Nodular lymphocyte predominant Hodgkin lymphoma at atypical locations may be associated with increased numbers of large cells and a diffuse histologic component.

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) typically affects predictable lymph node groups with excellent treatment outcomes, but cases with a diffuse histologic pattern are associated with recurrence and rarely, cases will transform to diffuse large B-cell lymphoma. Although increased numbers of large cells has not been associated with poor prognosis, transformation is thought to histologically progress through a stage distinguished by increasing numbers of large atypical B-cells. From 55 cases of NLPHL, we describe a possible subset of NLPHL occurring in older individuals at atypical sites, associated with increased numbers of large cells, a diffuse histologic component, and expression of Bcl-2.