Some higher grade lymphomas may have moderate amounts of cytoplasm. Almost always they grow diffusely and destructively. The median patient age is 60. These lymphomas account for almost a half of adult lymphomas but are not uncommon in children. Patients present with multiple painless, enlarged lymph nodes, uncommonly with significant extranodal extension.
Patients often present with a single, quickly growing nodal or extranodal mass.
Focal or extranodal disease is much more common. Lymphoma may involve privileged sites. Though not common, spleen and liver involvement takes the form of many tiny deposits. Though not common, spleen and liver involvement takes the form of large, destructive masses. Although significant numbers of lymphoma cells spill into the peripheral blood only in small lymphocytic lymphoma, numbers of circulating low grade lymphoma cells can usually be detected by sensitive techniques.