Search Database ICD-O-3 Code Lists

Name

Follicular lymphoma (FL), NOS

ICD-O-1 Morphology

9690/3: Follicular lymphoma, NOS
9614/3: Malignant lymphoma, centroblastic-centrocytic diffuse
9623/3: Malignant lymphoma, follicular center cell, cleaved, NOS
9692/3: Malignant lymphoma, centroblastic-centrocytic, follicular
Effective 1978 - 1991

ICD-O-2 Morphology

9690/3: Follicular lymphoma, NOS
9676/3: Malignant lymphoma, centroblastic-centrocytic, diffuse
Effective 1992 - 2000

ICD-O-3 Morphology

9690/3: Follicular lymphoma, NOS
Effective 2001 and later

Reportable

for cases diagnosed 1978 and later

Primary Site(s)

See Module 7
Most common sites of involvement: lymph nodes, spleen, bone marrow (BM), peripheral blood (PB), and Waldeyer ring, skin, duodenum, ocular adnexa, breast and testis

Coding Manual: Hematopoietic Coding Manual (PDF)

Abstractor Notes

Follicular lymphoma, NOS (9690/3) histology is a generic disease description. DCO cases or path report only cases usually stay in this classification. The NOS histology may be the working diagnosis. Further review of the medical record should be done to look for the tests listed as definitive diagnosis.

The more specific follicular lymphomas are:
1. Follicular lymphoma, grade 1 (9695/3)
2. Follicular lymphoma, grade 2 (9691/3)
3. Follicular lymphoma, grade 3 [3A, 3B] (9698/3)

When a more specific diagnosis is identified, the histology should be changed to the more specific neoplasm name and code.

FL is graded according to the proportion of large cells (centroblasts). Studies suggest this histologic grading predicts clinical outcome, with more large cells behaving more aggressively and having a higher likelihood of transformation to diffuse large cell lymphoma.

1) Grade 1-2 (low grade): 0-15 centroblasts per HPF (9691/3)
2) Grade 1: 0-5 centroblasts per HPF (9695/3)
3) Grade 2: 6-15 centroblasts per HPF (9691/3)
4) Grade 3: > 15 centroblasts per HPF (9698/3)
5) Grade 3A: Centrocytes present (9698/3)
6) Grade 3B: Solid sheets of centroblasts (9698/3)

Most patients present with widespread disease, including peripheral and central (abdominal and thoracic) lymphadenopathy and splenomegaly. The BM is involved in 40-70%.

Only 1/3 of patients present with stage I or II at the time of diagnosis.

When any area of diffuse large-B-cell lymphoma (DLBCL) is present in a FL the disease should be reported as diffuse large B-cell lymphoma (9680/3) (See PH rules).

Diagnostic Confirmation

This histology can be determined by positive histology (including peripheral blood) with or without genetics and/or immunophenotyping. Review the Definitive Diagnostic Methods, Immunophenotyping and Genetics Data sections below, and the instructions in the Hematopoietic Manual for further guidance on assigning Diagnostic confirmation.

Grade

See Abstractor Notes

Module Rule

None

Alternate Names

Follicular lymphoma, diffuse, NOS
Follicular lymphoma, low grade
Malignant lymphoma, centroblastic-centrocytic, follicular [OBS]
Malignant lymphoma, follicle center, follicular
Malignant lymphoma, follicle center, NOS
Malignant lymphoma, follicular, NOS
Malignant lymphoma, lymphocytic, nodular, NOS [OBS]
Malignant lymphoma, nodular, NOS [OBS]
Pediatric-type follicular lymphoma (PTFL)

Definition

Follicular lymphoma (FL) is a neoplasm composed of follicle centre (germinal center) B cells (typically both centrocytes and centroblasts/large transformed cells), which usually has at least a partially follicular pattern. Progression in cytological grade is common during the natural history of the disease.

There are several variants/subtypes of Follicular lymphoma

1) Diffuse variant of follicular lymphoma. See below
2) Duodenal-type follicular lymphoma. See 9695/3.
3) Large B-cell lymphoma with IRF4 rearrangement. See 9698/3.
4) Pediatric-type follicular lymphoma. See below.
5) Testicular follicular lymphoma. See 9698/3.

Diffuse follicular lymphoma variant is characterized by a predominantly diffuse growth pattern and consistent absence of the chromosomal translocation t(14;18)(q32;q21). This particular follicular lymphoma variant occurs in the inguinal region, forming larger tumors, but with little tendency to disseminate.

Pediatric-type follicular lymphoma is an uncommon nodal follicular lymphoma (FL) that occurs primarily in children and young adults, but also occurs sporadically in other individuals. Most patients present with isolated asymptomatic lymph node enlargement.

Definitive Diagnostic Methods

FISH
Genetic testing
Histologic confirmation
Immunophenotyping

Genetics Data

CREBBP mutation
EPHA7 mutation
KMT2D (MLL2) mutation
MEF2B mutation
MYC gain
TNFAIP3 (also called A20) deletion, mutation
TNFRSF14 deletion, mutation

Immunophenotyping

BCL2+ (expression/positive)
BCL6+ (expression/positive)
CD5- (no expression/negative)
CD10 expression and positive
CD19+ (expression/positive)
CD20+ (expression/positive)
CD22+ (expression/positive)
CD23+ (expression/positive)
CD43- (no expression/negative)
CD79a+ (expression/positive)
GCET1+ (expression/positive)
GCET2 (HGAL)+ (expression/positive)
IgD- (no expression/negative)
IgM+ (expression/positive)
LMO2+ (expression/positive)
PAX5+ (expression/positive)

Treatments

Chemotherapy
Hematologic Transplant and/or Endocrine Procedures
Immunotherapy
Radiation therapy

Transformations to

Transformations from

None

Same Primaries

Corresponding ICD-9 Codes

202.0 Nodular lymphoma

Corresponding ICD-10 Codes

C82.9 Follicular non-Hodgkin lymphoma, unspecified

Corresponding ICD-10-CM Codes (U.S. only)

C82.9 Follicular lymphoma, unspecified (effective October 01, 2015)
C82.8 Other types of follicular lymphoma (effective October 01, 2015)

Signs and Symptoms

Drenching night sweats
Fatigue
Fever (for no known reason)
Lymphadenopathy (abdominal and thoracic)
Pain in chest, abdomen or bones (for no known reason)
Painless swelling in the lymph nodes in the neck, underarm, groin or stomach
Skin rash or itchy skin
Splenomegaly
Weight loss for no known reason

Diagnostic Exams

Blood chemistry studies
Bone marrow aspiration and biopsy
CT (CAT) scan
Cytogenetic analysis
Flow cytometry
Immunohistochemistry
Immunophenotyping
Laparoscopy (rarely performed)
Laparotomy (rarely performed)
Lymph node biopsy

Progression and Transformation

25-35% of patients transform to DLBCL

Epidemiology and Mortality

Age: 60 years median age (rare occurrence under 20 years of age)
Incidence: Follicular lymphomas account for 20% of all lymhpomas
Sex: slight female predominance
Survival: 8-15 years median survival, closely related to the extent of the disease at diagnosis

Sources

Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J (Eds):
WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues (Revised 4th edition)
IARC: Lyon 2017
Section: Mature B-cell neoplasms
Pages: 266-281

International Classification of Diseases for Oncology, Third Edition, Second Revision. Geneva: World Health Organization, 2020.
Section: ICD-O-3.2 (2020) Morphological Codes
Pages: http://www.iacr.com.fr/index.php?option=com_content&view=category&layout=blog&id=100&Itemid=577

National Cancer Institute
Section: General Information About Adult Non-Hodgkin Lymphoma (NHL)
Pages: https://www.cancer.gov/types/lymphoma/hp/adult-nhl-treatment-pdq
Glossary