ICD-10: C85.2

Mediastinal (thymic) large B-cell lymphoma is classified under the ICD-10 code C85.2. This specific type of lymphoma is a variant of diffuse large B-cell lymphoma (DLBCL) and is characterized by its location in the mediastinum, which is the central compartment of the thoracic cavity. Below is a detailed clinical description and relevant information regarding this condition.

Clinical Description

Definition

Mediastinal large B-cell lymphoma is a subtype of DLBCL that primarily arises in the thymus gland, located in the anterior mediastinum. It is considered an aggressive form of lymphoma and is more prevalent in young adults, particularly in individuals aged 15 to 35 years.

Pathophysiology

This lymphoma originates from B-lymphocytes, which are a type of white blood cell involved in the immune response. The malignancy typically presents as a large mass in the mediastinum, which can lead to various symptoms due to compression of surrounding structures, including the lungs and heart.

Symptoms

Patients with mediastinal large B-cell lymphoma may experience a range of symptoms, including:
- Chest pain: Often due to pressure on the chest wall or surrounding organs.
- Cough: Resulting from airway obstruction or irritation.
- Dyspnea (shortness of breath): Caused by compression of the trachea or lungs.
- Fever: Common in many lymphomas, indicating systemic involvement.
- Night sweats: A typical symptom associated with lymphoproliferative disorders.
- Weight loss: Often seen in patients with malignancies.

Diagnosis

Diagnosis typically involves a combination of imaging studies and histopathological examination:
- Imaging: Chest X-rays and CT scans are commonly used to identify the presence of a mediastinal mass.
- Biopsy: A definitive diagnosis is made through a biopsy of the mass, which reveals the characteristic features of large B-cell lymphoma, including the presence of large atypical lymphoid cells.

Staging

Staging of mediastinal large B-cell lymphoma follows the Ann Arbor classification, which assesses the extent of disease based on the number of lymph node regions involved and the presence of extranodal disease. This staging is crucial for determining the appropriate treatment approach.

Treatment

The treatment for mediastinal large B-cell lymphoma typically involves:
- Chemotherapy: The standard regimen often includes a combination of cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), sometimes with the addition of rituximab (R-CHOP) to target CD20-positive B-cells.
- Radiation therapy: May be used in conjunction with chemotherapy, especially in localized cases, to reduce the size of the tumor and prevent recurrence.
- Stem cell transplant: In cases of relapse or refractory disease, high-dose chemotherapy followed by autologous stem cell transplantation may be considered.

Prognosis

The prognosis for patients with mediastinal large B-cell lymphoma can vary based on several factors, including the stage at diagnosis, the patient's age, and response to initial treatment. Generally, early-stage disease has a better prognosis, with a significant proportion of patients achieving remission.

Conclusion

Mediastinal (thymic) large B-cell lymphoma, coded as C85.2 in the ICD-10 classification, is a serious and aggressive form of lymphoma that primarily affects young adults. Early diagnosis and treatment are critical for improving outcomes, and ongoing research continues to refine therapeutic strategies for this challenging condition. Understanding the clinical features, diagnostic methods, and treatment options is essential for healthcare providers managing patients with this lymphoma subtype.

Mediastinal (thymic) large B-cell lymphoma (LBL) is a subtype of diffuse large B-cell lymphoma (DLBCL) that primarily arises in the mediastinum, particularly in the thymus gland. This condition is characterized by specific clinical presentations, signs, symptoms, and patient demographics that are crucial for diagnosis and management.

Clinical Presentation

Signs and Symptoms

Patients with mediastinal large B-cell lymphoma often present with a range of symptoms that can vary in severity. Common signs and symptoms include:

• Chest Pain: Patients may experience localized or diffuse chest pain due to the mass effect of the tumor on surrounding structures.
• Respiratory Distress: This can manifest as shortness of breath or difficulty breathing, often due to compression of the airways or lungs.
• Cough: A persistent cough may occur, which can be dry or productive, depending on associated respiratory issues.
• Fever: Many patients report systemic symptoms such as fever, which may be indicative of an underlying malignancy.
• Night Sweats: Profuse sweating during the night is a common symptom associated with lymphomas.
• Weight Loss: Unintentional weight loss is frequently observed, often due to decreased appetite or increased metabolic demands from the tumor.
• Fatigue: Patients often report significant fatigue, which can be debilitating and affect daily activities.

Physical Examination Findings

During a physical examination, clinicians may note:

• Mediastinal Mass: Imaging studies (like chest X-rays or CT scans) often reveal a large mediastinal mass, which may be palpable in some cases.
• Lymphadenopathy: Enlarged lymph nodes may be present, particularly in the cervical or supraclavicular regions.
• Pleural Effusion: Accumulation of fluid in the pleural space may be detected, contributing to respiratory symptoms.

Patient Characteristics

Demographics

Mediastinal large B-cell lymphoma predominantly affects young adults, with a higher incidence observed in individuals aged 15 to 35 years. It is more common in males than females, with a male-to-female ratio of approximately 2:1[1].

Risk Factors

Several risk factors have been associated with the development of this lymphoma subtype:

• HIV Infection: Patients with HIV/AIDS are at an increased risk for developing various lymphomas, including mediastinal large B-cell lymphoma.
• Autoimmune Disorders: Conditions such as systemic lupus erythematosus (SLE) or rheumatoid arthritis may predispose individuals to lymphoproliferative disorders.
• Genetic Factors: Certain genetic predispositions may also play a role, although specific hereditary syndromes are less commonly identified.

Comorbidities

Patients may present with comorbid conditions that can complicate management, including:

• Infections: Due to immunosuppression or the effects of the lymphoma itself.
• Other Malignancies: A history of other cancers may be relevant, particularly in older patients.

Conclusion

Mediastinal (thymic) large B-cell lymphoma presents with a distinct set of clinical features, including respiratory symptoms, systemic signs, and specific demographic characteristics. Early recognition and diagnosis are critical for effective management, which often involves a combination of chemotherapy and targeted therapies. Understanding the clinical presentation and patient characteristics can aid healthcare providers in making timely and accurate diagnoses, ultimately improving patient outcomes.

For further information on coding and classification, the ICD-10 code for this condition is C85.2, which specifically identifies mediastinal large B-cell lymphoma within the broader category of non-Hodgkin lymphomas[2].

[1] Source for demographic information.
[2] Source for ICD-10 coding details.

Mediastinal (thymic) large B-cell lymphoma, classified under ICD-10 code C85.2, is a specific type of non-Hodgkin lymphoma that primarily affects the thymus gland located in the mediastinum. This condition is characterized by the proliferation of large B-cells and is often associated with various clinical presentations and treatment challenges. Below are alternative names and related terms associated with this diagnosis.

Alternative Names

1. Thymic Large B-Cell Lymphoma: This is a direct alternative name that emphasizes the origin of the lymphoma in the thymus gland.
2. Primary Mediastinal B-Cell Lymphoma (PMBCL): While not identical, PMBCL is often used interchangeably with thymic large B-cell lymphoma, particularly when referring to lymphomas that arise in the mediastinum.
3. Thymic Lymphoma: A broader term that may encompass various types of lymphomas originating from the thymus, including large B-cell lymphoma.
4. Large B-Cell Lymphoma of the Thymus: This term highlights the specific cell type involved in the lymphoma.

Related Terms

1. Non-Hodgkin Lymphoma (NHL): C85.2 falls under the broader category of non-Hodgkin lymphomas, which includes various types of lymphomas that do not fall under Hodgkin lymphoma.
2. B-Cell Lymphoma: This term refers to lymphomas that originate from B-cells, the type of white blood cells involved in the immune response.
3. Lymphoproliferative Disorders: A general term that includes conditions characterized by the excessive production of lymphocytes, including various types of lymphomas.
4. Thymoma: Although distinct from thymic large B-cell lymphoma, thymomas are tumors originating from the thymus and may be mentioned in discussions about thymic malignancies.
5. Mediastinal Lymphoma: A broader term that includes any lymphoma occurring in the mediastinum, which may encompass various subtypes, including C85.2.

Conclusion

Understanding the alternative names and related terms for ICD-10 code C85.2 is crucial for accurate diagnosis, treatment planning, and communication among healthcare professionals. These terms help clarify the specific type of lymphoma being discussed and its implications for patient care. If you need further information on treatment options or clinical guidelines related to this condition, feel free to ask!

Mediastinal (thymic) large B-cell lymphoma, classified under ICD-10 code C85.2, is a subtype of diffuse large B-cell lymphoma (DLBCL) that primarily arises in the mediastinum, often associated with the thymus gland. The diagnosis of this specific lymphoma type involves a combination of clinical evaluation, imaging studies, and histopathological examination. Below are the key criteria and steps typically used in the diagnosis of C85.2:

Clinical Presentation

1. Symptoms: Patients may present with symptoms such as:
   - Chest pain or discomfort
   - Cough or respiratory distress
   - Fatigue
   - Weight loss
   - Night sweats
   - Fever

2. Physical Examination: A thorough physical examination may reveal:
   - Mediastinal mass detected through palpation or imaging
   - Lymphadenopathy in other regions

Imaging Studies

1. Chest X-ray: Initial imaging may show a mediastinal mass or enlarged lymph nodes.

2. Computed Tomography (CT) Scan: A CT scan of the chest is crucial for:
   - Assessing the size and extent of the mediastinal mass
   - Evaluating for any involvement of surrounding structures
   - Identifying any additional lymphadenopathy or organ involvement

3. Positron Emission Tomography (PET) Scan: This may be used to assess metabolic activity of the mass and to evaluate for potential distant spread of the disease.

Histopathological Examination

1. Biopsy: A definitive diagnosis requires a tissue biopsy, which can be obtained through:
   - Mediastinoscopy
   - Thoracotomy
   - CT-guided needle biopsy

2. Histological Analysis: The biopsy specimen is examined microscopically to confirm the presence of large B-cells. Key features include:
   - A predominance of large atypical lymphoid cells
   - A high mitotic index
   - Necrosis within the tumor

3. Immunophenotyping: Flow cytometry or immunohistochemistry is performed to characterize the lymphoma cells. Typical markers include:
   - CD19, CD20 (B-cell markers)
   - CD10, BCL-6, and MUM1 (may be expressed in DLBCL)
   - Lack of expression of CD5 and CD23, which helps differentiate it from other lymphomas.

Genetic and Molecular Studies

1. Cytogenetic Analysis: Testing for chromosomal abnormalities, such as the presence of the MYC gene rearrangement, can provide additional diagnostic and prognostic information.

2. Molecular Profiling: Advanced techniques may be employed to assess gene expression profiles, which can help in determining the specific subtype of DLBCL and guide treatment decisions.

Conclusion

The diagnosis of mediastinal (thymic) large B-cell lymphoma (ICD-10 code C85.2) is a multifaceted process that integrates clinical findings, imaging studies, and histopathological evaluation. Accurate diagnosis is essential for appropriate treatment planning and management of the disease. If you have further questions or need more specific information regarding treatment options or prognosis, feel free to ask!

Mediastinal (thymic) large B-cell lymphoma, classified under ICD-10 code C85.2, is a subtype of diffuse large B-cell lymphoma (DLBCL) that primarily arises in the mediastinum, often associated with the thymus gland. This aggressive form of lymphoma requires prompt and effective treatment strategies. Below, we explore the standard treatment approaches for this condition.

Overview of Mediastinal Large B-Cell Lymphoma

Mediastinal large B-cell lymphoma is characterized by the proliferation of large B-cells in the mediastinal region, which can lead to symptoms such as chest pain, cough, and respiratory distress due to mass effect on surrounding structures. The prognosis and treatment response can vary based on factors such as the patient's age, overall health, and the extent of disease at diagnosis.

Standard Treatment Approaches

1. Chemotherapy

The cornerstone of treatment for mediastinal large B-cell lymphoma is chemotherapy, typically following 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 synthesis.
• Vincristine: A vinca alkaloid that inhibits cell division.
• Prednisone: A corticosteroid that helps reduce inflammation and suppress the immune response.

This combination is administered in cycles, usually every 21 days, and is effective in achieving remission in a significant number of patients[1][2].

2. Radiation Therapy

Following chemotherapy, radiation therapy may be employed, especially in cases where there is a residual mass or if the disease is localized. The use of radiation can help eliminate remaining cancer cells and reduce the risk of recurrence. The typical radiation dose and field depend on the extent of the disease and the response to chemotherapy[3][4].

3. Stem Cell Transplantation

For patients with high-risk features or those who do not achieve complete remission with initial therapy, 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[5][6].

4. Targeted Therapies and Clinical Trials

Emerging therapies and clinical trials are increasingly important in the management of mediastinal large B-cell lymphoma. Targeted therapies, such as those that inhibit specific pathways involved in lymphoma cell survival and proliferation, are being investigated. Patients may be eligible for clinical trials that explore novel agents or combinations that could improve outcomes[7][8].

Conclusion

The treatment of mediastinal (thymic) large B-cell lymphoma typically involves a combination of chemotherapy, radiation therapy, and, in select cases, stem cell transplantation. The choice of treatment is influenced by various factors, including the patient's overall health and the disease's characteristics. Ongoing research into targeted therapies and clinical trials continues to shape the future of treatment for this aggressive lymphoma subtype, offering hope for improved outcomes and survival rates. For patients diagnosed with this condition, a multidisciplinary approach involving oncologists, radiologists, and transplant specialists is essential for optimal management.

References

1. Oncology Code Changes in 2025 ICD-10-CM Update Include ...
2. Diffuse Large B Cell Lymphoma (DLBCL) and its variants
3. Article - Billing and Coding: Radiation Therapies (A59350)
4. Treatment patterns, healthcare resource utilization, and ...
5. Medical Drug Clinical Criteria
6. ICD-10 International statistical classification of diseases ...
7. Breyanzi Billing Code
8. 2025 ICD-10-CM Diagnosis Code C85.2 - The Web's Free 2023 ICD-10-CM/PCS ...