Nodular lymphocyte predominant Hodgkin lymphoma (NLPHL) has clinicopathologic, immunophenotypic, and molecular features that are distinct from classical Hodgkin lymphoma (cHL). Distinguishing these entities is usually straightforward, but unusual variants of NLPHL have been described that can be problematic diagnostically and potentially have clinical significance. We describe a case of NLPHL showing a variant histologic pattern characterized by small and large clusters of lymphocyte predominance cells within nodules defined by follicular dendritic cell meshworks, associated with numerous neutrophils and areas of internodular fibrosis. Focally, the neoplastic cells had lacunar cell-like cytologic features. The resulting combination, not previously reported, closely mimicked the syncytial variant of nodular sclerosis cHL. After chemotherapy the patient was free of disease 14 years later. In our review of the literature we identified rare cases of NLPHL that had similar histologic features, but lacked the neutrophilic infiltration. Recognition of this rare variant, facilitated by immunohistochemical studies in this case, further expands the morphologic spectrum of NLPHL.