ICD-10: C83.36

Diffuse large B-cell lymphoma (DLBCL), particularly when it involves intrapelvic lymph nodes, is a subtype 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 C83.36, 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 consists of:
- 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].

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 combined with chemotherapy (as in R-CHOP) and has been shown to enhance the effectiveness of treatment by targeting malignant B-cells directly[3].

CAR-T Cell Therapy

For patients who do not achieve remission with initial therapy or who experience relapse, CAR-T cell therapy may be considered. This innovative treatment involves modifying a patient’s T-cells to better recognize and attack cancer cells. CAR-T therapy has shown promising results in patients with refractory DLBCL[4].

3. Radiation Therapy

While chemotherapy and immunotherapy are the primary treatments, radiation therapy may be utilized in specific scenarios, particularly for localized disease or to manage symptoms. It can be effective in reducing tumor burden in the intrapelvic region, especially if there is significant lymphadenopathy causing discomfort or other complications[5].

4. Stem Cell Transplantation

For patients with high-risk DLBCL or those who relapse after initial treatment, autologous stem cell transplantation (ASCT) may be an option. This procedure involves harvesting the patient’s own 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 are often encouraged to consider participation in clinical trials, which may offer access to new therapies and treatment strategies that are not yet widely available. These trials can provide valuable options for patients, especially those with relapsed or refractory disease[7].

Conclusion

The treatment of diffuse large B-cell lymphoma, particularly when it involves intrapelvic lymph nodes, is multifaceted and tailored to the individual patient. The standard approach typically includes the R-CHOP chemotherapy regimen, with additional options such as immunotherapy, radiation, and stem cell transplantation available based on the patient's specific circumstances. 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 is crucial for optimizing care and enhancing survival rates.

References

1. Article - Billing and Coding: Radiation Therapies (A59350).
2. NON-HODGKIN LYMPHOMA Includes Follicular.
3. Medical Drug Clinical Criteria.
4. CAR-T CELL & GENE.
5. HCT for Non-Hodgkin Lymphoma.
6. Medical Policy - MMM-pr.com.
7. Monjuvi (tafasitamab-cxix).

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 C83.36 specifically refers to DLBCL that is localized in the intrapelvic lymph nodes. 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, often presenting with rapidly enlarging masses. The disease can occur at any age but is more prevalent in older adults.

Pathophysiology

The pathogenesis of DLBCL involves genetic mutations and alterations that lead to the uncontrolled growth of B cells. These changes can include translocations involving the MYC, BCL2, and BCL6 genes, which play critical roles in cell cycle regulation and apoptosis. The intrapelvic lymph nodes, which include nodes located in the pelvic region, can become involved as the disease progresses.

Symptoms

Patients with DLBCL may present with a variety of symptoms, including:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the neck, armpits, or groin.
- B symptoms: Fever, night sweats, and unexplained weight loss.
- Abdominal discomfort: Due to enlarged lymph nodes in the pelvic region, which may cause pressure on surrounding organs.
- Fatigue: Generalized weakness and tiredness.

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 the surface markers on the cells.
- Imaging studies: CT scans or PET scans are often used to assess the extent of the disease and to identify any extranodal involvement.

Staging

The staging of DLBCL is crucial for treatment planning and prognosis. The Ann Arbor staging system is commonly used, which categorizes the disease based on the number of lymph node regions involved and whether extranodal sites are affected.

Treatment Options

The treatment for DLBCL typically involves a combination of therapies:
- 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.
- Targeted therapies: Newer agents, such as CAR T-cell therapy and monoclonal antibodies, are being explored 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, and overall health. The International Prognostic Index (IPI) is often used to predict outcomes based on clinical parameters.

Conclusion

ICD-10 code C83.36 specifically identifies diffuse large B-cell lymphoma localized to the intrapelvic lymph nodes, highlighting the importance of accurate coding for effective treatment and management. Understanding the clinical features, diagnostic criteria, and treatment options is essential for healthcare providers managing patients with this aggressive lymphoma subtype. Early diagnosis and appropriate therapy can significantly improve patient outcomes.

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 the intrapelvic 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 C83.36.

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 and is known for its aggressive nature, requiring prompt diagnosis and treatment[1].

Involvement of Intrapelvic Lymph Nodes

When DLBCL affects the intrapelvic lymph nodes, it may present with specific symptoms related to the pelvic region. The lymph nodes in this area can become enlarged, leading to various clinical manifestations.

Signs and Symptoms

Common Symptoms

Patients with DLBCL involving intrapelvic lymph nodes may experience a range of symptoms, including:

• Abdominal Pain or Discomfort: Due to the enlargement of lymph nodes, patients may report localized pain or a feeling of fullness in the lower abdomen[1].
• Pelvic Pressure: Enlarged lymph nodes can exert pressure on surrounding structures, leading to discomfort or a sensation of heaviness in the pelvic area[1].
• Weight Loss: Unintentional weight loss is a common symptom in lymphoma patients, often due to systemic effects of the disease[1].
• Fever and Night Sweats: These systemic symptoms are indicative of lymphoma and may occur alongside other signs[1].
• Fatigue: Patients often report significant fatigue, which can be attributed to the disease itself or the body's response to cancer[1].

Physical Examination Findings

During a physical examination, healthcare providers may note:

• Palpable Lymphadenopathy: Enlarged lymph nodes in the pelvic region may be palpable during a physical exam[1].
• Abdominal Distension: In cases of significant lymph node enlargement, abdominal distension may be observed[1].

Patient Characteristics

Demographics

• Age: DLBCL can occur at any age but is more common in older adults, typically those aged 60 and above[1].
• Gender: There is a slight male predominance in DLBCL cases, although it can affect both genders[1].

Risk Factors

Several risk factors may predispose individuals to develop DLBCL, including:

• Immunosuppression: Patients with weakened immune systems, such as those with HIV/AIDS or those on immunosuppressive therapy, are at higher risk[1].
• Autoimmune Diseases: Conditions like rheumatoid arthritis or lupus may increase the risk of developing lymphomas[1].
• Family History: A family history of lymphoma or other hematologic malignancies can also be a contributing factor[1].

Conclusion

Diffuse large B-cell lymphoma involving intrapelvic lymph nodes presents with a distinct clinical picture characterized by abdominal pain, pelvic pressure, systemic symptoms like fever and night sweats, and significant fatigue. Understanding these signs and symptoms, along with patient demographics and risk factors, is crucial for timely diagnosis and management. Early intervention can significantly improve outcomes for patients diagnosed with this aggressive form of lymphoma. For accurate coding and billing, the ICD-10 code C83.36 specifically identifies this condition, ensuring appropriate treatment and care pathways are followed.

Diffuse large B-cell lymphoma (DLBCL) is a type of non-Hodgkin lymphoma characterized by the rapid growth of large B-cells. The specific ICD-10 code C83.36 refers to DLBCL located in the intrapelvic lymph nodes. Understanding alternative names and related terms can help in better comprehending the condition and its classification.

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 cancerous cells.
2. B-Cell Lymphoma: Since DLBCL originates from B-cells, this broader term encompasses various types of lymphomas that arise from B-lymphocytes.
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. ICD-10 Code C83.3: This code represents diffuse large B-cell lymphoma in general, without specifying the location, which can include various lymph node regions.
2. ICD-O Code: The International Classification of Diseases for Oncology (ICD-O) provides specific codes for different types of cancers, including DLBCL, which may be relevant for pathology and oncology coding.
3. Follicular Lymphoma: While distinct from DLBCL, this is another type of B-cell lymphoma that may be mentioned in discussions about B-cell malignancies.
4. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which can occur in DLBCL and is often a presenting symptom.
5. Stage IV Lymphoma: If DLBCL has spread to the intrapelvic lymph nodes, it may be classified as stage IV, indicating advanced disease.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C83.36 is crucial for healthcare professionals, researchers, and patients alike. It aids in accurate diagnosis, treatment planning, and communication within the medical community. If you need further information on treatment options or prognosis related to DLBCL, feel free to ask!

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 C83.36 specifically refers to DLBCL that is located in the intrapelvic lymph nodes. 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 nonspecific symptoms such as:
   - Unexplained weight loss
   - Night sweats
   - Fever
   - Fatigue
   - Swollen lymph nodes, particularly in the pelvic region

2. Physical Examination: A thorough physical examination is essential to identify lymphadenopathy, hepatosplenomegaly, or other signs of systemic involvement.

Imaging Studies

1. Computed Tomography (CT) Scan: A CT scan of the abdomen and pelvis is often performed to assess the size and extent of lymphadenopathy. It helps visualize the intrapelvic lymph nodes and any associated masses.

2. Positron Emission Tomography (PET) Scan: PET scans can be used to evaluate metabolic activity in lymph nodes and other tissues, helping to differentiate between benign and malignant processes.

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. Immunophenotyping: The biopsy sample is analyzed using immunohistochemistry to identify specific markers characteristic of DLBCL, such as:
   - CD19
   - CD20
   - CD22
   - CD79a

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

Staging

Once diagnosed, the disease is staged according to 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 appropriate treatment plan.

Conclusion

The diagnosis of diffuse large B-cell lymphoma, particularly in the context of intrapelvic lymph nodes (ICD-10 code C83.36), relies on a comprehensive approach that includes clinical assessment, imaging studies, and histopathological confirmation. Early diagnosis and accurate staging are vital for effective management and treatment of this aggressive lymphoma. If you have further questions or need more specific information, feel free to ask!