Name

Lymphomatoid granulomatosis grade 3

ICD-O-3 Morphology

9766/3: Lymphomatoid granulomatosis grade 3
Effective 2021 and later

Reportable

for cases diagnosed 2021 and later

Primary Site(s)

No primary site specified
See Module 7

Most common sites of involvement: lung, upper respiratory tract, brain, kidney, liver, skin, gastrointestinal.
Rare involvement of the lymph nodes and spleen

Abstractor Notes

(This code is effective for cases diagnosed 2021 and later. For cases diagnosed prior to 2021 see code: 9680/3.)

The clinical behavior of LyG varies widely; the disease ranges from an indolent process to an aggressive large B-cell lymphoma. In its most indolent form (see 9766/1), LyG presents with pulmonary nodules in an otherwise asymptomatic patient.

A more typical course is characterized by symptoms and multiorgan involvement.

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

Not Applicable

Module Rule

None

Alternate Names

None

Definition

Lymphoid granulomatosis (LyG) is an angiocentric and angiodestructive lymphoproliferative disease involving extranodal sites, composed of EBV-positive B cells admixed with reactive T cells, which usually predominate. The lesion has a spectrum of histological grade and clinical aggressiveness, which is related to the proportion of large B cells.

LyP is divided into three different grades

1) Grade 1: see 9766/1

2) Grade 2: see 9766/1

3) Grade 3 lesions show an inflammatory background, but also contain large atypical B cells that are readily identified by CD20 and can form larger aggregates. Markedly pleomorphic and Hodgkin-like cells are often present, and necrosis is usually extensive. EBV-positive cells are numerous, and focally may form small confluent sheets.

Definitive Diagnostic Methods

Bone marrow biopsy
Genetic testing
Immunophenotyping

Genetics Data

None

Immunophenotyping

CD3 positive
CD4 positive
CD8 positive
CD15 negative
CD20 expression
CD30 positive
EBNA2 positive
LMP1 positive

Treatments

Chemotherapy
Immunotherapy

Transformations from

None

Corresponding ICD-9 Codes

200.8 Other named variants of lymphosarcoma and reticulosarcoma

Corresponding ICD-10 Codes

C83.8 Other types of diffuse non-Hodgkin lymphoma

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

C83.8 Other non-follicular lymphoma (effective October 01, 2015)

Signs and Symptoms

Drenching night sweats
Fatigue
Fever (for no known reason)
Pain in the chest, abdomen, or bones (for no known reason)
Painless swelling in the lymph node
Shortness of breath

Diagnostic Exams

CT (CAT) scan
Flow cytometry
Immunohistochemistry
Immunophenotyping
Lymph node biopsy
PET (positron emission tomography) scan

Progression and Transformation

None

Epidemiology and Mortality

Age: Usually presents in adults, but may be seen in children
Incidence: Rare condition, female predominance
Survival: Up to 5 year survival rate of 70%

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: 312-314

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