The Ann Arbor staging system for Hodgkin lymphoma is modified by the 'Cotswolds modification'. The suffix 'E' in staging denotes:
- A Extensive mediastinal disease (ratio >0.35 on chest X-ray)
- B Extranodal disease by direct contiguous extension from a nodal site ✓
- C Bone marrow involvement
- D Bulky disease measuring >10 cm in any dimension
Correct answer: B. Extranodal disease by direct contiguous extension from a nodal site
Explanation
In the Cotswolds-modified Ann Arbor system, the suffix 'E' denotes involvement of a single extranodal site by direct contiguous extension from an involved node or nodal group — this is distinguished from true Stage IV disease (disseminated extranodal involvement). The suffix 'X' denotes bulky disease (≥10 cm or mediastinal ratio >0.33). Bone marrow involvement designates Stage IV disease, not the 'E' suffix.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.