ICD-10: C83.33

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid proliferation of large B lymphocytes. It is one of the most common forms of lymphoma, accounting for a significant percentage of all non-Hodgkin lymphoma cases. The ICD-10 code C83.33 specifically refers to DLBCL that primarily affects intra-abdominal lymph nodes.

Clinical Description of Diffuse Large B-Cell Lymphoma

Pathophysiology

DLBCL arises from B cells, which are a type of white blood cell involved in the immune response. The disease is marked by the presence of large, atypical lymphoid cells in lymphoid tissues. The exact cause of DLBCL is not fully understood, but it is associated with various risk factors, including age, immunosuppression, and certain infections (e.g., Epstein-Barr virus).

Symptoms

Patients with DLBCL may present with a variety of symptoms, which can include:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the neck, armpits, or groin.
- Abdominal Symptoms: In cases where intra-abdominal lymph nodes are involved, patients may experience abdominal pain, swelling, or discomfort.
- Systemic Symptoms: Fever, night sweats, and unexplained weight loss (often referred to as "B symptoms") are common in lymphoma patients.
- Fatigue: A general feeling of tiredness or weakness.

Diagnosis

Diagnosis of DLBCL typically involves:
- Imaging Studies: CT scans or PET scans to identify the extent of lymph node involvement and any abdominal masses.
- Biopsy: A definitive diagnosis is made through a biopsy of the affected lymph nodes, which allows for histological examination and immunophenotyping to confirm the presence of large B cells.
- Staging: The disease is staged using the Ann Arbor classification, which helps determine the extent of the disease and guides treatment decisions.

Treatment Options

Treatment for DLBCL often involves a combination of therapies, including:
- Chemotherapy: The standard treatment regimen is R-CHOP, which includes rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.
- Radiation Therapy: May be used in localized cases or as a consolidation treatment after chemotherapy.
- Stem Cell Transplant: In certain cases, particularly for relapsed or refractory disease, autologous or allogeneic stem cell transplantation may be considered.

Prognosis

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

Conclusion

ICD-10 code C83.33 specifically identifies diffuse large B-cell lymphoma affecting intra-abdominal lymph nodes, highlighting the importance of accurate coding for effective treatment and management of this aggressive lymphoma type. Early diagnosis and appropriate treatment are crucial for improving patient outcomes in DLBCL. For further information on coding and billing related to this condition, healthcare providers can refer to specific medical coding resources and guidelines.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid proliferation of large B-cells. When it specifically involves intra-abdominal lymph nodes, it presents with a unique set of clinical features, signs, symptoms, and patient characteristics. Below is a detailed overview of these aspects related to ICD-10 code C83.33.

Clinical Presentation

Overview of DLBCL

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, including the gastrointestinal tract, skin, and central nervous system. The intra-abdominal variant often involves lymph nodes in the abdomen, which can lead to various systemic and localized symptoms.

Signs and Symptoms

Patients with DLBCL involving intra-abdominal lymph nodes may present with a range of symptoms, which can be categorized as follows:

General Symptoms

• B Symptoms: These include fever, night sweats, and unexplained weight loss. B symptoms are significant as they often indicate a more aggressive disease and poorer prognosis[1].
• Fatigue: Patients frequently report a general sense of tiredness or lack of energy, which can be debilitating[1].

Abdominal Symptoms

• Abdominal Pain: This is a common complaint, often due to lymphadenopathy or organ involvement. The pain may be localized or diffuse, depending on the extent of the disease[1][2].
• Abdominal Distension: Patients may experience a feeling of fullness or bloating, which can be attributed to enlarged lymph nodes or associated fluid accumulation (ascites)[2].
• Nausea and Vomiting: These symptoms can occur due to gastrointestinal involvement or obstruction caused by enlarged lymph nodes[2].

Other Symptoms

• Lymphadenopathy: Patients may have palpable lymph nodes in the abdomen or other areas, which can be detected during a physical examination[1].
• Splenomegaly: Enlargement of the spleen may occur, leading to discomfort and further abdominal symptoms[2].

Patient Characteristics

Demographics

• Age: DLBCL can occur at any age but is most commonly diagnosed in older adults, typically between the ages of 60 and 70[1][3].
• Gender: There is a slight male predominance in DLBCL cases, with men being more frequently affected than women[3].

Risk Factors

• Immunocompromised State: Patients with weakened immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, are at increased risk for developing DLBCL[3].
• Chronic Infections: Certain infections, such as Epstein-Barr virus (EBV) and hepatitis C virus (HCV), have been associated with an increased risk of lymphoma[3].
• Family History: A family history of lymphoma or other hematologic malignancies may also increase risk[3].

Comorbidities

Patients with DLBCL may present with various comorbid conditions, including cardiovascular disease, diabetes, and other malignancies, which can complicate treatment and management strategies[1][2].

Conclusion

Diffuse large B-cell lymphoma, particularly when involving intra-abdominal lymph nodes, presents with a distinct clinical picture characterized by systemic symptoms, abdominal discomfort, and specific patient demographics. Recognizing these signs and symptoms is crucial for timely diagnosis and effective management. Early intervention can significantly impact patient outcomes, emphasizing the importance of awareness among healthcare providers regarding this aggressive lymphoma subtype.

For further information on diagnosis and treatment options, healthcare professionals should refer to the latest clinical guidelines and research studies related to DLBCL management.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid growth of large B-cells in lymphatic tissues. The ICD-10 code C83.33 specifically refers to DLBCL that is localized in the intra-abdominal lymph nodes. Here are some alternative names and related terms associated with this condition:

Alternative Names for Diffuse Large B-Cell Lymphoma

1. Large Cell Lymphoma: This term is often used interchangeably with DLBCL, emphasizing the size of the malignant cells.
2. B-Cell Lymphoma: A broader category that includes various types of lymphomas originating from B-cells, including DLBCL.
3. Aggressive B-Cell Lymphoma: This term highlights the aggressive nature of DLBCL, which typically requires prompt treatment.
4. Non-Hodgkin Lymphoma, Diffuse Large B-Cell Type: This is a more descriptive term that places DLBCL within the larger category of non-Hodgkin lymphomas.

Related Terms

1. ICD-10 Code C83.3: This is the broader category for all types of diffuse large B-cell lymphoma, with C83.33 being the specific code for intra-abdominal lymph node involvement.
2. Follicular Lymphoma: While distinct, this is another type of non-Hodgkin lymphoma that can sometimes be confused with DLBCL due to overlapping symptoms and treatment approaches.
3. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
4. Stage IV Lymphoma: DLBCL can be classified as stage IV if it has spread to distant lymph nodes or organs, including the abdominal area.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in diagnosis, treatment, and coding for billing purposes. Accurate coding is essential for effective communication among healthcare providers and for ensuring appropriate reimbursement for services rendered.

In summary, the ICD-10 code C83.33 for diffuse large B-cell lymphoma affecting intra-abdominal lymph nodes is associated with various alternative names and related terms that reflect its classification and clinical significance.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid growth of large B-cells. The ICD-10 code C83.33 specifically refers to DLBCL that is located in the intra-abdominal lymph nodes. The diagnosis of DLBCL, including its intra-abdominal manifestation, involves several criteria and diagnostic steps.

Diagnostic Criteria for DLBCL

1. Clinical Evaluation

• Symptoms: Patients may present with symptoms such as unexplained weight loss, fever, night sweats, and fatigue, often referred to as "B symptoms." Abdominal pain or swelling may also occur if intra-abdominal lymph nodes are involved[1].
• Physical Examination: A thorough physical examination may reveal lymphadenopathy (swollen lymph nodes) in the abdomen or other areas.

2. Imaging Studies

• CT Scans: Computed tomography (CT) scans of the abdomen and pelvis are commonly used to identify enlarged lymph nodes and assess the extent of the disease. These scans help visualize the intra-abdominal lymph nodes and any associated masses[1].
• PET Scans: Positron emission tomography (PET) scans may be utilized to evaluate metabolic activity in lymph nodes and other tissues, aiding in the diagnosis and staging of lymphoma[1].

3. Biopsy

• Tissue Sampling: A definitive diagnosis of DLBCL requires a biopsy of the affected lymph node or tissue. This can be performed through various methods, including:
• Excisional Biopsy: Removal of an entire lymph node for examination.
• Core Needle Biopsy: A less invasive method that uses a needle to extract a core of tissue from the lymph node.
• Histopathological Examination: The biopsy sample is examined microscopically to identify the presence of large atypical B-cells, which are characteristic of DLBCL. Immunohistochemistry tests are often performed to confirm the B-cell lineage and to rule out other types of lymphoma[1].

4. Laboratory Tests

• Blood Tests: Routine blood tests may be conducted to assess overall health and to check for anemia, elevated lactate dehydrogenase (LDH) levels, and other markers that may indicate lymphoma[1].
• Cytogenetic and Molecular Studies: Additional tests may be performed on the biopsy sample to identify specific genetic abnormalities associated with DLBCL, which can influence prognosis and treatment options[1].

5. Staging

• Ann Arbor Staging System: Once diagnosed, the lymphoma is staged using the Ann Arbor classification, which considers the number of lymph node regions involved and whether the disease has spread to other organs. Intra-abdominal involvement is classified as stage II or higher, depending on the extent of the disease[1].

Conclusion

The diagnosis of diffuse large B-cell lymphoma, particularly when involving intra-abdominal lymph nodes, is a multifaceted process that includes clinical evaluation, imaging studies, biopsy, laboratory tests, and staging. Each of these components plays a crucial role in confirming the diagnosis and guiding treatment decisions. For accurate coding and documentation, it is essential to follow these diagnostic criteria closely, as they align with the ICD-10 code C83.33 for DLBCL in intra-abdominal lymph nodes.

Diffuse large B-cell lymphoma (DLBCL), particularly when it involves intra-abdominal lymph nodes, is a type of non-Hodgkin lymphoma characterized by aggressive behavior and a need for prompt treatment. The standard treatment approaches for DLBCL, including cases coded under ICD-10 C83.33, typically involve a combination of chemotherapy, immunotherapy, and sometimes radiation therapy. Below is a detailed overview of the standard treatment modalities.

1. Chemotherapy

R-CHOP Regimen

The cornerstone of treatment for DLBCL is the R-CHOP regimen, which combines:
- Rituximab: A monoclonal antibody targeting CD20 on B-cells.
- Cyclophosphamide: An alkylating agent that interferes with DNA replication.
- Doxorubicin (Adriamycin): An anthracycline 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 regimen 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

Monoclonal Antibodies

In addition to chemotherapy, the use of monoclonal antibodies like Rituximab has significantly improved outcomes for patients with DLBCL. Rituximab is often given in conjunction with chemotherapy to enhance the effectiveness of the treatment[2].

Tafasitamab (Monjuvi)

For patients who are not candidates for standard chemotherapy or have relapsed disease, Tafasitamab (Monjuvi) is an option. It is a CD19-targeting monoclonal antibody that can be used in combination with lenalidomide for patients with relapsed or refractory DLBCL[3].

3. Radiation Therapy

While chemotherapy and immunotherapy are the primary treatments, radiation therapy may be considered in specific scenarios, such as:
- Localized disease: If the lymphoma is confined to a specific area and has not spread extensively.
- Post-chemotherapy: To target residual disease after the initial treatment.

Radiation therapy is typically used in conjunction with systemic therapies to improve local control of the disease[4].

4. Stem Cell Transplantation

For patients with high-risk DLBCL or those who experience relapse after initial treatment, hematopoietic stem cell transplantation (HCT) may be considered. This approach involves:
- Autologous stem cell transplant: Using the patient's own stem cells after high-dose chemotherapy.
- Allogeneic stem cell transplant: Using stem cells from a donor, which may be considered in certain cases of refractory disease[5].

5. Clinical Trials

Patients with DLBCL are often encouraged to consider participation in clinical trials, which may offer access to novel therapies and treatment strategies that are not yet widely available. These trials can provide valuable options for patients who have limited responses to standard treatments[6].

Conclusion

The treatment of diffuse large B-cell lymphoma, particularly when it involves intra-abdominal lymph nodes, is multifaceted and tailored to the individual patient. The R-CHOP regimen remains the standard first-line therapy, supplemented by immunotherapy and, in some cases, radiation or stem cell transplantation. Ongoing research and clinical trials continue to evolve the treatment landscape, offering hope for improved outcomes in this aggressive form of lymphoma. For patients and healthcare providers, staying informed about the latest treatment options and clinical trials is crucial for optimizing care.

References

1. Non-Hodgkin Lymphoma Treatment Guidelines.
2. Immunotherapy in Non-Hodgkin Lymphoma.
3. Tafasitamab (Monjuvi) Clinical Use.
4. Radiation Therapy in Lymphoma Treatment.
5. Stem Cell Transplantation for Lymphoma.
6. Clinical Trials in Lymphoma Treatment.