ICD-10: C82.9

Follicular lymphoma, classified under ICD-10 code C82.9, is a type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This condition is characterized by the proliferation of B-lymphocytes, which can lead to various clinical presentations and symptoms. Understanding the clinical features, signs, symptoms, and patient characteristics associated with follicular lymphoma is crucial for diagnosis and management.

Clinical Presentation

Signs and Symptoms

1. Lymphadenopathy:
   - The most common clinical sign of follicular lymphoma is painless swelling of the lymph nodes, particularly in the neck, armpits, or groin. Patients may notice enlarged lymph nodes during routine examinations or while feeling for lumps.

2. 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 through clothing and bedding.
   • Weight Loss: Unintentional weight loss of more than 10% of body weight over six months.

3. Fatigue:
   - Patients often report a general sense of fatigue or weakness, which can be debilitating and affect daily activities.

4. Abdominal Symptoms:
   - In cases where lymph nodes in the abdomen are involved, patients may experience abdominal pain, fullness, or discomfort due to enlarged lymph nodes or splenomegaly (enlarged spleen).

5. Skin Manifestations:
   - Rarely, follicular lymphoma can present with skin lesions, which may appear as nodules or plaques.

Patient Characteristics

1. Age:
   - Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is less common in younger individuals.

2. Gender:
   - There is a slight male predominance, with men being more frequently diagnosed than women.

3. Ethnicity:
   - The incidence of follicular lymphoma varies by ethnicity, with higher rates observed in Caucasian populations compared to African American populations.

4. Comorbidities:
   - Patients may have other health conditions, such as autoimmune diseases or prior infections, which can influence the clinical course and treatment options.

5. Family History:
   - A family history of lymphoproliferative disorders may increase the risk of developing follicular lymphoma, suggesting a potential genetic predisposition.

Conclusion

Follicular lymphoma, unspecified (ICD-10 code C82.9), presents with a range of clinical features primarily characterized by lymphadenopathy and systemic symptoms. Understanding these signs and patient characteristics is essential for healthcare providers to facilitate timely diagnosis and appropriate management. Early recognition of symptoms, particularly in at-risk populations, can lead to better outcomes and improved quality of life for patients. If you suspect follicular lymphoma based on these clinical presentations, further diagnostic evaluation, including imaging and biopsy, is warranted to confirm the diagnosis and determine the best treatment approach.

Follicular lymphoma, classified under ICD-10 code C82.9, is a type of non-Hodgkin lymphoma (NHL) characterized by the proliferation of follicle center (germinal center) B-cells. This lymphoma is typically indolent, meaning it often progresses slowly, and it is one of the most common forms of NHL. Below is a detailed overview of this condition, including its clinical description, characteristics, and relevant coding information.

Clinical Description

Definition

Follicular lymphoma is a malignancy that arises from B-lymphocytes, specifically those found in the germinal centers of lymphoid follicles. The term "unspecified" in the ICD-10 code C82.9 indicates that the specific subtype or characteristics of the lymphoma have not been detailed, which can include variations in grade or specific anatomical sites affected.

Epidemiology

Follicular lymphoma is more prevalent in adults, particularly those over the age of 60, and it is slightly more common in women than in men. The incidence of this lymphoma has been increasing over the past few decades, which may be attributed to improved diagnostic techniques and increased awareness of the disease.

Symptoms

Patients with follicular lymphoma may present with a variety of symptoms, which can include:
- Painless swelling of lymph nodes (lymphadenopathy)
- Fever
- Night sweats
- Unexplained weight loss
- Fatigue

In many cases, patients may be asymptomatic and the lymphoma is discovered incidentally during imaging studies or routine examinations.

Diagnosis

Diagnosis typically involves a combination of:
- Physical Examination: Assessment of lymph nodes and spleen.
- Imaging Studies: CT scans or PET scans to evaluate the extent of the disease.
- Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph node, which is then examined histologically to identify the characteristic follicular architecture and the presence of B-cell markers.

Staging

Follicular lymphoma is staged using the Ann Arbor system, which considers the number of lymph node regions involved, the presence of systemic symptoms, and whether the disease has spread to extranodal sites.

Treatment Options

Treatment for follicular lymphoma varies based on the stage of the disease, the patient's symptoms, and overall health. Common approaches include:
- Watchful Waiting: In asymptomatic patients, especially those with early-stage disease.
- Chemotherapy: Often combined with immunotherapy (e.g., rituximab).
- Radiation Therapy: Used in localized disease.
- Stem Cell Transplantation: Considered for relapsed or refractory cases.

Prognosis

The prognosis for patients with follicular lymphoma can vary widely. The indolent nature of the disease often allows for long-term survival, but it can transform into a more aggressive form of lymphoma in some cases. The Follicular Lymphoma International Prognostic Index (FLIPI) is commonly used to assess prognosis based on clinical factors.

Coding Information

The ICD-10-CM code C82.9 specifically denotes "Follicular lymphoma, unspecified." This code is used in medical billing and documentation to categorize cases where the specific subtype or characteristics of the follicular lymphoma are not detailed. It is essential for healthcare providers to use accurate coding to ensure proper treatment and reimbursement.

In summary, follicular lymphoma (ICD-10 code C82.9) is a common form of non-Hodgkin lymphoma characterized by its indolent nature and potential for long-term management. Understanding its clinical features, diagnostic criteria, and treatment options is crucial for effective patient care and management.

Follicular lymphoma, classified under ICD-10 code C82.9, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This condition is often noted for its indolent nature, meaning it typically progresses slowly. Below are alternative names and related terms associated with this diagnosis.

Alternative Names for Follicular Lymphoma

1. Follicular Lymphoma, Unspecified: This is the direct translation of the ICD-10 code C82.9, indicating that the specific characteristics of the lymphoma are not detailed.

2. Follicular Lymphoma, Grade 1: This term refers to a specific grade of follicular lymphoma, which is often considered low-grade and has a better prognosis compared to higher-grade variants[5].

3. Follicular Non-Hodgkin Lymphoma: This term emphasizes that follicular lymphoma is a subtype of non-Hodgkin lymphoma, which encompasses a variety of lymphoproliferative disorders[9].

4. B-cell Follicular Lymphoma: This name highlights the B-cell origin of the lymphoma, as it arises from B-lymphocytes in the germinal centers of lymphoid follicles.

5. Chronic Follicular Lymphoma: While not a formal term, this phrase may be used informally to describe the chronic nature of the disease, particularly in cases where it is asymptomatic for long periods.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes various types of lymphomas, including follicular lymphoma. It is essential to understand that follicular lymphoma is one of the many subtypes within this classification[9].

2. Lymphoproliferative Disorders: This term encompasses a range of conditions, including lymphomas, where there is an abnormal proliferation of lymphocytes.

3. Indolent Lymphoma: This term is often used to describe follicular lymphoma due to its slow-growing nature, distinguishing it from more aggressive forms of lymphoma.

4. Stage I/II Follicular Lymphoma: These terms refer to the staging of the disease, which can help in determining the prognosis and treatment options.

5. Recurrent Follicular Lymphoma: This term is used when the lymphoma returns after treatment, indicating the need for ongoing management and monitoring.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.9 is crucial for accurate diagnosis, treatment planning, and communication among healthcare professionals. Follicular lymphoma, while classified under a specific code, is part of a broader spectrum of lymphoproliferative disorders, and its terminology reflects its characteristics and clinical implications. For further information on treatment and management, consulting specialized oncology resources or guidelines is recommended.

Follicular lymphoma, classified under the ICD-10 code C82.9, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The diagnosis of follicular lymphoma, particularly when unspecified, involves 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 painless lymphadenopathy, which is the most common symptom. Other symptoms can include fever, night sweats, weight loss, and fatigue, often referred to as "B symptoms" in lymphoma.

2. Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes, spleen, or liver, which may indicate lymphatic involvement.

Laboratory Tests

1. Blood Tests: Routine blood tests may show anemia, elevated lactate dehydrogenase (LDH) levels, and abnormal white blood cell counts. However, these findings are not specific to follicular lymphoma.

2. Bone Marrow Biopsy: A bone marrow biopsy may be performed to assess for the presence of lymphoma cells, which can help confirm the diagnosis.

Imaging Studies

1. CT Scans: Computed tomography (CT) scans of the chest, abdomen, and pelvis are commonly used to evaluate the extent of lymphadenopathy and organ involvement.

2. PET Scans: Positron emission tomography (PET) scans can help assess metabolic activity in lymph nodes and other tissues, aiding in staging and treatment planning.

Histopathological Examination

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of an affected lymph node or tissue. The biopsy specimen is examined microscopically to identify characteristic features.

2. Immunophenotyping: Flow cytometry or immunohistochemistry is used to analyze the surface markers on the lymphoma cells. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2, while lacking CD5.

3. Genetic Studies: The presence of the t(14;18) chromosomal translocation, which results in the overexpression of the BCL2 gene, is a hallmark of follicular lymphoma and can be detected through molecular techniques.

Diagnostic Criteria Summary

To summarize, the diagnosis of follicular lymphoma (ICD-10 code C82.9) is based on:

• Clinical symptoms and physical examination findings.
• Laboratory tests, including blood work and bone marrow biopsy.
• Imaging studies to assess the extent of disease.
• Histopathological examination of biopsy specimens, including immunophenotyping and genetic studies.

These criteria collectively help in establishing a diagnosis of follicular lymphoma, ensuring that appropriate treatment strategies can be implemented for affected patients[1][2][3].

In conclusion, the diagnosis of follicular lymphoma is multifaceted, requiring a combination of clinical, laboratory, and histopathological evaluations to confirm the presence of this specific type of lymphoma.

Follicular lymphoma, classified under ICD-10 code C82.9, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This indolent form of lymphoma can vary significantly in its clinical presentation and progression, necessitating a tailored approach to treatment. Below, we explore the standard treatment approaches for follicular lymphoma, particularly when it is unspecified.

Overview of Follicular Lymphoma

Follicular lymphoma is typically diagnosed in adults and is known for its slow progression. Patients may present with painless lymphadenopathy, and the disease can be asymptomatic for extended periods. The prognosis and treatment strategies can vary based on factors such as the stage of the disease, the presence of symptoms, and the patient's overall health.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For patients with early-stage, asymptomatic follicular lymphoma, 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 older patients or those with comorbidities, as it helps avoid unnecessary treatment-related side effects[1].

2. Chemotherapy

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

• CHOP: Cyclophosphamide, doxorubicin, vincristine, and prednisone.
• R-CHOP: This regimen includes the addition of rituximab, a monoclonal antibody that targets CD20 on B-cells, enhancing the effectiveness of chemotherapy[2].

These regimens are typically administered in cycles, and the choice of regimen may depend on the patient's specific circumstances, including age and overall health.

3. Immunotherapy

Rituximab, as mentioned, 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, rituximab may be administered as a single agent or in combination with other agents such as bendamustine[3].

4. Radioimmunotherapy

This approach combines radiation therapy with immunotherapy. Agents like ibritumomab tiuxetan deliver targeted radiation to CD20-positive B-cells, effectively treating the lymphoma while minimizing damage to surrounding tissues. Radioimmunotherapy is often considered for patients with localized disease or those who have relapsed after initial treatment[4].

5. Stem Cell Transplantation

For patients with aggressive or relapsed 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 a good performance status, as it carries significant risks and requires careful patient selection[5].

6. Novel Therapies

Emerging treatments, including targeted therapies such as PI3K inhibitors (e.g., idelalisib) and BTK inhibitors (e.g., ibrutinib), are being investigated in clinical trials. These agents may offer new options for patients with relapsed or refractory disease, particularly those who are not candidates for traditional chemotherapy[6].

Conclusion

The treatment of follicular lymphoma (ICD-10 code C82.9) is multifaceted and should be individualized based on the patient's specific clinical scenario. While watchful waiting may be appropriate for asymptomatic patients, various treatment modalities, including chemotherapy, immunotherapy, radioimmunotherapy, and emerging targeted therapies, provide effective options for managing this disease. Ongoing research continues to refine these approaches, aiming to improve outcomes and quality of life for patients with follicular lymphoma.

References

1. SEER Cancer Statistics.
2. Treatment Patterns of Follicular Lymphoma in the United States.
3. Radioimmunotherapy in the Treatment of Non-Hodgkin Lymphoma.
4. Non-Hodgkin's Lymphoma Overview.
5. MolDX: Minimal Residual Disease Testing for Cancer.
6. Emerging Therapies in Follicular Lymphoma.