ICD-10: C83.31

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid growth of large B-cells in lymphoid tissues. The ICD-10 code C83.31 specifically refers to DLBCL located in the lymph nodes of the head, face, and neck. Here are some alternative names and related terms associated with this condition:

Alternative Names

1. Large B-cell lymphoma: A broader term that encompasses various types of B-cell lymphomas, including DLBCL.
2. Diffuse large B-cell lymphoma, nodal: This term emphasizes the nodal (lymph node) involvement of the lymphoma.
3. B-cell non-Hodgkin lymphoma: A general classification that includes DLBCL as one of its subtypes.
4. Aggressive B-cell lymphoma: Refers to the aggressive nature of DLBCL, highlighting its rapid progression.

Related Terms

1. Non-Hodgkin lymphoma (NHL): A category of lymphomas that includes DLBCL and other types of lymphomas that do not fall under Hodgkin lymphoma.
2. Lymphadenopathy: A term describing the enlargement of lymph nodes, which is a common symptom in patients with DLBCL.
3. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
4. B-cell lymphoma: A specific type of lymphoma that arises from B-cells, which are a type of white blood cell involved in the immune response.
5. Stage IV lymphoma: In cases where DLBCL has spread beyond the lymph nodes to other organs, it may be classified as stage IV.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in the diagnosis, treatment, and coding of DLBCL. Accurate coding using ICD-10 is essential for proper billing and insurance purposes, as well as for tracking epidemiological data related to this aggressive form of lymphoma.

In summary, the ICD-10 code C83.31 for diffuse large B-cell lymphoma in the lymph nodes of the head, face, and neck is associated with various alternative names and related terms that reflect its classification, symptoms, and clinical implications.

Diffuse large B-cell lymphoma (DLBCL), particularly when it affects the lymph nodes of the head, face, and neck, is a type of non-Hodgkin lymphoma characterized by aggressive behavior and a need for prompt treatment. The standard treatment approaches for this condition typically involve a combination of chemotherapy, immunotherapy, and sometimes radiation therapy. Below is a detailed overview of the standard treatment modalities for DLBCL, specifically for cases coded under ICD-10 C83.31.

1. Chemotherapy

R-CHOP Regimen

The cornerstone of treatment for DLBCL is the R-CHOP regimen, which includes:
- Rituximab: A monoclonal antibody targeting CD20 on B-cells.
- Cyclophosphamide: An alkylating agent that interferes with DNA replication.
- Doxorubicin (Adriamycin): An anthracycline antibiotic that disrupts DNA and RNA synthesis.
- Vincristine (Oncovin): A vinca alkaloid that inhibits cell division.
- Prednisone: A corticosteroid that helps reduce inflammation and suppress the immune response.

This combination is typically administered in cycles over several months, with the exact number of cycles depending on the patient's response and overall health status[1].

2. Immunotherapy

Targeted Therapy

In addition to chemotherapy, immunotherapy plays a significant role in treating DLBCL. Rituximab, as part of the R-CHOP regimen, is a key component. For patients with relapsed or refractory DLBCL, additional immunotherapeutic options may include:
- CAR-T Cell Therapy: This involves modifying a patient’s T-cells to better recognize and attack lymphoma cells. CAR-T therapy has shown promising results in patients who do not respond to standard treatments[2].
- Polatuzumab vedotin: An antibody-drug conjugate that targets CD79b, used in combination with other agents for relapsed cases[3].

3. Radiation Therapy

Indications for Radiation

Radiation therapy may be indicated in certain scenarios, particularly:
- Localized Disease: If the lymphoma is confined to a specific area, such as the head and neck, radiation may be used to target those lymph nodes directly.
- Post-Chemotherapy: Radiation can be employed after chemotherapy to eliminate any residual disease, especially in cases where there is a high risk of local recurrence[4].

4. Stem Cell Transplantation

High-Intensity Treatment

For patients with high-risk DLBCL or those who experience relapse after initial treatment, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) may be considered. This approach allows for the administration of higher doses of chemotherapy than would be tolerable without the support of stem cell rescue[5].

5. Clinical Trials

Emerging Therapies

Patients with DLBCL may also consider participation in clinical trials, which can provide access to new therapies and treatment strategies that are not yet widely available. These trials often explore novel agents, combinations, or treatment approaches that may improve outcomes for patients with this aggressive lymphoma[6].

Conclusion

The treatment of diffuse large B-cell lymphoma, particularly in the lymph nodes of the head, face, and neck, involves a multifaceted approach that includes chemotherapy, immunotherapy, and potentially radiation therapy or stem cell transplantation. The R-CHOP regimen remains the standard first-line treatment, while newer therapies like CAR-T cell therapy offer hope for patients with relapsed disease. As research continues, clinical trials may provide additional options for improving patient outcomes. It is essential for patients to discuss their specific case with their healthcare provider to determine the most appropriate treatment plan tailored to their individual needs.

References

1. Article - Billing and Coding: Radiation Therapies (A59350)
2. HCT for Non-Hodgkin Lymphoma
3. Medical Drug Clinical Criteria
4. ICD - O International Classification of Diseases for Oncology
5. CAR-T CELL & GENE
6. Medical Policy - MMM-pr.com

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid proliferation of large B lymphocytes. The ICD-10 code C83.31 specifically refers to DLBCL located in the lymph nodes of the head, face, and neck. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Diffuse Large B-Cell Lymphoma (DLBCL)

Overview

DLBCL is the most common subtype of non-Hodgkin lymphoma, accounting for approximately 30% of all cases. It can arise in lymph nodes or extranodal sites and is known for its aggressive nature, often presenting with rapidly enlarging masses. The disease can occur at any age but is more prevalent in older adults.

Pathophysiology

DLBCL originates from B cells, which are a type of white blood cell involved in the immune response. The exact cause of DLBCL is not fully understood, but several risk factors have been identified, including:

• Immunosuppression: Conditions such as HIV/AIDS or organ transplantation can increase the risk.
• Autoimmune diseases: Disorders like rheumatoid arthritis or Sjögren's syndrome may predispose individuals to DLBCL.
• Genetic mutations: Certain chromosomal abnormalities and mutations in genes such as BCL2 and MYC are associated with DLBCL.

Symptoms

Patients with DLBCL may present with a variety of symptoms, including:

• Lymphadenopathy: Swelling of lymph nodes, particularly in the head, face, and neck region, which may be painless.
• B symptoms: These include fever, night sweats, and unexplained weight loss.
• Fatigue: Generalized weakness and fatigue are common complaints.
• Respiratory symptoms: If lymph nodes in the neck compress airways, patients may experience difficulty breathing or swallowing.

Diagnosis

Diagnosis of DLBCL typically involves:

• Physical examination: Assessment of lymphadenopathy and other systemic symptoms.
• Imaging studies: CT scans or PET scans to evaluate the extent of disease.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph node, followed by histopathological examination to identify the presence of large B cells.

Treatment

The treatment for DLBCL often includes:

• Chemotherapy: The standard treatment regimen is R-CHOP, which combines rituximab with cyclophosphamide, doxorubicin, vincristine, and prednisone.
• Radiation therapy: May be used in localized cases or as a consolidation treatment after chemotherapy.
• Stem cell transplant: Considered for relapsed or refractory cases.

Prognosis

The prognosis for patients with DLBCL varies based on several factors, including the stage of the disease at diagnosis, the patient's age, and overall health. The International Prognostic Index (IPI) is commonly used to assess risk and guide treatment decisions.

Conclusion

ICD-10 code C83.31 designates diffuse large B-cell lymphoma affecting the lymph nodes of the head, face, and neck. This aggressive lymphoma requires prompt diagnosis and treatment to improve patient outcomes. Understanding the clinical features, diagnostic methods, and treatment options is crucial for healthcare providers managing patients with this condition. Regular follow-up and monitoring are essential to address potential relapses and manage any long-term effects of treatment.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid proliferation of large B-cells. The ICD-10 code C83.31 specifically refers to DLBCL affecting the lymph nodes of the head, face, and neck. Understanding the clinical presentation, signs, symptoms, and patient characteristics associated with this condition is crucial for diagnosis and management.

Clinical Presentation

Signs and Symptoms

Patients with DLBCL in the lymph nodes of the head, face, and neck may exhibit a variety of signs and symptoms, including:

• Lymphadenopathy: The most common presentation is the enlargement of lymph nodes in the neck, which may be painless or tender. Patients often notice swelling in the jaw, neck, or behind the ears.
• Systemic Symptoms: Patients may experience constitutional symptoms such as:
• Fever: Often low-grade but can be persistent.
• Night Sweats: Profuse sweating during the night that can soak clothing and bedding.
• Weight Loss: Unintentional weight loss over a short period, typically more than 10% of body weight.
• Fatigue: A common complaint, often due to the body's response to the malignancy.
• Respiratory Symptoms: If lymph nodes compress the airway, patients may experience difficulty breathing or stridor.
• Facial Swelling: Involvement of lymph nodes can lead to facial edema, particularly if there is obstruction of venous drainage.

Patient Characteristics

Certain demographic and clinical characteristics are often associated with DLBCL:

• Age: DLBCL can occur at any age but is more common in older adults, typically those aged 60 and above.
• Gender: There is a slight male predominance in the incidence of DLBCL.
• Comorbidities: Patients may have underlying conditions such as autoimmune diseases or immunosuppression, which can increase the risk of developing lymphomas.
• Ethnicity: While DLBCL can affect individuals of any ethnicity, some studies suggest variations in incidence and outcomes among different racial groups.

Diagnostic Considerations

Diagnosis of DLBCL typically involves a combination of clinical evaluation, imaging studies, and histopathological examination:

• Imaging: CT scans or PET scans are often used to assess the extent of disease and involvement of lymph nodes.
• Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph node, which is then examined histologically to confirm the presence of large B-cells.
• Immunophenotyping: Flow cytometry or immunohistochemistry is used to characterize the lymphoma cells and confirm the diagnosis.

Conclusion

Diffuse large B-cell lymphoma affecting the lymph nodes of the head, face, and neck presents with distinctive clinical features, including lymphadenopathy and systemic symptoms. Understanding these characteristics is essential for timely diagnosis and effective management. Early recognition and intervention can significantly impact patient outcomes, making awareness of the signs and symptoms critical for healthcare providers.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid growth of large B lymphocytes. The ICD-10 code C83.31 specifically refers to DLBCL located in the lymph nodes of the head, face, and neck. The diagnosis of DLBCL involves several criteria, which can be categorized into clinical, histopathological, and imaging assessments.

Clinical Criteria

1. Symptoms: Patients may present with symptoms such as:
   - Painless swelling of lymph nodes in the head, face, or neck.
   - Systemic symptoms like fever, night sweats, and unexplained weight loss (often referred to as "B symptoms").
   - Fatigue and malaise.

2. Physical Examination: A thorough physical examination is essential to identify enlarged lymph nodes and any other signs of lymphoma.

Histopathological Criteria

1. Biopsy: A definitive diagnosis of DLBCL requires a biopsy of the affected lymph node. The biopsy can be:
   - Excisional (removal of an entire lymph node).
   - Incisional (removal of a portion of the lymph node).
   - Core needle biopsy.

2. Microscopic Examination: The biopsy specimen is examined under a microscope by a pathologist. Key histological features include:
   - Presence of large atypical B cells.
   - A diffuse pattern of growth.
   - Lack of significant fibrosis or necrosis.

3. Immunophenotyping: Immunohistochemical staining is performed to determine the cell type. DLBCL typically expresses:
   - CD19, CD20, and CD22 (B-cell markers).
   - CD10, BCL-6, and MUM1 may also be assessed to help classify the subtype of DLBCL.

4. Genetic Testing: In some cases, genetic tests may be performed to identify specific chromosomal abnormalities, such as the presence of the BCL2 gene rearrangement, which can influence prognosis and treatment decisions.

Imaging Studies

1. CT or PET Scans: Imaging studies are crucial for staging the disease and assessing the extent of lymph node involvement. These scans help determine:
   - The size and number of affected lymph nodes.
   - Involvement of other organs or tissues.

2. MRI: In certain cases, MRI may be used, especially if there is concern about central nervous system involvement.

Staging

The Ann Arbor staging system is commonly used to classify the extent of lymphoma. Staging involves determining whether the lymphoma is localized (stage I or II) or disseminated (stage III or IV). This classification is based on the number of lymph node regions involved and whether extranodal sites are affected.

Conclusion

The diagnosis of diffuse large B-cell lymphoma, particularly in the lymph nodes of the head, face, and neck, relies on a combination of clinical evaluation, histopathological examination, immunophenotyping, and imaging studies. Accurate diagnosis is essential for determining the appropriate treatment plan and prognosis for the patient. If you have further questions or need more specific information, feel free to ask!