Correct!
5. Bronchogenic malignancy
The presence of a metabolically active right apical lung mass with metabolically active right paratracheal lymphadenopathy in an older smoker is highly suspicious for primary bronchogenic malignancy. Lymphoproliferative disorder is not entirely excluded, but in non-immunocompromised adults, lymphoproliferative disease arising from the lung is relatively rare, and when presenting in a primarily extranodal fashion, the presence of noncontiguous lymphadenopathy also is unusual. No imaging or clinical evidence points towards fungal infection A neuroendocrine neoplasm, particularly large cell neuroendocrine malignancy, would appear very similar to this patient’s lesion and remains a consideration, but is less common than primary bronchogenic malignancy. Similarly, inflammatory myofibroblastic tumor could also present in this fashion, although the lymphadenopathy is not typical of that rare disorder.).
Based on the information available thus far, which of the following represents the best choice for establishing the diagnosis and furthering management in this patient? (Click on the correct answer to be directed to the tenth of 12 pages)
