ICD-10: C82.94

Follicular lymphoma is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. The ICD-10-CM code C82.94 specifically refers to follicular lymphoma that is unspecified and located in the lymph nodes of the axilla (armpit area) and upper limb.

Clinical Description of Follicular Lymphoma

Overview

Follicular lymphoma is typically indolent, meaning it often progresses slowly compared to other types of lymphoma. It arises from B-lymphocytes and is classified as a low-grade lymphoma. The disease is characterized by the presence of neoplastic follicle-like structures in lymphoid tissue, which can lead to the enlargement of lymph nodes.

Symptoms

Patients with follicular lymphoma may present with:
- Painless swelling of lymph nodes, particularly in the neck, armpits, or groin.
- Fatigue or weakness.
- Unexplained weight loss.
- Night sweats.
- Fever.

Diagnosis

Diagnosis is usually confirmed through:
- Physical Examination: Assessment of swollen lymph nodes.
- Imaging Studies: CT scans or PET scans to evaluate the extent of the disease.
- Biopsy: A lymph node biopsy is essential for histological examination to confirm the diagnosis and subtype of lymphoma.

Staging

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 involvement of lymph nodes in the axilla and upper limb would be classified as stage II if localized to one side of the diaphragm.

Details for ICD-10 Code C82.94

Code Specification

• ICD-10 Code: C82.94
• Description: Follicular lymphoma, unspecified, lymph nodes of axilla and upper limb.
• Classification: This code falls under the category of non-Hodgkin lymphoma, specifically within the follicular lymphoma subtype.

Treatment Options

Treatment for follicular lymphoma may vary based on the stage and symptoms:
- Watchful Waiting: In asymptomatic cases, especially in early stages.
- Chemotherapy: Common regimens include combinations of drugs such as bendamustine, rituximab, or CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone).
- Radiation Therapy: Often used for localized disease.
- Targeted Therapy: Agents like rituximab or newer drugs such as copanlisib may be utilized.

Prognosis

The prognosis for patients with follicular lymphoma can vary widely. Factors influencing outcomes include the patient's age, overall health, the extent of the disease at diagnosis, and response to treatment. Generally, follicular lymphoma has a good prognosis, especially in early stages, but it can transform into a more aggressive form of lymphoma over time.

Conclusion

ICD-10 code C82.94 is crucial for accurately documenting cases of follicular lymphoma affecting the lymph nodes of the axilla and upper limb. Understanding the clinical presentation, diagnostic criteria, and treatment options is essential for healthcare providers managing patients with this condition. Regular follow-up and monitoring are important to address any changes in the disease status and to adjust treatment plans accordingly.

Follicular lymphoma, classified under ICD-10 code C82.94, 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 Characteristics

Follicular lymphoma is typically indolent, meaning it often progresses slowly. Patients may not exhibit symptoms in the early stages, and the disease can be asymptomatic for extended periods. When symptoms do occur, they may vary based on the extent of the disease and the specific lymph nodes involved.

Common Signs and Symptoms

1. Lymphadenopathy: The most common clinical finding is painless swelling of lymph nodes, particularly in the axillary (armpit) and upper limb regions. Patients may notice enlarged lymph nodes during self-examination or routine medical check-ups[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 that can soak clothing and bedding.
   - Weight Loss: Unintentional weight loss of more than 10% of body weight over six months[2].

3. Fatigue: Patients often report a general sense of fatigue or weakness, which can be attributed to the body's response to the lymphoma or the effects of the disease on overall health[3].

4. Pruritus: Some individuals may experience itching, which can be localized or generalized, although this symptom is less common[4].

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

Patient Characteristics

Demographics

• Age: Follicular lymphoma is more commonly diagnosed in adults, particularly those aged 50 and older. The median age at diagnosis is around 60 years[6].
• Gender: There is a slight male predominance, with men being more frequently diagnosed than women[7].

Risk Factors

• Family History: A family history of lymphoma or other hematologic malignancies may increase risk.
• Immune System Status: Patients with compromised immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, are at higher risk for developing lymphomas, including follicular lymphoma[8].
• Environmental Exposures: Certain environmental factors, such as exposure to pesticides or solvents, have been suggested as potential risk factors, although evidence is not definitive[9].

Comorbidities

Patients with follicular lymphoma may have other health conditions that can complicate diagnosis and treatment, including:
- Autoimmune Disorders: Conditions like rheumatoid arthritis or lupus may coexist with lymphoma.
- Other Cancers: A history of other malignancies can be relevant, as patients with one type of cancer may be at increased risk for developing another[10].

Conclusion

Follicular lymphoma, particularly when affecting the lymph nodes of the axilla and upper limb, presents with a range of clinical signs and symptoms, primarily characterized by painless lymphadenopathy and potential systemic symptoms. Understanding the patient demographics and risk factors is crucial for early detection and management. If you suspect follicular lymphoma based on these characteristics, it is essential to seek further evaluation through imaging studies and biopsy for definitive diagnosis and treatment planning.

ICD-10 code C82.94 refers specifically to "Follicular lymphoma, unspecified, lymph nodes of axilla and upper 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 for Follicular Lymphoma

1. Follicular Lymphoma, Unspecified: This is a direct synonym, emphasizing the unspecified nature of the lymphoma.
2. Follicular Lymphoma, Stage IV: In some contexts, this term may be used to describe advanced cases, although it is not specific to the axillary region.
3. Indolent Non-Hodgkin Lymphoma: Follicular lymphoma is often classified as an indolent (slow-growing) form of non-Hodgkin lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes follicular lymphoma among other types.
2. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with follicular lymphoma.
3. B-cell Lymphoma: Follicular lymphoma is a type of B-cell lymphoma, as it originates from B lymphocytes.
4. Lymphoma, Follicular Type: This term may be used interchangeably with follicular lymphoma, though it can sometimes refer to specific histological features.
5. Lymphoma, Low-Grade: Follicular lymphoma is often considered low-grade, indicating a slower progression compared to high-grade lymphomas.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. It is important to note that while C82.94 specifies the lymph nodes of the axilla and upper limb, follicular lymphoma can also present in other lymphatic regions and may have systemic manifestations.

Understanding these alternative names and related terms can aid healthcare professionals in accurately diagnosing and coding for this condition, ensuring appropriate treatment and management strategies are employed.

Follicular lymphoma, classified under ICD-10 code C82.94, 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 axilla and upper limb, involves several criteria and diagnostic steps.

Diagnostic Criteria for Follicular Lymphoma

1. Clinical Evaluation

• Symptoms: Patients may present with painless lymphadenopathy, which is often the first sign. Other symptoms can include fever, night sweats, and weight loss, although these are less common in early stages.
• Physical Examination: A thorough physical examination is essential to assess lymph node involvement, particularly in the axillary and upper limb regions.

2. Imaging Studies

• CT Scans: Computed tomography (CT) scans of the chest, abdomen, and pelvis are commonly used to evaluate the extent of lymphadenopathy and to identify any additional sites of disease.
• PET Scans: Positron emission tomography (PET) scans may be utilized to assess metabolic activity in lymph nodes and to differentiate between benign and malignant processes.

3. Histopathological Examination

• Biopsy: A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph node. This can be done through excisional biopsy or fine-needle aspiration (FNA).
• Histology: The biopsy specimen is examined microscopically for the characteristic follicular architecture and the presence of neoplastic follicle center cells. The diagnosis is confirmed if there is a predominance of small cleaved and large cells in a follicular pattern.

4. Immunophenotyping

• Flow Cytometry: This technique is used to analyze the surface markers on the cells obtained from the biopsy. Follicular lymphoma typically expresses CD19, CD20, and CD10, while showing a lack of expression of CD5.
• Genetic Studies: The presence of the t(14;18) chromosomal translocation, which results in the BCL2 gene rearrangement, is a hallmark of follicular lymphoma and can be detected through molecular techniques.

5. Staging

• 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 the presence of systemic symptoms. This staging is crucial for determining the prognosis and treatment approach.

Conclusion

The diagnosis of follicular lymphoma (ICD-10 code C82.94) involves a combination of clinical evaluation, imaging studies, histopathological examination, immunophenotyping, and staging. Each of these components plays a critical role in confirming the diagnosis and guiding treatment decisions. 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 C82.94, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This indolent form of lymphoma typically presents in the lymph nodes, including those in the axilla and upper limb. 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. Below, we explore the standard treatment modalities for this condition.

Standard Treatment Approaches

1. Watchful Waiting (Active Surveillance)

For patients with asymptomatic follicular lymphoma, especially those with early-stage disease, a strategy of watchful waiting may be employed. This approach involves regular monitoring without immediate treatment, as many patients may not require intervention for years. This is particularly relevant for indolent lymphomas, where the disease may progress slowly.

2. Chemotherapy

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

• CHOP Regimen: This includes Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone. It is often used for more aggressive forms or advanced stages of follicular lymphoma.
• R-CHOP: The addition of Rituximab (a monoclonal antibody) to the CHOP regimen has significantly improved outcomes. Rituximab 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 disease, particularly in cases where the lymphoma is confined to a limited number of lymph nodes. It may be used as a primary treatment or as a consolidation therapy following chemotherapy.

5. Targeted Therapy

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

• PI3K Inhibitors: Such as Copanlisib (Aliqopa), which is indicated for patients who have received at least two prior therapies.
• BCL-2 Inhibitors: Like Venetoclax, which can be used in combination with other agents for relapsed or refractory cases.

6. Stem Cell Transplantation

For patients with relapsed or refractory follicular lymphoma, autologous stem cell transplantation may be considered, particularly in younger patients or those with high-risk features. This approach involves high-dose chemotherapy followed by the infusion of the patient's own stem cells.

7. Radioimmunotherapy

This innovative treatment combines radiation therapy with immunotherapy. Agents like Ibritumomab tiuxetan deliver targeted radiation to lymphoma cells, minimizing damage to surrounding healthy tissue. It is typically used in relapsed cases or when other treatments have failed.

Conclusion

The management of follicular lymphoma, particularly for cases coded as C82.94, is multifaceted and tailored to the individual patient. Treatment decisions are influenced by the disease's stage, the patient's symptoms, and their overall health. Ongoing research continues to refine these approaches, with a focus on improving outcomes and minimizing treatment-related toxicity. Patients should engage in discussions with their healthcare providers to determine the most appropriate treatment strategy based on their specific circumstances.