ICD-10: C83.92

ICD-10 code C83.92 refers to Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes. This classification falls under the broader category of non-Hodgkin lymphoma (NHL), which encompasses a diverse group of blood cancers that originate in the lymphatic system. Below is a detailed clinical description and relevant information regarding this specific code.

Clinical Description

Definition

Non-follicular lymphoma is characterized by the proliferation of lymphoid tissue that does not exhibit the follicular architecture typical of follicular lymphoma. This type of lymphoma can manifest in various forms, including diffuse large B-cell lymphoma (DLBCL) and other aggressive subtypes. The term "unspecified" indicates that the precise subtype of non-follicular lymphoma has not been determined or documented.

Location

The designation "intrathoracic lymph nodes" specifies that the lymphoma is located within the thoracic cavity, which includes the mediastinum and the pleural spaces. This area contains critical structures such as the heart, lungs, and major blood vessels, making the presence of lymphoma in these lymph nodes particularly significant due to potential impacts on respiratory and cardiovascular function.

Symptoms

Patients with non-follicular lymphoma affecting intrathoracic lymph nodes may present with a variety of symptoms, including:
- Respiratory distress: Due to compression of the airways or lung tissue.
- Cough: Often persistent and may be accompanied by hemoptysis (coughing up blood).
- Chest pain: Can occur due to lymph node enlargement or associated pleural effusion.
- Fever, night sweats, and weight loss: Common systemic symptoms associated with lymphoma.

Diagnosis

Diagnosis typically involves a combination of imaging studies (such as CT scans or PET scans) and biopsy of the affected lymph nodes. Histopathological examination is crucial for determining the specific type of lymphoma and guiding treatment decisions.

Treatment Options

Treatment for non-follicular lymphoma, particularly when it involves intrathoracic lymph nodes, may include:
- Chemotherapy: Often the first line of treatment, especially for aggressive forms of lymphoma.
- Radiation therapy: May be used in conjunction with chemotherapy or as a standalone treatment for localized disease.
- Targeted therapies: Depending on the specific characteristics of the lymphoma, targeted agents may be employed.
- Stem cell transplant: In certain cases, particularly for relapsed or refractory disease, hematopoietic stem cell transplantation may be considered.

Prognosis

The prognosis for patients with non-follicular lymphoma can vary widely based on several factors, including the specific subtype, stage at diagnosis, and response to treatment. Generally, aggressive forms of non-Hodgkin lymphoma, such as DLBCL, can be effectively treated, with many patients achieving remission.

Conclusion

ICD-10 code C83.92 captures a critical aspect of non-follicular lymphoma, specifically when it involves the intrathoracic lymph nodes. Understanding the clinical implications, symptoms, diagnostic approaches, and treatment options is essential for healthcare providers managing patients with this condition. Early diagnosis and appropriate treatment are key to improving outcomes for individuals affected by this type of lymphoma.

Non-follicular (diffuse) lymphoma, unspecified, particularly affecting intrathoracic lymph nodes, is classified under ICD-10 code C83.92. This type of lymphoma is a form of non-Hodgkin lymphoma (NHL) characterized by the diffuse infiltration of malignant lymphoid cells, which can lead to various clinical presentations and symptoms. Below is a detailed overview of the clinical presentation, signs, symptoms, and patient characteristics associated with this condition.

Clinical Presentation

Overview of Non-Follicular Lymphoma

Non-follicular lymphoma encompasses a range of aggressive lymphomas that do not exhibit the follicular pattern typical of some other lymphomas. The unspecified nature of C83.92 indicates that the specific subtype of diffuse lymphoma has not been determined, which can complicate diagnosis and treatment.

Intrathoracic Involvement

When lymph nodes within the thoracic cavity are involved, patients may experience symptoms related to both the lymphatic system and respiratory function. The intrathoracic lymph nodes can include mediastinal and hilar lymph nodes, which are critical in the context of lung and chest pathology.

Signs and Symptoms

Common Symptoms

Patients with C83.92 may present with a variety of symptoms, including:

• Lymphadenopathy: Swelling of lymph nodes, particularly in the neck, armpits, or groin, may be observed. In cases of intrathoracic involvement, mediastinal lymphadenopathy can lead to compression of surrounding structures.
• Respiratory Symptoms: Patients may experience cough, shortness of breath, or chest pain due to the pressure exerted by enlarged lymph nodes on the trachea or bronchi.
• Systemic Symptoms: Common systemic symptoms include:
• Fever
• Night sweats
• Unexplained weight loss
• Fatigue

Specific Signs

• Physical Examination Findings: Upon examination, healthcare providers may note:
• Enlarged lymph nodes in the cervical or supraclavicular regions.
• Signs of respiratory distress or abnormal lung sounds upon auscultation.
• Possible hepatosplenomegaly (enlargement of the liver and spleen) in advanced cases.

Patient Characteristics

Demographics

• Age: Non-follicular lymphomas can occur in adults of any age but are more common in older adults, typically those over 60 years.
• Gender: There is a slight male predominance in the incidence of non-Hodgkin lymphomas, including diffuse lymphomas.

Risk Factors

• Immunocompromised State: Patients with weakened immune systems, such as those with HIV/AIDS or those undergoing immunosuppressive therapy, are at higher risk.
• Previous Infections: Certain viral infections, such as Epstein-Barr virus (EBV), have been associated with the development of lymphomas.
• Environmental Exposures: Exposure to certain chemicals or radiation may increase the risk of developing lymphomas.

Comorbidities

Patients may present with other health conditions that can complicate the clinical picture, such as chronic respiratory diseases, autoimmune disorders, or previous malignancies.

Conclusion

The clinical presentation of non-follicular (diffuse) lymphoma, unspecified, affecting intrathoracic lymph nodes, is characterized by a combination of local and systemic symptoms. Early recognition of signs such as lymphadenopathy, respiratory distress, and systemic symptoms is crucial for timely diagnosis and management. Understanding patient demographics and risk factors can aid healthcare providers in identifying at-risk individuals and implementing appropriate diagnostic strategies. If you suspect a patient may have this condition, further diagnostic imaging and biopsy may be warranted to confirm the diagnosis and determine the specific subtype of lymphoma for optimal treatment planning.

ICD-10 code C83.92 refers specifically to "Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes." This classification falls under the broader category of non-Hodgkin lymphoma (NHL), which encompasses various types of lymphomas that do not originate from follicle center cells. Below are alternative names and related terms associated with this specific code:

Alternative Names

1. Diffuse Large B-Cell Lymphoma (DLBCL): While DLBCL is a specific subtype of non-follicular lymphoma, it is often included in discussions about diffuse lymphomas due to its prevalence.
2. Non-Hodgkin Lymphoma (NHL): This is a broader term that includes all types of lymphomas that are not classified as Hodgkin lymphoma, including non-follicular types.
3. Aggressive Non-Follicular Lymphoma: This term may be used to describe the aggressive nature of certain non-follicular lymphomas, including those affecting intrathoracic lymph nodes.

Related Terms

1. Lymphadenopathy: This term refers to the enlargement of lymph nodes, which is a common symptom in various types of lymphoma, including C83.92.
2. Intrathoracic Lymph Nodes: This specifies the location of the lymph nodes involved, indicating that the lymphoma is affecting nodes within the thoracic cavity.
3. Stage IV Lymphoma: If the lymphoma has spread to the intrathoracic lymph nodes, it may be classified as stage IV, indicating advanced disease.
4. B-cell Lymphoma: Since many non-follicular lymphomas are of B-cell origin, this term is often used in conjunction with discussions about non-follicular types.

Clinical Context

Understanding these alternative names and related terms is crucial for healthcare professionals involved in the diagnosis and treatment of lymphomas. Accurate coding and terminology ensure proper communication among medical teams and facilitate appropriate treatment plans.

In summary, while C83.92 specifically denotes non-follicular lymphoma affecting intrathoracic lymph nodes, it is part of a larger classification of non-Hodgkin lymphomas and is associated with various terms that reflect its clinical characteristics and implications.

The diagnosis of Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes, classified under ICD-10 code C83.92, involves a comprehensive evaluation that includes clinical, laboratory, and imaging assessments. Below is a detailed overview of the criteria typically used for diagnosing this condition.

Clinical Presentation

Symptoms

Patients with diffuse lymphoma may present with a variety of symptoms, which can include:
- Lymphadenopathy: Swelling of lymph nodes, particularly in the thoracic region.
- B symptoms: These include fever, night sweats, and unexplained weight loss, which are common in lymphomas.
- Respiratory symptoms: Such as cough or difficulty breathing, which may arise if lymph nodes in the thorax are involved.

Medical History

A thorough medical history is essential, including:
- Previous history of lymphoproliferative disorders.
- Family history of lymphoma or other malignancies.
- Exposure to risk factors such as certain infections (e.g., Epstein-Barr virus) or environmental toxins.

Diagnostic Tests

Imaging Studies

Imaging plays a crucial role in identifying and assessing the extent of lymphadenopathy:
- Chest X-ray: Often the first imaging study performed, which may reveal enlarged lymph nodes in the thoracic region.
- CT Scan: A computed tomography scan of the chest can provide detailed images of the lymph nodes and help assess their size and distribution.
- PET Scan: Positron emission tomography may be used to evaluate metabolic activity in lymph nodes, helping to distinguish between benign and malignant processes.

Laboratory Tests

• Blood Tests: Complete blood count (CBC) may show abnormalities such as anemia or thrombocytopenia, which can be associated with lymphoma.
• Lymph Node Biopsy: A definitive diagnosis typically requires a biopsy of the affected lymph nodes. This can be done through:
• Excisional biopsy: Removal of an entire lymph node for histopathological examination.
• Core needle biopsy: A less invasive option that can still provide sufficient tissue for diagnosis.

Histopathological Examination

The biopsy specimen is examined microscopically to identify:
- Cell type: The presence of large atypical lymphoid cells is indicative of diffuse large B-cell lymphoma (DLBCL), which is a common subtype of non-follicular lymphoma.
- Immunophenotyping: Flow cytometry or immunohistochemistry may be used to characterize the lymphoma cells further, determining their lineage (B-cell vs. T-cell) and other markers.

Staging

Once diagnosed, staging is crucial to determine the extent of the disease:
- Ann Arbor Staging System: This system classifies lymphomas based on the number of lymph node regions involved and whether the disease has spread to other organs.

Conclusion

The diagnosis of Non-follicular (diffuse) lymphoma, unspecified, intrathoracic lymph nodes (ICD-10 code C83.92) is a multifaceted process that requires careful clinical evaluation, imaging studies, laboratory tests, and histopathological analysis. 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!

Non-follicular (diffuse) lymphoma, classified under ICD-10 code C83.92, refers to a type of non-Hodgkin lymphoma (NHL) that primarily affects the intrathoracic lymph nodes. This condition is characterized by the rapid proliferation of malignant lymphocytes, leading to various symptoms and necessitating a comprehensive treatment approach. Below, we explore the standard treatment modalities for this specific type of lymphoma.

Overview of Non-Follicular Lymphoma

Non-follicular lymphomas encompass a range of aggressive lymphomas, including diffuse large B-cell lymphoma (DLBCL) and other subtypes. The designation "unspecified" indicates that the precise subtype has not been determined, which can influence treatment decisions. Intrathoracic lymph nodes involvement suggests that the lymphoma may be affecting the chest area, potentially leading to respiratory symptoms or other complications.

Standard Treatment Approaches

1. Chemotherapy

Chemotherapy remains the cornerstone of treatment for diffuse lymphomas. The most commonly used regimen for aggressive non-follicular lymphoma is the R-CHOP protocol, 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 synthesis.
• Vincristine: 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, depending on the patient's response and overall health status[1].

2. Radiation Therapy

Radiation therapy may be employed as a complementary treatment, particularly in localized cases or when there is a significant mass effect from the lymph nodes. Intensity-modulated radiation therapy (IMRT) is often preferred due to its precision in targeting tumor cells while sparing surrounding healthy tissue. This approach can be particularly beneficial for patients with bulky disease in the thoracic region[2].

3. Stem Cell Transplantation

For patients with relapsed or refractory diffuse lymphoma, high-dose chemotherapy followed by autologous stem cell transplantation (ASCT) may be considered. This procedure involves harvesting the patient's stem cells, administering high doses of chemotherapy to eradicate the lymphoma, and then reinfusing the stem cells to restore bone marrow function[3].

4. Targeted Therapy and Immunotherapy

In recent years, targeted therapies and immunotherapies have emerged as promising options for treating non-follicular lymphomas. Agents such as:

• Brentuximab vedotin: An antibody-drug conjugate that targets CD30, effective in certain subtypes of lymphoma.
• CAR T-cell therapy: A form of immunotherapy that modifies a patient’s T-cells to better recognize and attack cancer cells.

These therapies are typically reserved for patients with specific characteristics or those who have not responded to standard treatments[4].

5. Clinical Trials

Participation in clinical trials may also be an option for patients, providing access to cutting-edge therapies and novel treatment combinations that are not yet widely available. These trials often focus on new drugs, combinations, or treatment strategies aimed at improving outcomes for patients with aggressive lymphomas[5].

Conclusion

The treatment of non-follicular (diffuse) lymphoma, particularly when involving intrathoracic lymph nodes, requires a multifaceted approach tailored to the individual patient's needs and disease characteristics. Standard treatments primarily include chemotherapy, radiation therapy, and potentially stem cell transplantation or targeted therapies. Ongoing research and clinical trials continue to evolve the landscape of treatment options, offering hope for improved outcomes in this challenging disease. For patients and healthcare providers, staying informed about the latest advancements is crucial in managing this condition effectively.

References

1. Medical Drug Clinical Criteria
2. Intensity-Modulated Radiation Therapy (IMRT)
3. HCT for Non-Hodgkin Lymphoma
4. Billing and Coding: Off-label Use of Rituximab
5. CMS Manual System