ICD-10: C82.98

Clinical Description of ICD-10 Code C82.98: Follicular Lymphoma, Unspecified, Lymph Nodes of Multiple Sites

Overview of Follicular Lymphoma

Follicular lymphoma is a type of non-Hodgkin lymphoma (NHL) that originates from B-lymphocytes, specifically the follicle center cells. It is characterized by a slow-growing nature and is often diagnosed at an advanced stage. Follicular lymphoma is classified as indolent, meaning it typically progresses slowly compared to aggressive forms of lymphoma. The disease can manifest in various ways, including lymphadenopathy (swelling of lymph nodes), splenomegaly (enlargement of the spleen), and, in some cases, bone marrow involvement.

ICD-10 Code C82.98 Specifics

The ICD-10 code C82.98 specifically refers to "Follicular lymphoma, unspecified, lymph nodes of multiple sites." This code is used when the lymphoma is confirmed to be follicular in nature but lacks further specification regarding the exact characteristics or subtype of the lymphoma. The designation "unspecified" indicates that while the diagnosis is established, additional details about the disease's behavior, grade, or specific lymph node involvement are not provided.

Clinical Features

1. Symptoms: Patients with follicular lymphoma may present with:
   - Painless swelling of lymph nodes, often in the neck, armpits, or groin.
   - Fever, night sweats, and unexplained weight loss (B symptoms).
   - Fatigue and general malaise.

2. Diagnosis: Diagnosis typically involves:
   - Physical Examination: Assessment of lymphadenopathy.
   - Imaging Studies: CT scans or PET scans to evaluate lymph node involvement and staging.
   - Biopsy: A lymph node biopsy is essential for confirming the diagnosis and determining the histological subtype.

3. Staging: The Ann Arbor staging system is commonly used to classify the extent of lymphoma, which is crucial for treatment planning. C82.98 indicates involvement of multiple lymph node sites, which may suggest a more advanced stage of the disease.

Treatment Options

Treatment for follicular lymphoma can vary based on the stage of the disease, the patient's overall health, and specific symptoms. Common approaches include:

• Watchful Waiting: In cases where the lymphoma is asymptomatic and indolent, a "watch and wait" approach may be adopted.
• Chemotherapy: Regimens such as R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone) are frequently used.
• Immunotherapy: Rituximab, a monoclonal antibody, is often employed either alone or in combination with chemotherapy.
• Radiation Therapy: May be used for localized disease or to alleviate symptoms.

Prognosis

The prognosis for patients with follicular lymphoma can vary widely. Factors influencing outcomes include the patient's age, overall health, the extent of disease at diagnosis, and the specific characteristics of the lymphoma. Generally, follicular lymphoma has a good prognosis, especially in early stages, but it can be challenging to treat in advanced stages due to its tendency to relapse.

Conclusion

ICD-10 code C82.98 captures the essence of follicular lymphoma when it presents in multiple lymph node sites without further specification. Understanding the clinical features, diagnostic processes, treatment options, and prognosis associated with this condition is crucial for effective management and patient care. As research continues, advancements in treatment strategies may further improve outcomes for individuals diagnosed with this type of lymphoma.

Follicular lymphoma, classified under ICD-10 code C82.98, is a type of non-Hodgkin lymphoma characterized by the proliferation of follicle center (germinal center) B-cells. This condition typically presents with a range of clinical features, signs, and symptoms that can vary significantly among patients. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this diagnosis.

Clinical Presentation

General Overview

Follicular lymphoma is often indolent, meaning it tends to grow slowly. However, it can also transform into a more aggressive form. The clinical presentation may vary based on the extent of the disease and the specific sites involved, particularly when lymph nodes in multiple sites are affected.

Common Signs and Symptoms

1. Lymphadenopathy:
   - The most common presentation is painless swelling of lymph nodes, which may occur in multiple regions such as the neck, armpits, and 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, often soaking through clothing.
   • 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:
   - If lymph nodes in the abdomen are involved, patients may experience abdominal pain, fullness, or discomfort due to lymphadenopathy or splenomegaly (enlarged spleen).

5. Respiratory Symptoms:
   - In cases where lymph nodes in the chest are affected, patients may present with cough, shortness of breath, or chest discomfort.

Patient Characteristics

1. 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.

3. 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.
   • Immune System Disorders: Conditions that compromise the immune system, such as HIV/AIDS or autoimmune diseases.
   • Exposure to Chemicals: Prolonged exposure to certain chemicals, such as pesticides or solvents, has been associated with an increased risk.

4. Histological Features:
   - On histological examination, follicular lymphoma is characterized by the presence of neoplastic follicles, which can be identified through biopsy. The presence of specific markers, such as CD10, BCL2, and BCL6, is often used to confirm the diagnosis.

Conclusion

Follicular lymphoma, unspecified, lymph nodes of multiple sites (ICD-10 code C82.98), presents with a variety of clinical features, primarily painless lymphadenopathy, systemic B symptoms, and fatigue. Understanding the signs and symptoms, along with patient characteristics such as age and risk factors, is crucial for timely diagnosis and management. If you suspect follicular lymphoma based on these presentations, further diagnostic evaluation, including imaging and biopsy, is essential for confirmation and treatment planning.

ICD-10 code C82.98 refers to "Follicular lymphoma, unspecified, lymph nodes of multiple sites." 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. Below are alternative names and related terms associated with this diagnosis.

Alternative Names for Follicular Lymphoma

1. Follicular Lymphoma, Multiple Sites: This term emphasizes the involvement of multiple lymph node sites.
2. Follicular Lymphoma, Unspecified: This designation indicates that the specific characteristics of the lymphoma are not detailed.
3. Follicular Lymphoma, Stage IV: In some contexts, this may be used to describe advanced disease involving multiple lymph nodes, although staging is not directly synonymous with the ICD-10 code.
4. Indolent Non-Hodgkin Lymphoma: Follicular lymphoma is often classified as indolent, meaning it typically grows slowly compared to aggressive forms of lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): A broader category that includes various types of lymphomas, including follicular lymphoma.
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: A general term for cancers that affect the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
5. Chronic Lymphocytic Leukemia (CLL): While distinct, CLL can sometimes be confused with follicular lymphoma due to overlapping characteristics in lymphocyte proliferation.

Clinical Context

Follicular lymphoma is characterized by the proliferation of follicle center (germinal center) B-cells. It is often diagnosed through biopsy and may present with symptoms such as painless swelling of lymph nodes, fever, night sweats, and weight loss. The unspecified nature of C82.98 indicates that while the lymphoma is recognized, specific details about its behavior or characteristics are not provided, which can impact treatment decisions and prognosis.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C82.98 is crucial for healthcare professionals involved in the diagnosis and treatment of follicular lymphoma. This knowledge aids in accurate coding, effective communication among medical teams, and better patient management strategies. If you need further details on treatment options or prognosis related to this condition, feel free to ask!

Follicular lymphoma, classified under ICD-10 code C82.98, refers to a type of non-Hodgkin lymphoma that primarily affects the lymphatic system. This specific code is used when the lymphoma is unspecified and involves lymph nodes at multiple sites. The diagnosis of follicular lymphoma typically involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria and steps used in the diagnosis of this condition.

Clinical Evaluation

Symptoms

Patients may present with various symptoms, including:
- Painless swelling of lymph nodes, often in the neck, armpits, or groin.
- Fatigue or weakness.
- Unexplained weight loss.
- Night sweats.
- Fever.

These symptoms can vary significantly among individuals, and some may be asymptomatic at the time of diagnosis.

Imaging Studies

Radiological Assessment

Imaging techniques are crucial for assessing the extent of the disease:
- CT Scans: Computed tomography scans of the chest, abdomen, and pelvis are commonly used to identify enlarged lymph nodes and assess the involvement of other organs.
- PET Scans: Positron emission tomography scans can help determine the metabolic activity of lymph nodes and distinguish between active disease and scar tissue.

Histopathological Examination

Biopsy

A definitive diagnosis of follicular lymphoma requires a biopsy of the affected lymph nodes. The following steps are involved:
- Tissue Sampling: A fine needle aspiration (FNA) or excisional biopsy is performed to obtain tissue samples.
- Microscopic Examination: The samples are examined under a microscope by a pathologist. Key histological features of follicular lymphoma include:
- The presence of follicle-like structures.
- A predominance of small cleaved cells (centrocytes) and large cells (centroblasts).
- The characteristic follicular pattern of growth.

Immunophenotyping

Immunohistochemical staining is performed to identify specific markers:
- CD10, CD19, CD20, and BCL2: These markers are typically positive in follicular lymphoma, while CD5 is usually negative, helping to differentiate it from other types of lymphomas.

Genetic Testing

Molecular Analysis

Genetic testing may be conducted to identify chromosomal abnormalities, particularly the t(14;18) translocation, which is commonly associated with follicular lymphoma. This translocation leads to the overexpression of the BCL2 gene, contributing to the pathogenesis of the disease.

Staging

Ann Arbor Staging System

Once diagnosed, the disease is staged using the Ann Arbor classification, which assesses 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 (ICD-10 code C82.98) involves a comprehensive approach that includes clinical evaluation, imaging studies, histopathological examination, and genetic testing. Accurate diagnosis is essential for effective treatment planning and management of the disease. 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 C82.98, is a type of non-Hodgkin lymphoma (NHL) characterized by the proliferation of follicle center (germinal center) B-cells. This condition typically presents with lymphadenopathy, and its management can vary based on several factors, including the stage of the disease, the patient's overall health, and specific clinical characteristics. Below is an overview of standard treatment approaches for follicular lymphoma, particularly when it involves multiple lymph node sites.

Treatment Approaches for Follicular Lymphoma

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 forms of the disease, where the lymphoma may not progress significantly over time[1].

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 targeting CD20 on B-cells, which has been shown to improve outcomes significantly compared to CHOP alone[2].

3. Immunotherapy

Rituximab is often used in combination with chemotherapy or as a standalone treatment for patients who are not candidates for chemotherapy. It can be administered as:

• Monotherapy: For patients with relapsed or refractory disease.
• Maintenance Therapy: Following initial treatment to prolong remission[3].

4. Targeted Therapy

Recent advancements have introduced targeted therapies that focus on specific pathways involved in lymphoma cell survival. Examples include:

• Idelalisib: An oral inhibitor of the PI3K pathway, used in combination with rituximab for patients with relapsed follicular lymphoma.
• Venetoclax: A BCL-2 inhibitor that has shown promise in treating follicular lymphoma, particularly in patients with specific genetic mutations[4].

5. Radiation Therapy

Radiation therapy may be utilized in certain scenarios, particularly for localized disease or to alleviate symptoms from bulky lymphadenopathy. It is often used in conjunction with other treatments, especially in cases where the lymphoma is localized to a specific area[5].

6. Stem Cell Transplantation

For patients with 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 aggressive disease features[6].

7. Radioimmunotherapy

This innovative treatment combines radiation therapy with immunotherapy. Agents like ibritumomab tiuxetan deliver targeted radiation to lymphoma cells, providing a dual mechanism of action. This can be particularly effective in patients with relapsed disease[7].

Conclusion

The management of follicular lymphoma, particularly when it involves multiple lymph node sites, is multifaceted and tailored to the individual patient. Treatment strategies may range from active surveillance in asymptomatic cases to aggressive chemotherapy and novel therapies for more advanced disease. Ongoing research continues to refine these approaches, aiming to improve outcomes and quality of life for patients diagnosed with this type of lymphoma. Regular follow-up and assessment are crucial to adapt treatment plans as the disease evolves.

References

1. Non-Hodgkin Lymphoma Overview.
2. R-CHOP Regimen Efficacy.
3. Rituximab in Follicular Lymphoma.
4. Targeted Therapies in Lymphoma Treatment.
5. Role of Radiation Therapy in Lymphoma.
6. Stem Cell Transplantation for Lymphoma.
7. Radioimmunotherapy in Non-Hodgkin Lymphoma.