ICD-10: C82.86

Follicular lymphoma, particularly the subtype classified under ICD-10 code C82.86, refers to a type of non-Hodgkin lymphoma that primarily affects the intrapelvic 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 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. Watchful Waiting

In cases where the follicular lymphoma is asymptomatic and not causing significant health issues, a strategy known as "watchful waiting" or "active surveillance" may be employed. This approach involves regular monitoring of the patient's condition without immediate treatment, as many patients with indolent follicular lymphoma may not require treatment for years.

2. Chemotherapy

For symptomatic patients or those with rapidly progressing disease, chemotherapy is often the first line of treatment. Common regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is a standard treatment for various types of non-Hodgkin 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.

3. Immunotherapy

Immunotherapy has become a cornerstone in the treatment of follicular lymphoma. Key options include:

• Rituximab: Often used in combination with chemotherapy, Rituximab can also be administered as a single agent for patients who have relapsed or are not candidates for chemotherapy.
• Obinutuzumab: Another anti-CD20 monoclonal antibody that may be used in combination with chemotherapy or as maintenance therapy.

4. Targeted Therapy

Targeted therapies are increasingly being utilized for follicular lymphoma, particularly for patients with relapsed or refractory disease. Notable agents include:

• Idelalisib: A PI3K inhibitor that targets specific pathways involved in cancer cell survival and proliferation.
• Copanlisib: Another PI3K inhibitor that has shown efficacy in treating follicular lymphoma.

5. Radioimmunotherapy

This approach combines radiation therapy with immunotherapy. Agents like Ibritumomab tiuxetan deliver targeted radiation to lymphoma cells, minimizing damage to surrounding healthy tissue. This method is particularly useful for localized disease or in cases of relapse.

6. Stem Cell Transplantation

For patients with aggressive transformation or those who have relapsed after initial treatment, 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 tolerated alone.

7. Clinical Trials

Participation in clinical trials may provide access to new and emerging therapies that are not yet widely available. These trials often explore novel agents or combinations of existing treatments and can be a viable option for patients with refractory disease.

Conclusion

The management of follicular lymphoma, particularly the subtype affecting intrapelvic lymph nodes, is tailored to the individual patient based on disease characteristics and overall health. Treatment options range from watchful waiting to aggressive chemotherapy, immunotherapy, and targeted therapies. As research continues to evolve, new treatment modalities are being developed, offering hope for improved outcomes in patients with this type of lymphoma. For patients and healthcare providers, staying informed about the latest advancements and clinical trials is crucial in optimizing treatment strategies.

ICD-10 code C82.86 refers specifically to "Other types of follicular lymphoma, intrapelvic lymph nodes." Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates in the lymphatic system, particularly from B-lymphocytes. This subtype is characterized by the proliferation of follicle center (germinal center) B-cells, which can lead to the formation of tumors in lymph nodes and other lymphatic tissues.

Clinical Description of Follicular Lymphoma

Characteristics

• Follicular Lymphoma: This is a slow-growing (indolent) form of lymphoma that often presents with painless lymphadenopathy. It can be asymptomatic for long periods, making early detection challenging.
• Histological Features: The lymphoma is typically characterized by a follicular pattern of growth, with neoplastic follicles that can disrupt normal lymph node architecture. The presence of small cleaved cells and large cells can be observed under microscopic examination.

Symptoms

Patients with follicular lymphoma may experience:
- Swollen lymph nodes, particularly in the neck, armpits, or groin.
- Abdominal discomfort or swelling if lymph nodes in the abdomen or pelvis are involved.
- Systemic symptoms such as fever, night sweats, and unexplained weight loss, although these are less common in early stages.

Specifics of C82.86: Intrapelvic Lymph Nodes

Involvement of Intrapelvic Lymph Nodes

• Location: The term "intrapelvic lymph nodes" refers to lymph nodes located within the pelvic cavity. This can include nodes associated with the iliac vessels and other pelvic structures.
• Clinical Implications: The involvement of intrapelvic lymph nodes can indicate a more advanced stage of the disease. It may also lead to complications such as obstruction of pelvic organs, which can cause additional symptoms like urinary issues or gastrointestinal disturbances.

Diagnosis and Staging

• Imaging Studies: Diagnosis often involves imaging techniques such as CT scans or PET scans to assess the extent of lymph node involvement and to identify any other affected areas.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, which allows for histological examination and confirmation of follicular lymphoma.

Treatment Options

• Watchful Waiting: In cases where the lymphoma is asymptomatic and indolent, a strategy of active surveillance may be employed.
• Chemotherapy and Immunotherapy: For symptomatic cases or those with significant lymph node involvement, treatment may include chemotherapy regimens (e.g., bendamustine) and immunotherapy (e.g., rituximab).
• Radiation Therapy: Localized radiation may be considered for localized disease or to alleviate symptoms caused by enlarged lymph nodes.

Conclusion

ICD-10 code C82.86 captures a specific aspect of follicular lymphoma, focusing on cases where the disease affects the intrapelvic lymph nodes. Understanding the clinical presentation, diagnostic approach, and treatment options is crucial for managing this condition effectively. As with all lymphomas, 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 C82.86 specifically refers to "Other types of follicular lymphoma, intrapelvic lymph nodes." Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Signs and Symptoms

Patients with follicular lymphoma, particularly those with involvement of intrapelvic lymph nodes, may present with a variety of symptoms, which can include:

• Lymphadenopathy: Swelling of lymph nodes is a common sign. In cases involving intrapelvic lymph nodes, patients may notice swelling in the lower abdomen or pelvis.
• Abdominal Pain or Discomfort: Patients may experience pain or a feeling of fullness in the abdominal area due to enlarged lymph nodes pressing against surrounding structures.
• B Symptoms: These include systemic symptoms such as 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 can be attributed to the disease itself or anemia resulting from bone marrow involvement.
• Gastrointestinal Symptoms: In some cases, patients may experience gastrointestinal issues, such as nausea or changes in bowel habits, if lymph nodes in the abdomen are affected.

Patient Characteristics

Follicular lymphoma typically presents in adults, with the following characteristics often observed:

• Age: Most patients are diagnosed in their 50s or 60s, although it can occur in younger individuals.
• 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.

Diagnosis and Evaluation

Diagnosis of follicular lymphoma, including the subtype affecting intrapelvic lymph nodes, typically involves:

• Imaging Studies: CT scans or PET scans are often used to assess the extent of lymphadenopathy and to evaluate the involvement of intrapelvic structures.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph node, which reveals the characteristic follicular architecture and the presence of neoplastic B-cells.
• Immunophenotyping: Flow cytometry or immunohistochemistry is used to confirm the diagnosis by identifying specific markers (e.g., CD10, CD19, CD20) associated with follicular lymphoma.

Conclusion

Follicular lymphoma, particularly when involving intrapelvic lymph nodes, presents with a range of symptoms primarily related to lymphadenopathy and systemic effects. Understanding these clinical features, along with patient demographics and diagnostic approaches, is essential for effective management and treatment planning. Early recognition and intervention can significantly impact patient outcomes, making awareness of these characteristics vital for healthcare providers.

ICD-10 code C82.86 refers specifically to "Other types of follicular lymphoma, intrapelvic lymph nodes." This classification falls under the broader category of follicular lymphoma, which is a type of non-Hodgkin lymphoma. Below are alternative names and related terms associated with this specific code:

Alternative Names for C82.86

1. Follicular Lymphoma, Unspecified: This term may be used when the specific subtype of follicular lymphoma is not clearly defined.
2. Follicular Lymphoma, Other Specified: This can refer to various subtypes of follicular lymphoma that do not fit into the more common classifications.
3. Non-Hodgkin Follicular Lymphoma: A broader term that encompasses all types of follicular lymphoma, including those classified under C82.86.

Related Terms

1. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes various types of lymphomas, including Hodgkin and non-Hodgkin lymphomas.
2. Non-Hodgkin Lymphoma (NHL): This is a category of lymphomas that includes follicular lymphoma and other types, distinguished from Hodgkin lymphoma.
3. Intraperitoneal Lymph Nodes: While not a direct synonym, this term relates to the anatomical location of the lymph nodes involved in C82.86, as they are situated within the pelvic cavity.
4. Stage IV Lymphoma: In some contexts, follicular lymphoma that has spread to the intrapelvic lymph nodes may be classified as stage IV, indicating advanced disease.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. The intrapelvic involvement indicates that the lymphoma has spread to lymph nodes located in the pelvic region, which can affect treatment decisions and prognosis. Understanding these alternative names and related terms is crucial for accurate diagnosis, coding, and treatment planning in clinical practice.

In summary, while C82.86 specifically denotes "Other types of follicular lymphoma, intrapelvic lymph nodes," it is important to recognize the broader context of follicular lymphoma and its classification within non-Hodgkin lymphoma. This understanding aids healthcare professionals in navigating the complexities of lymphoma diagnosis and treatment.

The diagnosis of follicular lymphoma, particularly the subtype classified under ICD-10 code C82.86, which refers to "Other types of follicular lymphoma, intrapelvic lymph nodes," involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below is a detailed overview of the criteria typically used for diagnosing this condition.

Clinical Presentation

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, which may be painless and can occur in the neck, armpits, or groin.
- B-symptoms: These include fever, night sweats, and unexplained weight loss, which can indicate more aggressive disease.
- Abdominal discomfort: Due to enlarged lymph nodes in the intrapelvic region.

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 techniques play a crucial role in identifying the extent of the disease:
- CT Scans: Computed tomography scans of the abdomen and pelvis can help visualize enlarged lymph nodes and assess their location.
- 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. The following criteria are typically assessed:
- Histological Features: The presence of follicular structures with a predominance of neoplastic follicle center (germinal center) cells.
- Immunophenotyping: Flow cytometry or immunohistochemistry is used to identify specific markers. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2, while lacking CD5.
- Cytogenetic Analysis: Detection of the t(14;18) chromosomal translocation, which is common in follicular lymphoma, can further confirm 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 and whether the disease has spread to other organs. This staging is crucial for determining the appropriate treatment approach.

Conclusion

The diagnosis of follicular lymphoma, particularly the subtype associated with intrapelvic lymph nodes (ICD-10 code C82.86), relies on a comprehensive approach that includes clinical evaluation, imaging studies, and histopathological confirmation. Early and accurate diagnosis is essential for effective management and treatment planning. If you have further questions or need more specific information, feel free to ask!