ICD-10: C83.34

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid proliferation of large B-lymphoid cells. The ICD-10-CM code C83.34 specifically refers to DLBCL that affects the lymph nodes of the axilla (armpit area) and upper limb. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description of Diffuse Large B-Cell Lymphoma

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, requiring prompt diagnosis and treatment. The disease is characterized by the presence of large, atypical lymphoid cells that can grow rapidly, leading to significant clinical symptoms.

Symptoms

Patients with DLBCL may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the axillary region, which may be painless or tender.
- B Symptoms: These include fever, night sweats, and unexplained weight loss, which are indicative of systemic involvement.
- Fatigue: Generalized weakness and fatigue are common due to the disease's metabolic demands.
- Local Symptoms: Depending on the location of the lymphoma, patients may experience pain or discomfort in the affected area.

Diagnosis

Diagnosis of DLBCL typically involves:
- Histopathological Examination: A biopsy of the affected lymph node is essential for confirming the diagnosis. The tissue is examined microscopically to identify the characteristic large B-cells.
- Immunophenotyping: This process helps determine the specific type of lymphoma by analyzing cell surface markers.
- Imaging Studies: CT scans or PET scans may be used to assess the extent of the disease and to identify any extranodal involvement.

Staging

DLBCL is staged using the Ann Arbor classification, which considers the number of lymph node regions involved and whether the disease has spread to extranodal sites. The stage of the disease significantly influences treatment decisions and prognosis.

Treatment Options

The treatment for DLBCL typically involves:
- Chemotherapy: The standard treatment regimen is R-CHOP, which includes rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone.
- Radiation Therapy: This may be used in localized cases or as a consolidation treatment after chemotherapy.
- Targeted Therapy: Newer agents, such as CAR T-cell therapy, may be considered for relapsed or refractory cases.

Prognosis

The prognosis for patients with DLBCL varies based on several factors, including the stage at diagnosis, the patient's age, overall health, and response to initial treatment. The International Prognostic Index (IPI) is often used to predict outcomes based on these factors.

Conclusion

ICD-10 code C83.34 specifically identifies diffuse large B-cell lymphoma affecting the lymph nodes of the axilla and upper limb. Understanding the clinical presentation, diagnostic methods, treatment options, and prognosis is crucial for effective management of this aggressive lymphoma subtype. Early detection and appropriate treatment are key to improving patient outcomes.

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 C83.34 specifically refers to DLBCL located in the lymph nodes of the axilla and upper limb. 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 may present with a variety of signs and symptoms, which can vary based on the extent of the disease and the specific lymph nodes involved. Common presentations include:

• Lymphadenopathy: The most prominent sign is the enlargement of lymph nodes, particularly in the axillary region. Patients may notice a palpable mass in the armpit or upper limb.
• Systemic Symptoms: Many patients experience "B symptoms," which include:
• Fever: Often low-grade but can be persistent.
• Night Sweats: Profuse sweating during the night that may soak clothing and bedding.
• Weight Loss: Unintentional weight loss of more than 10% of body weight over six months.
• Fatigue: A common complaint, often due to the body's response to the malignancy.
• Pain: Some patients may experience pain in the affected area, particularly if the lymph nodes are pressing on surrounding structures.

Additional Symptoms

In advanced cases, patients may exhibit:
- Splenomegaly: Enlargement of the spleen, which can be detected during a physical examination.
- Hepatomegaly: Enlargement of the liver may also occur, although it is less common.
- Respiratory Symptoms: If lymph nodes in the mediastinum are involved, patients may experience cough or difficulty breathing.

Patient Characteristics

Demographics

• Age: DLBCL can occur at any age but is most commonly diagnosed in adults, particularly those aged 60 and older.
• Gender: There is a slight male predominance in the incidence of DLBCL.

Risk Factors

Several risk factors have been associated with an increased likelihood of developing DLBCL:
- Immunosuppression: Patients with weakened immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, are at higher risk.
- Autoimmune Diseases: Conditions like rheumatoid arthritis or lupus may increase the risk of lymphoma.
- Family History: A family history of lymphoma or other hematologic malignancies can be a contributing factor.

Comorbidities

Patients may present with various comorbid conditions that can complicate the management of DLBCL, including:
- Cardiovascular Disease: Pre-existing heart conditions may affect treatment options.
- Diabetes: Can influence overall health and treatment response.

Conclusion

Diffuse large B-cell lymphoma, particularly in the lymph nodes of the axilla and upper limb, presents with distinct clinical features that include lymphadenopathy, systemic symptoms, and fatigue. Understanding the demographic and risk factors associated with this condition is essential for timely diagnosis and effective management. Early recognition of symptoms and appropriate diagnostic workup can significantly impact patient outcomes, making awareness of these characteristics vital for healthcare providers.

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 C83.34 specifically refers to DLBCL located in the lymph nodes of the axilla (armpit area) and upper limb. Here are some alternative names and related terms associated with this condition:

Alternative Names

1. Diffuse Large B-Cell Lymphoma (DLBCL): This is the primary name for the condition, emphasizing its diffuse nature and the type of cells involved.
2. B-cell Lymphoma: A broader term that encompasses various types of lymphomas originating from B-cells, including DLBCL.
3. Non-Hodgkin Lymphoma (NHL): DLBCL is a subtype of non-Hodgkin lymphoma, which includes a variety of lymphomas that do not fall under the Hodgkin lymphoma category.

Related Terms

1. Lymphoma: A general term for cancers that originate in the lymphatic system, which includes both Hodgkin and non-Hodgkin lymphomas.
2. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in patients with DLBCL.
3. Stage II Non-Hodgkin Lymphoma: If the lymphoma is localized to the axilla and upper limb, it may be classified as Stage II, indicating that it has spread to nearby lymph nodes.
4. B-cell Neoplasm: A term that describes tumors arising from B-cells, which includes DLBCL among other types of B-cell lymphomas.
5. Aggressive Lymphoma: DLBCL is often classified as an aggressive lymphoma due to its rapid growth and the need for prompt treatment.

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, such as using ICD-10 code C83.34, is essential for proper billing and medical record-keeping, ensuring that patients receive appropriate care and that healthcare providers are reimbursed correctly for their services.

In summary, the terminology surrounding diffuse large B-cell lymphoma is diverse, reflecting its classification within the broader categories of lymphomas and B-cell neoplasms. Recognizing these terms can aid in effective communication among healthcare providers and enhance patient understanding of their diagnosis.

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 C83.34 specifically refers to DLBCL located in the lymph nodes of the axilla and upper limb. Diagnosing this condition involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria used for diagnosis:

Clinical Evaluation

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

2. Physical Examination: A thorough physical examination is essential to assess lymphadenopathy and any other signs of systemic involvement.

Imaging Studies

1. Ultrasound: This imaging modality can help visualize lymph nodes and assess their size and characteristics.

2. CT Scan: A computed tomography scan of the chest, abdomen, and pelvis is often performed to evaluate the extent of lymphadenopathy and to check for any other involved sites.

3. PET Scan: Positron emission tomography may be used to assess metabolic activity in lymph nodes and to help stage the disease.

Histopathological Examination

1. Biopsy: A definitive diagnosis of DLBCL requires a biopsy of the affected lymph node. This can be done through:
   - Excisional biopsy: Removal of an entire lymph node.
   - Core needle biopsy: Removal of a small core of tissue from the lymph node.

2. Immunohistochemistry: The biopsy specimen is analyzed using immunohistochemical staining to identify specific markers characteristic of DLBCL, such as:
   - CD19, CD20, CD22, and CD79a (B-cell markers).
   - Ki-67 proliferation index to assess the growth rate of the tumor.

3. Molecular Studies: Additional tests, such as fluorescence in situ hybridization (FISH), may be performed to detect genetic abnormalities associated with DLBCL, including the presence of the MYC gene rearrangement.

Staging

The Ann Arbor staging system is commonly used to determine the extent of the disease, which is crucial for treatment planning. Staging involves assessing whether the lymphoma is localized (stage I or II) or has spread to other parts of the body (stage III or IV).

Conclusion

The diagnosis of diffuse large B-cell lymphoma, particularly in the lymph nodes of the axilla and upper limb, relies on a comprehensive approach that includes clinical assessment, imaging studies, and histopathological confirmation. Early diagnosis and accurate staging are vital for effective treatment and management of the disease. If you have further questions or need more specific information, feel free to ask!

Diffuse large B-cell lymphoma (DLBCL), classified under ICD-10 code C83.34, is a common and aggressive form of non-Hodgkin lymphoma (NHL) that primarily affects B-lymphocytes. The treatment for DLBCL typically involves a combination of chemotherapy, immunotherapy, and sometimes radiation therapy, depending on the stage of the disease and the patient's overall health. Below is a detailed overview of the standard treatment approaches for this condition.

Standard Treatment Approaches

1. Chemotherapy

The cornerstone of treatment for DLBCL is chemotherapy, often administered in combination regimens. The most widely used regimen is R-CHOP, which includes:

• Rituximab: A monoclonal antibody that targets CD20 on B-cells.
• Cyclophosphamide: An alkylating agent that interferes with DNA replication.
• Doxorubicin (Adriamycin): An anthracycline antibiotic that disrupts DNA 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 specific clinical factors[1][2].

2. Immunotherapy

In addition to chemotherapy, immunotherapy plays a crucial role in treating DLBCL. Rituximab, as mentioned, is a key component of the R-CHOP regimen. For patients with relapsed or refractory DLBCL, other immunotherapeutic options may include:

• CAR T-cell therapy: This involves modifying a patient's T-cells to better recognize and attack cancer cells. CAR T-cell therapy has shown promising results in patients with aggressive forms of DLBCL who have not responded to standard treatments[3].
• Polatuzumab vedotin: An antibody-drug conjugate that targets CD79b, used in combination with other agents for relapsed DLBCL[4].

3. Radiation Therapy

Radiation therapy may be used in specific situations, particularly for localized disease or to target residual disease after chemotherapy. It is not typically the primary treatment for DLBCL but can be effective in certain cases, especially when lymph nodes are involved in the axilla and upper limb[5].

4. Stem Cell Transplantation

For patients with high-risk or relapsed DLBCL, autologous stem cell transplantation (ASCT) may be considered. This involves harvesting the patient's stem cells, administering high-dose chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function[6].

5. Clinical Trials

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 approaches to improve outcomes for patients with this aggressive lymphoma[7].

Conclusion

The treatment of diffuse large B-cell lymphoma, particularly in the lymph nodes of the axilla and upper limb, involves a multifaceted approach that includes chemotherapy, immunotherapy, and potentially radiation therapy or stem cell transplantation. The choice of treatment is tailored to the individual patient based on various factors, including the stage of the disease, the presence of specific biomarkers, and the patient's overall health. Ongoing research and clinical trials continue to enhance the understanding and management of this complex disease, offering hope for improved outcomes in affected patients.

For the most current treatment options and clinical guidelines, consulting with a healthcare professional or oncologist is essential.