomegaly: Enlargement of the spleen may occur, leading to discomfort or a sense of fullness.
• Hepatomegaly: In some cases, liver involvement may also be present, contributing to abdominal symptoms.

Patient Characteristics

Certain demographic and clinical characteristics are often associated with patients diagnosed with follicular lymphoma:

• Age: Follicular lymphoma is more common in adults, typically diagnosed in individuals aged 50 and older. The median age at diagnosis is around 60 years.
• Gender: There is a slight male predominance in the incidence of follicular lymphoma.
• History of Autoimmune Disorders: Some patients may have a history of autoimmune diseases, which have been associated with an increased risk of developing lymphomas.
• Family History: A family history of lymphoma or other hematologic malignancies may be present in some patients.
• Ethnicity: Incidence rates can vary by ethnicity, with higher rates observed in Caucasian populations compared to African American populations.

Diagnosis and Evaluation

Diagnosis of follicular lymphoma, including the intra-abdominal variant, typically involves:

• Imaging Studies: CT scans or PET scans are often used to assess the extent of lymphadenopathy and any organ involvement.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, which reveals the characteristic follicular architecture and B-cell markers.
• Laboratory Tests: Blood tests may show anemia or other abnormalities, and specific markers (e.g., CD10, BCL2) are evaluated to confirm the diagnosis.

Conclusion

Follicular lymphoma, particularly the intra-abdominal variant coded as C82.83, presents with a range of symptoms primarily related to lymphadenopathy and abdominal discomfort. Understanding the clinical presentation, signs, symptoms, and patient characteristics is essential for timely diagnosis and effective management. Regular follow-up and monitoring are crucial, as the disease can transform into a more aggressive form, necessitating different therapeutic approaches.

ICD-10 code C82.83 refers specifically to "Other types of follicular lymphoma, intra-abdominal lymph nodes." This classification falls under the broader category of non-Hodgkin lymphoma (NHL), which encompasses various types of lymphatic cancers. Below are alternative names and related terms associated with this specific code:

Alternative Names for C82.83

1. Follicular Lymphoma, Unspecified: This term may be used when the specific subtype of follicular lymphoma is not clearly defined.
2. Intra-abdominal Follicular Lymphoma: This emphasizes the location of the lymphoma within the abdominal lymph nodes.
3. Follicular Lymphoma, Other Specified: This can refer to cases that do not fit neatly into the more common subtypes of follicular lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes various types of lymphomas, including follicular lymphoma.
2. Lymphadenopathy: This term describes the enlargement of lymph nodes, which can occur in cases of follicular lymphoma.
3. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
4. B-cell Lymphoma: Follicular lymphoma is a type of B-cell lymphoma, which is characterized by the proliferation of B lymphocytes.
5. Stage IV Lymphoma: If the lymphoma has spread to the abdominal lymph nodes, it may be classified as stage IV, indicating advanced disease.

Clinical Context

Follicular lymphoma is a type of indolent (slow-growing) non-Hodgkin lymphoma that often presents with painless lymphadenopathy. The intra-abdominal involvement can complicate diagnosis and treatment, making it essential for healthcare providers to accurately code and classify the condition for effective management and billing purposes.

Understanding these alternative names and related terms can aid in better communication among healthcare professionals and improve the accuracy of medical records and billing processes. If you need further details or specific information regarding treatment or management of this condition, feel free to ask!

Diagnosing follicular lymphoma, particularly the subtype classified under ICD-10 code C82.83 (Other types of follicular lymphoma, intra-abdominal lymph nodes), involves a comprehensive evaluation that includes clinical assessment, imaging studies, and histopathological examination. Below is a detailed overview of the criteria and processes typically used in the diagnosis of this condition.

Clinical Presentation

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, which can include:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the abdomen, neck, or groin.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which may indicate more aggressive disease.
- Abdominal Symptoms: Due to intra-abdominal lymph node involvement, patients may experience abdominal pain, fullness, or discomfort.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoproliferative disorders.
- Family history of lymphoma or other cancers.
- Exposure to risk factors such as certain infections (e.g., HIV, hepatitis C) or environmental toxins.

Diagnostic Imaging

Imaging Studies

Imaging plays a crucial role in identifying lymph node involvement and assessing the extent of the disease:
- CT Scans: Computed tomography scans of the abdomen and pelvis are commonly used to visualize enlarged lymph nodes and assess the extent of disease.
- PET Scans: Positron emission tomography scans can help determine metabolic activity in lymph nodes, aiding in the differentiation between benign and malignant processes.

Histopathological Examination

Biopsy

A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes. The following steps are typically involved:
- Excisional Biopsy: Removal of an entire lymph node or a significant portion for examination.
- Core Needle Biopsy: A less invasive option that can also provide sufficient tissue for diagnosis.

Pathological Analysis

The biopsy specimen is analyzed for:
- Histological Features: Follicular lymphoma is characterized by the presence of neoplastic follicle-like structures composed of small to medium-sized lymphoid cells.
- Immunophenotyping: Flow cytometry or immunohistochemistry is used to identify specific markers (e.g., CD10, CD19, CD20, and BCL2) that confirm the diagnosis of follicular lymphoma.
- Cytogenetic Studies: Detection of the t(14;18) chromosomal translocation, which is commonly associated with follicular lymphoma, can further support the diagnosis.

Staging and Classification

Ann Arbor Staging System

Once diagnosed, the disease is staged using the Ann Arbor classification, which considers:
- The number of lymph node regions involved.
- Whether the disease is localized (stage I or II) or disseminated (stage III or IV).
- Presence of B symptoms.

WHO Classification

The World Health Organization (WHO) classification of lymphoid neoplasms provides a framework for categorizing follicular lymphoma based on histological features and genetic markers, which is essential for determining prognosis and treatment options.

Conclusion

The diagnosis of follicular lymphoma, particularly the subtype classified under ICD-10 code C82.83, involves a multifaceted approach that includes clinical evaluation, imaging studies, and histopathological confirmation. Accurate diagnosis is crucial for effective management and treatment planning, as it influences the therapeutic strategies employed and the overall prognosis for the patient. If you have further questions or need more specific information, feel free to ask!

Follicular lymphoma, particularly the subtype classified under ICD-10 code C82.83, refers to a type of non-Hodgkin lymphoma that primarily affects the intra-abdominal lymph nodes. This condition is characterized by the proliferation of follicle center (germinal center) B-cells and is known for its indolent nature, although it can transform into a more aggressive form. The treatment approaches for this specific type of lymphoma are multifaceted and depend 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)

For patients with asymptomatic follicular lymphoma, especially those with early-stage disease, a common approach is "watchful waiting." This strategy involves regular monitoring without immediate treatment, as many patients may not require intervention for extended periods. This approach is particularly suitable for indolent forms of the disease, allowing patients to avoid the side effects of treatment until the disease progresses or symptoms develop[1].

2. Chemotherapy

When treatment is necessary, chemotherapy is often the first-line option. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is frequently used for more aggressive cases or when the lymphoma has transformed.
• R-CHOP: The addition of Rituximab (a monoclonal antibody) to the CHOP regimen has become standard practice, significantly improving outcomes for many patients[2].

3. Immunotherapy

Rituximab, a CD20-targeting monoclonal antibody, is a cornerstone of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. In cases of relapsed or refractory disease, other monoclonal antibodies, such as Obinutuzumab, may also be considered[3].

4. Radiation Therapy

Radiation therapy can be effective, particularly for localized disease or as a palliative measure to relieve symptoms. It is often used in conjunction with other treatments, especially in cases where the lymphoma is confined to a specific area, such as intra-abdominal lymph nodes[4].

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be an option. This approach is typically reserved for younger patients or those with a good performance status, as it carries significant risks and requires careful patient selection[5].

6. Targeted Therapies

Recent advancements have introduced targeted therapies that focus on specific pathways involved in lymphoma cell survival and proliferation. Examples include:

• PI3K Inhibitors: Such as Copanlisib (Aliqopa), which has shown efficacy in treating relapsed follicular lymphoma.
• BTK Inhibitors: Like Ibrutinib, which may be used in certain cases, particularly for patients who are not candidates for chemotherapy[6].

7. Clinical Trials

Participation in clinical trials may also be an option for patients, providing access to new therapies and treatment strategies that are not yet widely available. These trials often explore novel agents or combinations that could improve outcomes for patients with follicular lymphoma[7].

Conclusion

The management of follicular lymphoma, particularly the subtype affecting intra-abdominal lymph nodes, involves a comprehensive approach tailored to the individual patient. Treatment options range from observation to aggressive chemotherapy, immunotherapy, and targeted therapies, depending on the disease's characteristics and the patient's overall health. As research continues to evolve, new therapies and combinations are likely to enhance the treatment landscape for this indolent yet complex disease. Patients are encouraged to discuss their treatment options thoroughly with their healthcare providers to determine the best course of action for their specific situation.

References

1. Billing and Coding: Intensity Modulated Radiation Therapy.
2. NON-HODGKIN LYMPHOMA Includes Follicular.
3. Aliqopa® (copanlisib).
4. Radioimmunotherapy in the Treatment of Non-Hodgkin.
5. HCT for Non-Hodgkin Lymphoma.
6. Medical Drug Clinical Criteria.
7. Clinical Medication Policy.