A group of five patients with Hodgkin's disease, nodular sclerosing in type, localized to the mediastinum (Stage IA) is reported. We believe that this presentation sometimes known as "granulomatous thymoma," warrants management in a manner somewhat different from that of the more common presentations of Hodgkin's disease. Nodular sclerosing Hodgkin's disease involving only the mediastinum affects a younger age group in whom the disease may be asymptomatic. Making the diagnosis may necessitate a thoracotomy, but an attempt should be made to obtain tissue short of thoracotomy, as by mediastinoscopy. An extensive attempt at surgical extirpation is not necessary because the disease is very radiosensitive and radiocurable. The combination of Stage I Hodgkin's disease, nodular sclerosing in form, limited to the mediastinum favors an excellent prognosis.