ICD-10: C82.85

Follicular lymphoma, particularly the subtype classified under ICD-10 code C82.85, refers to a type of non-Hodgkin lymphoma that primarily affects the lymph nodes in the inguinal region and lower limbs. 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 symptoms. Below is a detailed overview of standard treatment approaches.

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 extended periods. This approach is particularly suitable for indolent lymphomas, where the disease may not progress significantly over time[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 forms of lymphoma but can also be applied in certain cases of follicular lymphoma.
• 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[2].

3. Immunotherapy

Rituximab is a cornerstone of treatment for follicular lymphoma. It can be used alone or in combination with chemotherapy. In cases where the disease is not responding to chemotherapy, Rituximab may be administered as a monotherapy. Other monoclonal antibodies and newer agents, such as Obinutuzumab, are also being explored in clinical settings[3].

4. Radiation Therapy

Radiation therapy may be employed in localized cases, particularly when the lymphoma is confined to a specific area, such as the inguinal region. It can be used as a primary treatment or as an adjunct to chemotherapy, especially in cases of localized disease or to alleviate symptoms[4].

5. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, 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. This treatment is typically reserved for younger patients or those with more aggressive disease[5].

6. Targeted Therapies

Recent advancements have led to the development of targeted therapies that focus on specific pathways involved in lymphoma growth. Agents such as copanlisib (Aliqopa) and idelalisib are examples of PI3K inhibitors that have shown promise in treating follicular lymphoma, particularly in cases that are resistant to standard therapies[6].

7. Clinical Trials

Participation in clinical trials may be an option for patients seeking access to cutting-edge therapies or novel treatment combinations. These trials often explore new drugs, combinations, or treatment strategies that may offer benefits over standard care[7].

Conclusion

The treatment of follicular lymphoma, particularly the subtype affecting the inguinal region and lower limbs, is multifaceted and tailored to the individual patient. While watchful waiting may be appropriate for asymptomatic patients, various treatment modalities, including chemotherapy, immunotherapy, radiation, and targeted therapies, are available for those requiring intervention. As research continues to evolve, new therapies and combinations are likely to enhance treatment outcomes for patients with this condition. It is essential for patients to discuss their specific case with their healthcare provider to determine the most appropriate treatment strategy based on their unique circumstances.

The diagnosis of follicular lymphoma, particularly under the ICD-10 code C82.85, which refers to "Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb," involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below is a detailed overview of the criteria typically used for diagnosing this specific type of lymphoma.

Clinical Evaluation

Symptoms

Patients may present with various symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the inguinal region and lower limbs.
- B-symptoms: These may include fever, night sweats, and unexplained weight loss, which can indicate more aggressive disease.

Medical History

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

Imaging Studies

Radiological Assessment

Imaging techniques are crucial for assessing the extent of the disease:
- CT Scans: Computed tomography scans of the abdomen, pelvis, and chest can help identify enlarged lymph nodes and any potential organ involvement.
- PET Scans: Positron emission tomography scans may be used to evaluate metabolic activity in lymph nodes, helping to distinguish between benign and malignant processes.

Histopathological Examination

Biopsy

A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes:
- Excisional Biopsy: This is the preferred method, where an entire lymph node is removed for examination.
- Core Needle Biopsy: In some cases, a core needle biopsy may be performed if excisional biopsy is not feasible.

Microscopic Analysis

The biopsy specimen is examined microscopically for:
- Cellularity: The presence of a high number of abnormal lymphoid cells.
- Follicular Architecture: The characteristic follicular pattern of growth, which is a hallmark of follicular lymphoma.
- Immunophenotyping: Flow cytometry or immunohistochemistry is used to identify specific markers (e.g., CD10, BCL2) that confirm the diagnosis of follicular lymphoma.

Molecular Studies

Genetic Testing

Molecular studies may be conducted to identify genetic abnormalities associated with follicular lymphoma:
- BCL2 Gene Rearrangement: The presence of the BCL2 gene rearrangement is a common finding in follicular lymphoma and can aid in diagnosis.

Conclusion

The diagnosis of follicular lymphoma, particularly under the ICD-10 code C82.85, involves a comprehensive approach that includes clinical evaluation, imaging studies, histopathological examination, and molecular testing. Each of these components plays a critical role in confirming the diagnosis and determining the appropriate treatment plan. If you have further questions or need more specific information, feel free to ask!

ICD-10 code C82.85 refers specifically to "Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb." This classification falls under the broader category of follicular lymphoma, which is a type of non-Hodgkin lymphoma (NHL) characterized by the proliferation of follicle center (germinal center) B-cells. Below is a detailed clinical description and relevant information regarding this specific code.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is a slow-growing (indolent) form of non-Hodgkin lymphoma that typically arises from B-lymphocytes. It is one of the most common types of NHL and is often diagnosed in adults. The disease is characterized by the formation of lymphoid follicles, which can lead to the enlargement of lymph nodes.

Types of Follicular Lymphoma

Follicular lymphoma can be classified into various grades based on histological features:
- Grade I: Predominantly small cleaved cells.
- Grade II: A mixture of small cleaved and large cells.
- Grade III: Predominantly large cells, which can be further divided into IIIA (mixed) and IIIB (predominantly large cells).

The ICD-10 code C82.85 specifically addresses cases that do not fit neatly into the more common classifications of follicular lymphoma, indicating a need for further specification regarding the lymph nodes involved.

Specifics of C82.85

Affected Areas

The code C82.85 is used when follicular lymphoma affects the lymph nodes located in the inguinal region (groin area) and lower limbs. This localization can have implications for both diagnosis and treatment, as lymphatic drainage patterns and the potential for metastasis may differ from other regions.

Symptoms

Patients with follicular lymphoma may present with:
- Painless swelling of lymph nodes, particularly in the inguinal region.
- Possible systemic symptoms such as fever, night sweats, and weight loss, although these are less common in indolent forms.
- Fatigue and general malaise.

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: Histological examination of lymph node tissue to confirm the diagnosis and determine the grade of lymphoma.

Treatment Options

Treatment for follicular lymphoma, particularly when localized to specific lymph nodes, may include:
- Watchful Waiting: In cases where the disease is asymptomatic and indolent.
- Chemotherapy: Common regimens may include agents like bendamustine or rituximab.
- Radiation Therapy: Often used for localized disease.
- Targeted Therapies: Newer agents such as epcoritamab (Epkinly™) are being explored for their efficacy in treating follicular lymphoma.

Conclusion

ICD-10 code C82.85 is crucial for accurately documenting cases of follicular lymphoma that specifically involve the lymph nodes of the inguinal region and lower limbs. Understanding the clinical implications of this code aids healthcare providers in diagnosing, treating, and managing patients with this type of lymphoma effectively. As research continues, treatment options may evolve, offering hope for improved outcomes in patients diagnosed with this condition.

ICD-10 code C82.85 refers to "Other types of follicular lymphoma, lymph nodes of inguinal region and lower limb." Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates from B-lymphocytes and is characterized by a proliferation of follicle center (germinal center) cells. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this specific diagnosis.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is typically indolent, meaning it often progresses slowly. It can present in various forms, but when it involves the inguinal region and lower limbs, it may manifest as localized or generalized lymphadenopathy.

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 and the specific lymph node involvement:

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes. In the case of C82.85, this would specifically involve the inguinal region (groin area) and potentially the lower limbs. Patients may notice enlarged lymph nodes that feel firm but are typically not tender.

• B Symptoms: Some patients may experience systemic symptoms known as "B symptoms," which include:

• 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.

• Fatigue: Many patients report a general sense of fatigue or malaise, which can be attributed to the underlying disease process.

• Abdominal Symptoms: If the lymphoma affects abdominal lymph nodes, patients may experience abdominal discomfort, fullness, or changes in bowel habits.

Patient Characteristics

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

• Age: Follicular lymphoma is more common 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, with men being more frequently diagnosed than women.

• Comorbidities: Patients may have other health conditions that can complicate the management of lymphoma, such as autoimmune diseases or other malignancies.

• Family History: A family history of lymphoproliferative disorders may be noted in some patients, suggesting a potential genetic predisposition.

• Ethnicity: While follicular lymphoma can affect individuals of any ethnicity, some studies suggest variations in incidence rates among different ethnic groups.

Conclusion

Follicular lymphoma, particularly when affecting the inguinal region and lower limbs, presents with characteristic signs such as lymphadenopathy and systemic B symptoms. Understanding the clinical presentation and patient characteristics is crucial for timely diagnosis and management. If you suspect follicular lymphoma based on these symptoms, it is essential to seek further evaluation through imaging studies and biopsy to confirm the diagnosis and determine the appropriate treatment plan.

ICD-10 code C82.85 refers specifically to "Other types of follicular lymphoma, lymph nodes of inguinal region and lower 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 code:

Alternative Names

1. Follicular Lymphoma, Other Types: This term indicates that the lymphoma does not fit into the more common subtypes of follicular lymphoma.
2. Inguinal Follicular Lymphoma: This specifies the location of the lymphoma in the inguinal (groin) region.
3. Lower Limb Follicular Lymphoma: This term highlights the involvement of lymph nodes in the lower limb.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes various types of lymphomas, including follicular lymphoma.
2. Lymphoma: A general term for cancers that originate in the lymphatic system.
3. Lymphadenopathy: Refers to the enlargement of lymph nodes, which can be a symptom of lymphoma.
4. Stage IV Lymphoma: If the lymphoma has spread to distant lymph nodes, including those in the inguinal region and lower limbs, it may be classified as stage IV.
5. B-cell Lymphoma: Follicular lymphoma is a type of B-cell lymphoma, which is characterized by the type of lymphocyte involved.

Clinical Context

Follicular lymphoma is typically indolent, meaning it often progresses slowly. The specific mention of the inguinal region and lower limb in the ICD-10 code indicates the anatomical focus of the disease, which can influence treatment decisions and prognosis.

Understanding these alternative names and related terms can be crucial for healthcare professionals in accurately diagnosing and coding for this condition, as well as for research and treatment planning.