**4. Clinical features**

The clinical presentation of the various lymphoid neoplasms is most often determined by the anatomic distribution of disease. Two-thirds of non-Hodgkin's Lymphomas present as enlarged nontender lymph nodes. The remaining one-third of NHLs present with symptoms related to the involvement of extranodal sites leading to mass effect, obstructive and compressive signs and symptoms. The lymphocytic leukemia most often come to attention because of signs and symptoms related to the suppression of normal hematopoiesis by tumor cells in the bone marrow. Plasma cell neoplasm, multiple myeloma, causes bony destruction of the skeleton and often presents with pain due to pathologic fractures. Other symptoms related to lymphoid tumors are frequently caused by proteins secreted from the tumor cells or from immune cells that are responding to the tumor. Specific examples include the plasma cell tumors, in which much of the pathophysiology is related to the secretion of whole antibodies or Ig fragments; Significant cytopenias are rare, unless marrow involvement is extensive, or there are associated immune-mediated cytopenias, hypersplenism, or, rarely, hemophagocytosis. Hepatosplenomegaly is a common feature of advanced low-grade B-cell lymphoma. Bleeding manifestations are common in lymphoblastic lymphomas/leukemia with marrow involvement [1, 2].
