Recurrent Nodular Lymphocyte Predominant Hodgkin Lymphoma with Diagnostic Evolution Over Two Decades.

Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) is a rare subtype of Hodgkin lymphoma with distinct pathologic and clinical characteristics. We present the case of a 51-year-old man with a nearly 20-year history of NLPHL characterized by multiple relapses, diagnostic reclassification, and treatment de-escalation. This case illustrates the diagnostic challenges in distinguishing NLPHL from lymphocyte-rich classical Hodg- kin lymphoma (LRCHL), the indolent natural history of NLPHL with prolonged remissions, and the role of active surveillance in managing asymptomatic relapsed disease.