A 62-year-old man with diffuse large B cell lymphoma presented with upper abdominal mass and shortness of breath. General physical examination revealed bilateral cervical, axillary, epitrochlear (Fig. 1), and inguinal lymphadenopathy. These nodes were symmetrical, large, discrete, firm, mobile, and nontender. A computed tomographic scan of the chest and abdomen showed gross left sided pleural effusion and a large lobulated lymph nodal mass in the retroperitoneum. He was started on chemotherapy using rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP).