ICD-10: C82.84

ICD-10 code C82.84 refers specifically to "Other types of follicular lymphoma, lymph nodes of axilla and upper limb." Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, particularly from B-cells, which are a type of white blood cell. This classification is crucial for accurate diagnosis, treatment planning, and billing purposes.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is characterized by the proliferation of neoplastic follicle center (germinal center) B-cells. It is typically indolent, meaning it tends to grow slowly compared to other types of lymphoma. However, it can transform into a more aggressive form over time. The disease is often diagnosed in its advanced stages, as early symptoms may be subtle or absent.

Symptoms

Patients with follicular lymphoma may present with:
- Painless swelling of lymph nodes, particularly in the axillary (armpit) and upper limb regions.
- Systemic symptoms such as fever, night sweats, and unexplained weight loss.
- Fatigue and general malaise.

Diagnosis

Diagnosis is usually confirmed through:
- Biopsy: A sample of the affected lymph node is examined histologically to identify the characteristic follicular architecture and the presence of neoplastic cells.
- Imaging Studies: CT scans or PET scans may be utilized to assess the extent of the disease and to identify other involved lymph nodes or organs.

Staging

Follicular lymphoma is staged using the Ann Arbor system, which considers the number of lymph node regions involved and whether the disease has spread to other organs. The involvement of lymph nodes in the axilla and upper limb is significant for staging and treatment decisions.

Treatment Options

Treatment for follicular lymphoma can vary based on the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma. Common treatment modalities include:
- Watchful Waiting: In cases where the lymphoma is asymptomatic and indolent, a "watch and wait" approach may be adopted.
- Chemotherapy: Regimens often include agents such as bendamustine, cyclophosphamide, and rituximab.
- Radiation Therapy: This may be used for localized disease or as a palliative measure.
- Targeted Therapy: Newer treatments, including monoclonal antibodies and other targeted agents, are being explored in clinical trials.

Prognosis

The prognosis for patients with follicular lymphoma can vary widely. Factors influencing outcomes include the grade of the lymphoma, the presence of symptoms, and the patient's overall health. Generally, follicular lymphoma has a relatively favorable prognosis, especially in early stages, but it can be challenging to treat if it transforms into a more aggressive form.

Conclusion

ICD-10 code C82.84 is essential for identifying cases of follicular lymphoma affecting the lymph nodes of the axilla and upper limb. Understanding the clinical characteristics, diagnostic methods, treatment options, and prognosis associated with this condition is crucial for healthcare providers in managing patient care effectively. Accurate coding not only aids in treatment planning but also ensures appropriate reimbursement and resource allocation in healthcare settings.

ICD-10 code C82.84 refers to "Other types of follicular lymphoma, lymph nodes of axilla and upper limb." Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this specific diagnosis is crucial for effective management and treatment.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma typically presents as a slow-growing (indolent) lymphoma that can be asymptomatic in its early stages. It often arises in lymph nodes but can also involve extranodal sites. The specific designation of C82.84 indicates that the lymphoma is localized to the lymph nodes in the axilla (armpit) and upper limb.

Signs and Symptoms

Patients with follicular lymphoma may exhibit a range of signs and symptoms, which can vary based on the extent of the disease:

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the axillary region. Patients may notice enlarged lymph nodes in the armpit or upper limb.
• B Symptoms: Some patients may experience systemic symptoms known as "B symptoms," which include:
• Unexplained fever
• Night sweats
• Unintentional weight loss
• Fatigue: Many patients report a general sense of fatigue or malaise, which can be attributed to the disease or its effects on the body.
• Pruritus: Itching may occur in some patients, although it is less common.
• Abdominal Symptoms: If the lymphoma involves abdominal lymph nodes, patients may experience abdominal discomfort or fullness.

Patient Characteristics

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

• Age: Follicular lymphoma is more commonly diagnosed in adults, particularly those aged 60 and older. The median age at diagnosis is typically 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 has been associated with an increased risk of developing lymphomas.
• Family History: A family history of lymphoproliferative disorders may also be a risk factor.

Diagnostic Considerations

Diagnosis of follicular lymphoma 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 subtype of follicular lymphoma.

Conclusion

ICD-10 code C82.84 encompasses a specific subset of follicular lymphoma localized to the axillary and upper limb lymph nodes. The clinical presentation is characterized by painless lymphadenopathy, potential systemic symptoms, and fatigue. Understanding these aspects is essential for healthcare providers to facilitate timely diagnosis and appropriate management of patients with this condition. Regular follow-up and monitoring are crucial, given the indolent nature of follicular lymphoma and its potential for transformation into a more aggressive form.

ICD-10 code C82.84 refers to "Other types of follicular lymphoma, lymph nodes of axilla and upper limb." This classification falls under the broader category of non-Hodgkin lymphoma, specifically focusing on follicular lymphoma, which is a type of cancer that originates in the lymphatic system.

Alternative Names for C82.84

1. Follicular Lymphoma, Unspecified: This term may be used when the specific subtype of follicular lymphoma is not detailed.
2. Follicular Lymphoma, Stage IV: In some contexts, this may refer to advanced cases affecting lymph nodes in the axilla and upper limb.
3. Lymphoma, Follicular Type: A general term that encompasses various forms of follicular lymphoma, including those affecting specific lymph node regions.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes various types of lymphomas, including follicular lymphoma.
2. Lymphadenopathy: Refers to the enlargement of lymph nodes, which can be a symptom of follicular lymphoma.
3. Lymphoma, Indolent: This term describes the slow-growing nature of many follicular lymphomas, including those classified under C82.84.
4. B-cell Lymphoma: Since follicular lymphoma is a type of B-cell lymphoma, this term is often used interchangeably in clinical discussions.
5. Lymphoma, Stage IIIB: This may be relevant in staging discussions, particularly if the lymphoma has spread to multiple lymph node regions, including the axilla and upper limb.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. The axillary and upper limb lymph nodes are common sites for lymphatic involvement, and the classification under C82.84 helps in identifying the specific location and type of lymphoma for treatment and management purposes.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.84 is crucial for healthcare professionals involved in the diagnosis and treatment of lymphomas. This knowledge aids in accurate coding, billing, and communication among medical teams, ensuring that patients receive appropriate care tailored to their specific condition.

The diagnosis of follicular lymphoma, particularly under the ICD-10 code C82.84, which specifies "Other types of follicular lymphoma, lymph nodes of axilla and upper limb," involves a comprehensive evaluation that includes clinical, histological, and imaging criteria. Below is a detailed overview of the criteria typically used for diagnosing this specific type of lymphoma.

Clinical Presentation

1. Symptoms: Patients may present with painless lymphadenopathy, which is often the first sign. In cases involving the axilla and upper limb, swelling or discomfort in these areas may be noted. Systemic symptoms such as fever, night sweats, and weight loss (B symptoms) can also occur but are less common in early stages of follicular lymphoma[1].

2. Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes, particularly in the axillary and upper limb regions. The examination may also include checking for splenomegaly or hepatomegaly, which can indicate more advanced disease[1].

Histological Criteria

1. Biopsy: A definitive diagnosis requires a biopsy of the affected lymph node. Histological examination typically reveals a proliferation of follicle center (germinal center) B-cells. The presence of follicular architecture is a hallmark of follicular lymphoma[1].

2. Immunophenotyping: Flow cytometry is often used to analyze the surface markers on the cells obtained from the biopsy. Follicular lymphoma cells typically express CD19, CD20, and CD10, while lacking CD5 and CD23, which helps differentiate it from other types of lymphomas[1][2].

3. Genetic Testing: The detection of the t(14;18) chromosomal translocation, which results in the BCL2 gene rearrangement, is a critical diagnostic criterion. This genetic alteration is found in the majority of follicular lymphoma cases and is instrumental in confirming the diagnosis[2].

Imaging Studies

1. CT or PET Scans: Imaging studies such as computed tomography (CT) or positron emission tomography (PET) scans are utilized to assess the extent of the disease. These scans help in identifying lymph node involvement and any potential extranodal sites of disease, which is crucial for staging and treatment planning[1].

2. Staging: The Ann Arbor staging system is commonly used to classify the extent of lymphoma. This includes determining whether the disease is localized (stage I or II) or disseminated (stage III or IV) and whether it involves the bone marrow or other organs[2].

Laboratory Tests

1. Blood Tests: Routine blood tests may be performed to assess overall health and to check for anemia, elevated lactate dehydrogenase (LDH) levels, and other markers that may indicate disease activity[1].

2. Bone Marrow Biopsy: In some cases, a bone marrow biopsy may be conducted to evaluate for involvement of the bone marrow, which can influence treatment decisions and prognosis[2].

Conclusion

The diagnosis of follicular lymphoma, particularly under the ICD-10 code C82.84, is a multifaceted process that combines clinical evaluation, histological examination, imaging studies, and laboratory tests. Each of these components plays a crucial role in confirming the diagnosis and determining the appropriate treatment strategy. If you have further questions or need more specific information, feel free to ask!

Follicular lymphoma, particularly the subtype classified under ICD-10 code C82.84, refers to a type of non-Hodgkin lymphoma that primarily affects the lymph nodes in the axilla (armpit) and upper limb. This condition is characterized by the proliferation of follicle center (germinal center) B-cells and is generally considered an indolent (slow-growing) form of lymphoma. The treatment approaches for this specific type of follicular lymphoma can vary based on several factors, including the stage of the disease, the patient's overall health, and specific characteristics of the lymphoma.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

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 years. This approach is particularly suitable for indolent forms of lymphoma that do not present significant symptoms or complications.

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 progressed.
• R-CHOP: This is a variation of the CHOP regimen that includes Rituximab, a monoclonal antibody that targets CD20 on B-cells, enhancing the effectiveness of chemotherapy.

3. Immunotherapy

Rituximab is a cornerstone in the treatment of follicular lymphoma. It can be used alone or in combination with chemotherapy. Other newer agents, such as:

• Obinutuzumab: Another anti-CD20 monoclonal antibody that may be used in combination with chemotherapy.
• Lenalidomide: An immunomodulatory drug that can be used in relapsed or refractory cases.

4. Radiation Therapy

Radiation therapy may be employed in localized cases, particularly when the lymphoma is confined to a specific area, such as the axilla. It can be used as a curative approach or to alleviate symptoms.

5. Targeted Therapy

Targeted therapies are increasingly being utilized in the treatment of follicular lymphoma. These include:

• PI3K Inhibitors: Such as Copanlisib (Aliqopa®), which target specific pathways involved in cancer cell growth.
• BCL-2 Inhibitors: Such as Venetoclax, which can be effective in certain cases, particularly in relapsed or refractory settings.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation may be considered. This approach is typically reserved for younger patients or those with more aggressive disease.

7. Radioimmunotherapy

This treatment combines radiation therapy with immunotherapy, using radiolabeled antibodies to target and destroy lymphoma cells. It can be particularly effective in cases that have not responded to other treatments.

Conclusion

The management of follicular lymphoma, particularly the subtype affecting the axilla and upper limb, is multifaceted and tailored to the individual patient. Treatment strategies may range from active surveillance to aggressive chemotherapy and innovative therapies like immunotherapy and targeted agents. Ongoing research continues to refine these approaches, aiming to improve outcomes and minimize side effects for patients with this indolent yet complex disease. Regular follow-up and monitoring are essential to adapt treatment plans as needed based on disease progression and patient response.