ICD-10: C82.91

ICD-10 code C82.91 refers to Follicular lymphoma, unspecified, lymph nodes of head, face, and neck. This classification falls under the broader category of non-Hodgkin lymphoma (NHL), specifically within the follicular lymphoma subtype. Below is a detailed clinical description and relevant information regarding this condition.

Overview of Follicular Lymphoma

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of B-lymphocytes, which are a type of white blood cell involved in the immune response. It is typically indolent, meaning it tends to grow slowly compared to other forms of lymphoma. Follicular lymphoma is often diagnosed in adults and can present with various symptoms depending on the extent of the disease.

Clinical Presentation

Patients with follicular lymphoma may exhibit the following clinical features:

• Lymphadenopathy: The most common presentation is painless swelling of lymph nodes, particularly in the neck, armpits, or groin. In the case of C82.91, the lymph nodes affected are specifically located in the head, face, and neck region.
• B Symptoms: Some patients may experience systemic symptoms such as fever, night sweats, and unexplained weight loss, which are referred to as "B symptoms."
• Fatigue: Generalized fatigue is also a common complaint among patients.

Diagnosis

The diagnosis of follicular lymphoma typically involves:

• Physical Examination: Assessment of lymph node enlargement and other physical signs.
• Imaging Studies: CT scans or PET scans may be used to evaluate the extent of lymphadenopathy and to check for involvement of other organs.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph node, which is examined histologically to identify the characteristic follicular pattern of lymphoma cells.
• Immunophenotyping: Flow cytometry and immunohistochemistry are used to confirm the presence of B-cell markers and to differentiate follicular lymphoma from other types of lymphoma.

Staging and Prognosis

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 prognosis can vary significantly based on the stage at diagnosis, the patient's age, and overall health. Follicular lymphoma is generally considered incurable but manageable, with many patients living for years with the disease.

Treatment Options

Treatment for follicular lymphoma may include:

• Watchful Waiting: In cases where the disease is asymptomatic and indolent, a "watch and wait" approach may be adopted.
• Chemotherapy: Combination chemotherapy regimens are commonly used for symptomatic patients.
• Immunotherapy: Monoclonal antibodies, such as rituximab, are often employed to target lymphoma cells.
• Radiation Therapy: Localized radiation may be used for localized disease or to alleviate symptoms.

Conclusion

ICD-10 code C82.91 captures the essence of follicular lymphoma affecting the lymph nodes in the head, face, and neck. Understanding the clinical presentation, diagnostic methods, staging, and treatment options is crucial for effective management of this condition. As with all lymphomas, early detection and tailored treatment strategies can significantly impact patient outcomes and quality of life.

Follicular lymphoma, classified under ICD-10 code C82.91, is a type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This condition is characterized by the proliferation of follicle center (germinal center) B-cells, leading to the formation of tumors in lymph nodes. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this specific diagnosis.

Clinical Presentation

General Overview

Follicular lymphoma is typically indolent, meaning it often progresses slowly. Patients may remain asymptomatic for extended periods, and the disease may be discovered incidentally during imaging studies or routine examinations. When symptoms do occur, they can vary widely among individuals.

Signs and Symptoms

1. Lymphadenopathy:
   - The most common clinical sign is painless swelling of lymph nodes, particularly in the head, face, and neck regions. Patients may notice enlarged lymph nodes in these areas, which can be palpable during a physical examination[1].

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, often soaking bedclothes.
   • Weight Loss: Unintentional weight loss of more than 10% of body weight over six months[1][2].

3. Fatigue:
   - Patients often report a general sense of fatigue or weakness, which can be attributed to the disease's impact on the body and the immune system[2].

4. Pruritus:
   - Some individuals may experience itching (pruritus), which is not always associated with skin lesions but can be a distressing symptom[2].

5. Abdominal Symptoms:
   - In cases where lymph nodes in the abdomen are involved, patients may experience abdominal discomfort, fullness, or pain due to lymphadenopathy[1].

Patient Characteristics

• Age:

• Follicular lymphoma is more commonly diagnosed in adults, particularly those aged 50 and older. The median age at diagnosis is around 60 years[2].

• Gender:

• There is a slight male predominance in the incidence of follicular lymphoma, although it can affect both genders[1].

• Risk Factors:

• Certain risk factors may increase the likelihood of developing follicular lymphoma, including:

  • Family History: A family history of lymphoma or other hematologic malignancies.
  • Autoimmune Diseases: Conditions such as rheumatoid arthritis or lupus may increase risk.
  • Exposure to Chemicals: Prolonged exposure to certain chemicals, such as pesticides or solvents, has been associated with a higher risk of lymphoma[2].

• Comorbidities:

• Patients may have other health conditions that can complicate the management of follicular lymphoma, including cardiovascular diseases or diabetes, which are common in older populations[1].

Conclusion

Follicular lymphoma, particularly when affecting the lymph nodes of the head, face, and neck, presents with a range of clinical signs and symptoms, primarily characterized by painless lymphadenopathy and potential systemic symptoms. Understanding the patient characteristics, including age, gender, and risk factors, is crucial for early diagnosis and management. Regular monitoring and appropriate diagnostic imaging are essential for managing this indolent form of lymphoma effectively. If you suspect symptoms related to follicular lymphoma, it is important to consult a healthcare professional for further evaluation and potential diagnostic testing.

References

1. [ICD-10-CM TABULAR LIST of DISEASES and INJURIES]
2. [MolDX: Minimal Residual Disease Testing for Cancer]

ICD-10 code C82.91 refers specifically to "Follicular lymphoma, unspecified, lymph nodes of head, face, and neck." This classification falls under the broader category of non-Hodgkin lymphoma, which encompasses various types of lymphomas that do not originate from Hodgkin cells. Below are alternative names and related terms associated with this specific code.

Alternative Names for Follicular Lymphoma

1. Follicular Lymphoma, Unspecified: This is the direct name associated with the ICD-10 code C82.91, indicating that the specific subtype of follicular lymphoma is not detailed.

2. Follicular Lymphoma: A general term for a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells.

3. B-cell Follicular Lymphoma: This term emphasizes the B-cell origin of the lymphoma, which is crucial for understanding its pathology and treatment.

4. Low-Grade Follicular Lymphoma: Often, follicular lymphoma is classified as low-grade, indicating a slower progression compared to high-grade lymphomas.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes all types of lymphomas except Hodgkin lymphoma. Follicular lymphoma is one of the most common subtypes of NHL.

2. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma, particularly in the head, face, and neck regions.

3. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.

4. Stage IV Follicular Lymphoma: If the lymphoma has spread beyond the lymph nodes to other organs, it may be classified as Stage IV, which is relevant for treatment and prognosis discussions.

5. Chronic Lymphocytic Leukemia (CLL): While distinct, CLL can sometimes be confused with follicular lymphoma due to overlapping features, particularly in the context of B-cell malignancies.

6. Lymphoid Tissue Neoplasm: A broader term that encompasses various neoplasms arising from lymphoid tissue, including follicular lymphoma.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.91 is essential for accurate diagnosis, treatment planning, and communication among healthcare professionals. This knowledge aids in the classification and management of follicular lymphoma, particularly when discussing patient cases or conducting research in hematology and oncology. If you need further details or specific information regarding treatment options or prognosis, feel free to ask!

Follicular lymphoma, classified under ICD-10 code C82.91, 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 it is unspecified and localized to the lymph nodes of the head, face, and neck, involves several criteria and diagnostic steps.

Diagnostic Criteria for Follicular Lymphoma

Clinical Evaluation

1. Symptoms: Patients may present with painless lymphadenopathy, which is the most common symptom. Other symptoms can include fever, night sweats, and weight loss, although these are less common in early stages.
2. Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes, particularly in the cervical region, which includes the head, face, and neck.

Imaging Studies

1. Ultrasound: This imaging modality can help assess the size and characteristics of lymph nodes.
2. CT or PET Scans: These scans are often used to evaluate the extent of the disease and to identify any additional lymph node involvement or extranodal disease.

Laboratory Tests

1. Blood Tests: Routine blood tests may be performed to assess overall health and to check for anemia or other abnormalities.
2. Bone Marrow Biopsy: This may be necessary to determine if the lymphoma has spread to the bone marrow, which is common in follicular lymphoma.

Histopathological Examination

1. Lymph Node Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph node. The biopsy sample is examined microscopically to identify the characteristic follicular architecture and the presence of neoplastic B-cells.
2. Immunophenotyping: Flow cytometry or immunohistochemistry is used to analyze the surface markers on the cells. Follicular lymphoma typically expresses CD10, CD19, CD20, and BCL2, while lacking CD5.

Genetic Testing

1. Cytogenetic Analysis: 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 aid in diagnosis.

Conclusion

The diagnosis of follicular lymphoma, particularly for the ICD-10 code C82.91, involves a combination of clinical evaluation, imaging studies, laboratory tests, histopathological examination, and genetic testing. Each of these components plays a crucial role in confirming the diagnosis and determining the appropriate treatment plan. If you have further questions or need more specific information regarding treatment options or prognosis, feel free to ask!

Follicular lymphoma, classified under ICD-10 code C82.91, is a type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This particular subtype is characterized by its slow-growing nature and typically arises in the lymph nodes, including those located in the head, face, and neck. The treatment approaches for 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 itself. Below is a detailed overview of standard treatment approaches for this condition.

Treatment Approaches for Follicular Lymphoma

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 closely monitoring the patient without immediate treatment, as many patients may not require intervention for years. Regular follow-ups and imaging studies are conducted to assess any changes in the disease status.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for follicular lymphoma, particularly in cases where the disease is symptomatic or has progressed. Common chemotherapy regimens include:

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for more aggressive forms of 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

Rituximab is a key component in the treatment of follicular lymphoma. It can be used alone or in combination with chemotherapy. Other immunotherapeutic agents, such as Obinutuzumab, may also be considered, particularly in relapsed cases.

4. Radiation Therapy

Radiation therapy can be effective for localized follicular lymphoma, especially when the disease is confined to a specific area, such as the lymph nodes in the head, face, and neck. It may be used as a primary treatment or as an adjunct to chemotherapy.

5. Targeted Therapy

Targeted therapies have emerged as important options for treating follicular lymphoma. These include:

• PI3K Inhibitors: Such as Copanlisib (Aliqopa), which target specific pathways involved in cancer cell growth and survival.
• BCL-2 Inhibitors: Like Venetoclax, which can induce apoptosis in lymphoma cells.

6. Stem Cell Transplantation

In cases of 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. Clinical Trials

Participation in clinical trials may provide access to new and innovative therapies that are not yet widely available. Patients are encouraged to discuss this option with their healthcare providers.

Conclusion

The management of follicular lymphoma, particularly in the head, face, and neck regions, involves a multifaceted approach tailored to the individual patient's needs. Treatment options range from active surveillance to chemotherapy, immunotherapy, radiation, and targeted therapies. As research continues to evolve, new treatment modalities are being explored, offering hope for improved outcomes in patients with this condition. It is essential for patients to work closely with their healthcare team to determine the most appropriate treatment strategy based on their specific circumstances and disease characteristics.