Nodular lymphoid hyperplasia (NLH), a benign localized lesion showing features of reactive lymphoid hyperplasia, is one of the entities that, typically, require a surgical biopsy for diagnosis. In the only published series, to our knowledge, reviewing Armed Forces Institute of Pathology records over a 24-year period, 14 NLH cases were identified. The median age at diagnosis was 65 years (range, 19-80 years) with a slight predominance in women. Of those, most were discovered incidentally on routine chest radiographs and represented a single lesion. In cases with multifocal presentation, the lesions were unilateral. Clinically, only four of the 14 patients had symptoms such as shortness of breath, cough, or pleuritic chest pain. PET scan uptake associated with NLH has been reported as mild to moderate. Grossly, NLH appears as a well-circumscribed rubbery nodule, measuring 2 to 4 cm in its greatest dimension. Histologically, it contains well-developed lymphoid follicles with reactive germinal centers and interfollicular plasma cells; interfollicular fibrosis and scattered granulomas may be present. There can be limited lymphangitic spread along the bronchovascular bundles and interlobular septa. Regional lymphadenopathy may be seen in a third of cases, but the lymph nodes are histologically benign. With surgical resection, the prognosis appears to be excellent. Nonetheless, long-term follow-up is recommended because little is known about the cause and natural history of NLH.