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Changes from previous Instruments

SOP Bulletin 174

ICD Coding

• ICD-9-CM Codes: 201
• ICD-10-AM Codes: C81

Brief description

This is a malignant neoplasm of the lymph nodes and of lymphoid tissue. This neoplasm arises from B lymphocytes but has a special type of cell called a Reed-Sternberg cell.  This neoplasm principally causes a space occupying lesion (mass) effect.

Confirming the diagnosis

The diagnosis is confirmed based on histopathology from a biopsy of an involved lymph node or a mediastinal mass, or less comonly by biopsy of an involved organ.

The relevant medical specialist is a haematologist or oncologist.

Additional diagnoses covered by SOP

• Hodgkin’s disease
• Hodgkin lymphoma
  • classic type
    • Nodular sclerosis cHL
    • Mixed cellularity cHL
    • Lymphocyte rich cHL
    • Lymphocyte depleted cHL
  • Nodular lymphocyte predominant type

Conditions excluded from SOP

• Burkitt’s lymphoma^#
• Chronic lymphoid leukaemia*
• Hairy cell leukaemia* - chronic lymphocytic leukaemia/small lymphocytic lymphoma SOP
• Non-Hodgkin Lymphoma*
• Plasma call malignancy* - myeloma SOP

* another SOP applies

^# non-SOP condition

Clinical onset

Most patients present with asymptomatic enlarged lymph nodes (particularly in the neck) or with non-specific symptoms in the form of fever, night sweats, or unintended weight loss.  In some patients the condition is detected after a finding of a mediastinal mass on chest Xray, and there may also be associated symptoms of cough, shortness of breath, or retrosternal chest pain.

There are two peak ages for this condition - first in late adolescence/young adulthood and then a second peak in older adults.

Clinical worsening

The only SOP worsening factor is for inability to obtain appropriate clinical management.  Advances in treatment (with chemotherapy and radiotherapy) have seen the condition go from a uniformly fatal disease to one that is now curable in about 75% of cases.  Treatment can be associated with serious complications.  The choice of treatment is tailored for the individual patient and involves balancing treatment effectiveness and complication risk.