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A large number of pathologic entities share an aggressive natural history; median survival untreated is 6 months, and nearly all untreated pts are dead within 1 year. Pts may present with asymptomatic adenopathy or symptoms referable to involvement of practically any nodal or extranodal site: Mediastinal involvement may produce superior vena cava syndrome or pericardial tamponade; retroperitoneal nodes may obstruct ureters; abdominal masses may produce pain, ascites, or GI obstruction or perforation; CNS involvement may produce confusion, cranial nerve signs, headache, seizures, and/or spinal cord compression; bone involvement may produce pain or pathologic fracture. About 45% of pts have B symptoms.
Diffuse large B-cell lymphoma is the most common histologic diagnosis among the aggressive lymphomas, accounting for 35–45% of all lymphomas. Aggressive lymphomas together account for ~60% of all lymphoid tumors. About 85% of aggressive lymphomas are of mature B-cell origin; 15% are derived from peripheral (postthymic) T cells.