This presentation of lymphoma is rather unique, in that no lymphadenopathy was noted in the original report and no lymphadenopathy was palpable on physical exam. This patient did have the so-called B symptoms (fevers, chills, night sweats, fatigue) with a concurrent anemia, indicating that a malignancy was present. However, her complaints of muscular chest pain, reproducible on the physical exam, were somewhat confounding and did not point to a diagnosis of lymphoma.On radiographic imaging, the appearance of a mass, instead of lymphadenopathy, suggested a solid malignancy, such as breast, lung, or colon, all of which can occur in this patient population (elderly, female). Multiple masses also are suggestive of a metastatic solid malignancy instead of a lymphomatous malignancy; however, lymphoma remains on the differential.An infectious process, especially TB, should be considered in this patient, especially in light of the symptoms of fevers, chills, night sweats, coupled with the appearance of multiple masses. This diagnosis, while unlikely in this patient, still must be considered, as it is treatable.CHOP and Rituximab (antibody to the CD20 marker on the B cells) were begun on this patient, because of the 60-80 percent complete remission rate of lymphoma. The hope was that this patient’s tumor would respond quickly to chemotherapy. However, given likely bone involvement, the patient’s prognosis was poor. Diffuse large B cell lymphoma accounts for 31% of Non-Hodgkin’s lymphoma, the largest portion of all NHL. Clinically, DLBCL presents as a rapidly enlarging nodal mass in the neck or abdomen, as it did in this patient. Stage I is involvement of one single node region, stage two is two or more lymph node regions on the same side of the diaphragm, mediastinal lymphadenopathy and a supraclavicular node. Stage three and four are involvement of nodal regions on both sides of the diaphragm, and disseminated disease respectively. This patient can be described as having Stage IV disease.