ICD-10: C82.93

Follicular lymphoma, classified under ICD-10 code C82.93, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This specific code refers to cases where the lymphoma is unspecified and primarily affects intra-abdominal lymph nodes. 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.

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 follicular lymphoma often progresses slowly. Treatment is initiated only if symptoms develop or if the disease shows signs of progression.

2. Chemotherapy

Chemotherapy remains a cornerstone of treatment for symptomatic follicular lymphoma. Common regimens include:

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

These regimens are typically administered in cycles and may be combined with other therapies depending on the patient's response and specific disease characteristics.

3. Immunotherapy

Rituximab is a key component in the treatment of follicular lymphoma. It can be used alone or in combination with chemotherapy. Other monoclonal antibodies, such as obinutuzumab, may also be considered. These therapies work by targeting specific proteins on the surface of cancer cells, helping the immune system to recognize and destroy them.

4. Radiation Therapy

Radiation therapy may be used in localized cases or as a palliative measure to relieve symptoms. It is particularly effective for patients with limited-stage disease or those with specific areas of lymph node involvement.

5. Targeted Therapy

Recent advancements have introduced targeted therapies that focus on specific molecular pathways involved in the growth of lymphoma cells. For example, copanlisib (Aliqopa) is an approved treatment for relapsed follicular lymphoma, particularly in patients who have received at least two prior therapies. It works by inhibiting the PI3K pathway, which is often activated in lymphoma cells.

6. 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 own stem cells, administering high-dose chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function.

7. Radioimmunotherapy

This innovative treatment combines radiation therapy with immunotherapy. Agents like ibritumomab tiuxetan deliver targeted radiation directly to the lymphoma cells, minimizing damage to surrounding healthy tissue. This approach is particularly useful for patients with relapsed disease.

Conclusion

The treatment of follicular lymphoma, particularly when it involves intra-abdominal lymph nodes, is multifaceted and tailored to the individual patient. The choice of therapy depends on various factors, including disease stage, symptoms, and patient preferences. Ongoing research continues to refine these approaches, with a focus on improving outcomes and minimizing side effects. For patients diagnosed with C82.93, a multidisciplinary team approach is essential to determine the most appropriate treatment plan. Regular follow-up and monitoring are crucial to manage the disease effectively and address any potential complications.

Clinical Description of ICD-10 Code C82.93

ICD-10 Code C82.93 refers specifically to follicular lymphoma, a type of non-Hodgkin lymphoma (NHL) characterized by the proliferation of B-lymphocytes in a follicular pattern. This particular code denotes cases where the lymphoma is unspecified and primarily affects the intra-abdominal lymph nodes.

Overview of Follicular Lymphoma

Follicular lymphoma is one of the most common forms of indolent (slow-growing) non-Hodgkin lymphoma. It typically arises from the germinal center B-cells and is often diagnosed in adults. The disease is characterized by:

• Symptoms: Patients may present with painless lymphadenopathy, which can occur in various regions, including the abdomen. Other symptoms may include fever, night sweats, weight loss, and fatigue, although many patients remain asymptomatic for extended periods.
• Diagnosis: Diagnosis is usually confirmed through a combination of physical examination, imaging studies (such as CT scans), and biopsy of affected lymph nodes. Histological examination reveals a characteristic follicular architecture with neoplastic follicles.
• Staging: The Ann Arbor staging system is commonly used to determine the extent of the disease, which is crucial for treatment planning.

Specifics of C82.93

The designation of C82.93 indicates that the lymphoma is located in the intra-abdominal lymph nodes, which can include lymph nodes in the mesentery, retroperitoneum, or other abdominal regions. This localization can influence both the clinical presentation and the management of the disease.

• Clinical Implications: Intra-abdominal involvement may lead to complications such as bowel obstruction or abdominal pain due to lymphadenopathy. The presence of lymphoma in this area can also affect treatment decisions, as it may require more aggressive management compared to lymphomas confined to peripheral lymph nodes.
• Treatment Options: Treatment for follicular lymphoma may include watchful waiting for asymptomatic patients, chemotherapy, immunotherapy (such as rituximab), or targeted therapies depending on the stage and symptoms. The choice of treatment is often influenced by the patient's overall health, age, and specific disease characteristics.

Conclusion

ICD-10 code C82.93 is essential for accurately coding and billing for cases of follicular lymphoma that are unspecified and localized to intra-abdominal lymph nodes. Understanding the clinical implications of this diagnosis is crucial for effective patient management and treatment planning. As with all lymphomas, ongoing monitoring and follow-up are vital to assess treatment response and manage any potential complications.

Follicular lymphoma, classified under ICD-10 code C82.93, is a type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This particular code specifies cases where the lymphoma is unspecified and localized to intra-abdominal lymph nodes. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Overview of Follicular Lymphoma

Follicular lymphoma is characterized by the proliferation of B-lymphocytes, typically presenting as a slow-growing tumor. It is often indolent, meaning it may not cause significant symptoms in the early stages. However, as the disease progresses, it can lead to various clinical manifestations.

Signs and Symptoms

Patients with follicular lymphoma, particularly those with involvement of intra-abdominal lymph nodes, may exhibit a range of signs and symptoms, including:

• Lymphadenopathy: Swelling of lymph nodes, which may be palpable in the abdomen or groin. Patients may notice enlarged lymph nodes in the neck, axilla, or abdomen.
• Abdominal Pain or Discomfort: Due to the enlargement of intra-abdominal lymph nodes, patients may experience pain or a feeling of fullness in the abdomen.
• B Symptoms: These include fever, night sweats, and unexplained weight loss, which are indicative of more aggressive disease or systemic involvement.
• Fatigue: A common symptom in many cancer patients, fatigue can be pronounced in those with lymphoma.
• Anemia: Patients may present with signs of anemia, such as pallor or weakness, due to bone marrow involvement or chronic disease.

Patient Characteristics

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

• Age: Follicular lymphoma typically occurs in adults, with a median age of diagnosis around 60 years. It is rare in children.
• 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 lymphoproliferative disorders may also be a risk factor.

Diagnosis and Evaluation

Diagnosis of follicular lymphoma involves a combination of clinical evaluation, imaging studies, and histopathological examination. Key diagnostic steps include:

• Imaging Studies: CT scans or PET scans are often used to assess the extent of lymphadenopathy and to identify intra-abdominal lymph node involvement.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, which reveals the characteristic follicular pattern of neoplastic B-cells.
• Laboratory Tests: Blood tests may show abnormalities such as anemia or elevated lactate dehydrogenase (LDH) levels, which can indicate tumor burden.

Conclusion

Follicular lymphoma, particularly when localized to intra-abdominal lymph nodes, presents with a variety of clinical signs and symptoms that can significantly impact patient quality of life. Early recognition and diagnosis are essential for effective management. Understanding the typical patient characteristics and clinical presentation can aid healthcare providers in identifying and treating this condition promptly. Regular follow-up and monitoring are crucial for managing the disease, given its indolent nature and potential for transformation into a more aggressive form.

ICD-10 code C82.93 refers to "Follicular lymphoma, unspecified, intra-abdominal lymph nodes." This classification falls under the broader category of non-Hodgkin lymphoma, specifically follicular lymphoma, which is a type of cancer that originates in the lymphatic system.

Alternative Names for Follicular Lymphoma

1. Follicular Lymphoma, Grade 1: This term is often used to describe the less aggressive form of follicular lymphoma.
2. Follicular Lymphoma, Grade 2: This refers to a more aggressive variant of the disease.
3. Follicular Lymphoma, Grade 3: This is the most aggressive form and is sometimes classified as a separate entity (e.g., diffuse large B-cell lymphoma).
4. B-cell Follicular Lymphoma: This term emphasizes the B-cell origin of the lymphoma.

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 occur in follicular lymphoma.
3. Lymphoma: A general term for cancers that affect the lymphatic system.
4. Stage IV Lymphoma: If the disease has spread to the intra-abdominal lymph nodes, it may be classified as stage IV.
5. Chronic Lymphocytic Leukemia (CLL): While distinct, CLL can sometimes be confused with follicular lymphoma due to overlapping characteristics.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. The unspecified nature of C82.93 indicates that the specific grade or subtype of the lymphoma has not been determined, which can affect treatment decisions and prognosis. The involvement of intra-abdominal lymph nodes suggests a more advanced stage of the disease, which may require more aggressive treatment strategies.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.93 is crucial for healthcare professionals involved in the diagnosis and treatment of lymphomas. This knowledge aids in accurate coding, effective communication among medical teams, and appropriate patient management strategies. If you need further details on treatment options or prognosis related to follicular lymphoma, feel free to ask!

The diagnosis of Follicular Lymphoma, specifically coded as ICD-10 code C82.93 (Follicular lymphoma, unspecified, intra-abdominal lymph nodes), involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria and steps typically used in the diagnostic process:

Clinical Evaluation

1. Patient History: A thorough medical history is essential, including any symptoms such as lymphadenopathy (swollen lymph nodes), fatigue, weight loss, fever, or night sweats. These symptoms can indicate the presence of lymphoma.

2. Physical Examination: A physical exam will often reveal enlarged lymph nodes, particularly in the abdomen, which may be palpable during the examination.

Imaging Studies

1. Ultrasound: This imaging technique can help visualize enlarged intra-abdominal lymph nodes and assess their characteristics.

2. CT Scan: A computed tomography (CT) scan of the abdomen and pelvis is commonly used to identify the size, number, and location of lymph nodes involved in the disease.

3. PET Scan: Positron emission tomography (PET) scans may be utilized to evaluate metabolic activity in lymph nodes, helping to distinguish between benign and malignant processes.

Histopathological Examination

1. Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes. This can be done through:
   - Excisional Biopsy: Removal of an entire lymph node for examination.
   - Core Needle Biopsy: A less invasive method that removes a small cylinder of tissue.

2. Pathological Analysis: The biopsy specimen is examined microscopically by a pathologist. Key features include:
   - Follicular Architecture: The presence of follicle-like structures is characteristic of follicular lymphoma.
   - Cell Type: The identification of neoplastic B-cells, often with a specific immunophenotype (CD10+, BCL2+, and BCL6+), is crucial for diagnosis.

3. Immunohistochemistry: This technique is used to detect specific proteins in the lymphoma cells, confirming the diagnosis and helping to differentiate follicular lymphoma from other types of lymphoma.

Staging and Classification

1. Ann Arbor Staging System: Once diagnosed, the 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.

2. WHO Classification: Follicular lymphoma is classified under the World Health Organization (WHO) classification of lymphoid neoplasms, which helps in understanding the prognosis and treatment options.

Conclusion

The diagnosis of Follicular Lymphoma, particularly when it involves intra-abdominal lymph nodes, is a multifaceted process that combines clinical assessment, imaging, and histopathological evaluation. Accurate diagnosis is crucial for determining the appropriate treatment strategy and managing the disease effectively. If you have further questions or need more specific information, feel free to ask!