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Assembly

Malignancy Imposter

Authors
Deepanjali Radhakrishnan Nair MD, Department of Internal Medicine, University of Tennessee Health Science Center, Nashville
Prativa Pandey MD, Department of Internal Medicine, University of Tennessee Health Science Center, Nashville
Jason Pritchett MD, Department of Pulmonary and Critical Care Medicine, University of Tennessee Health Science Center, Nashville


Case

A 67-year-old male with past history of COPD presented to the pulmonology clinic for follow up of a left upper lobe pulmonary nodule that was noted on chest CT scan 2 months ago. On presentation, the patient was short of breath and reported increasing left sided chest pain in addition to a 12-pound weight loss in the previous 2 months. He denied hemoptysis, fever, chills or night sweats. On exam, he had distant breath sounds without wheezing. Anterior chest wall had a left-sided 3 cm firm parasternal mass with minimal erythema and tenderness to palpation. CT scan of the chest with contrast is shown below (Figures 1 ). CT guided biopsy of the lung nodule was obtained. Hematoxylin and Eosin stain of the biopsy specimen is shown below (Figure 2).

Figure 1: CT chest axial view 1
Figure 1: CT chest axial view 1
Figure 2: Hematoxylin and Eosin stain of the biopsy specimen
Figure 2: Hematoxylin and Eosin stain of the biopsy specimen

Question

What is the diagnosis?

A. Locally invasive malignant tumor
B. Invasive aspergillosis
C. Tuberculosis
D. Invasive actinomycosis

Answer