Wiki Need lymphoma expert!

[KMayercsik]

I am hoping for a lymphoma expert....
Dictation:

Patient was diagnosed with a follicular lymphoma in the summer 2021. He subsequently underwent palliative chemotherapy with Bendamustine and Rituxan which was completed in January of this year. He tolerated this treatment with no significant complications. Follow-up imaging studies showed favorable response within the previously enlarged lymph nodes. However, the paraspinal and soft tissue mass in the lower thoracic spine area had slightly increased in size. Biopsy performed by Dr. Tatineni demonstrated again marginal zone B-cell lymphoma.

I don't understand the 'again demonstrated' and have asked the physician, waiting for the response. The pathology does state marginal zone B-cell lymphoma. He has been referred to our radiation department, but the diagnosis codes entered by the the previous MedOnc include C82.13 (follicular) and C85.98 (NHL unspecified). Would marginal zone B-cell lymphoma be considered 'low grade' lymphoma and coded to C83.XX. The 2021 pathology states: "Paraspinal mass, core biopsy: Low-grade B-cell lymphoma, most consistent with marginal zone lymphoma.", The pathology again in 2022 states the same, marginal zone B-cell lymphoma.

Any direction would be helpful.

 

[rachaelwilleford]

Favorable response doesn't mean it's gone. Provider is stating that it's again demonstrated because while he's been treated, it hasn't gone away. What is the diagnosis referred to in the assessment/plan?

 

[KMayercsik]

He will be treating the soft tissue, marginal zone b-Cell lymphoma. Treatment will be to that area, soft tissue of the thoracic spine. I agree he still has the follicular but we will be directing treatment to the soft tissue of the lower thoracic spine, MZL. Would it be the NHL of the extra nodal sites?
Thanks for looking at and responding.