Correct!
3. Lung carcinoma with metastasis to the mediastinum and brain
All the diagnosis are possible. However, the most likely diagnosis with an endobronchial mass, mediastinal lymphadenopathy and an intracranial lesion would be lung cancer with metastases. Biopsy of the endobronchial masses was non-diagnostic. However, the needle biopsy of the mediastinal mass showed a single, classic coccidioidomycosis spherule (Figure 6).
Figure 6. Histology from the needle biopsy of the mediastinum. Panel A: Low power view of the biopsy. Panel B: High power view showing the cocci spherule (arrow).
The patient was begun on fluconazole and was both clinically and radiographically improving at his last visit.
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