What is the Ann Arbor staging system for diffuse large cell lymphoma?

Updated: Jun 12, 2019
  • Author: Shipra Gandhi, MBBS; Chief Editor: Emmanuel C Besa, MD  more...
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Answer

The Ann Arbor staging system, originally designed for Hodgkin disease, is traditionally used to assess the extent of disease involvement in patients with non-Hodgkin lymphoma (NHL). The stages are characterized as follows:

  • Stage I - Involvement of a single lymph node region (I) or localized involvement of a single extralymphatic organ or site (IE)

  • Stage II - Involvement of 2 or more lymph node regions on the same side of the diaphragm (II) or localized involvement of a single associated extralymphatic organ or site and its regional lymph nodes, with or without involvement of other lymph node regions on the same side of the diaphragm (IIE)

  • Stage III - Involvement of lymph node regions on both sides of the diaphragm (III), which may also be accompanied by localized involvement of an associated extralymphatic organ or site (III E ), by involvement of the spleen (IIIs), or by both (IIIE+S)

  • Stage IV - Disseminated (multifocal) involvement of one or more extra lymphatic organs, with or without associated lymph node involvement, or isolated extralymphatic organ involvement with distant (nonregional) nodal involvement

  • A - No systemic symptoms present

  • B - Unexplained fever ≥ 38o C; drenching night sweats; weight loss ≥ 10% body weight

Cotswold’s modifications are as follows:

  • X = bulky disease - Bulky disease is defined as a mass of nodes with one diameter of >10 cm or a mediastinal mass larger than one third of the transthoracic (mediastinal) width

  • Number or anatomic regions involved - The number of anatomic regions involved should be indicated by a subscript (eg, II3)


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