Correct!
2. Hamartoma
The slow increase in size and metabolic activity within the anterior segment right upper lobe nodule is inconsistent with pulmonary hamartoma, nor is there fat within the lesion to suggest this diagnosis. The other choices are certainly possibilities. Pulmonary lymphoma is probably less likely as a diagnosis since the nodule’s behavior appears discrepant from the behavior of the lymphadenopathy known to reflect lymphoma, but that possibility is difficult to exclude on the basis of imaging alone.
Coccioidomycosis serology was unrevealing. Pulmonary medicine was consulted and robotic bronchoscopy (Figure 12) was performed and the diagnosis of adenocarcinoma was established.
Figure 12. Robotic bronchoscopic biopsy of the anterior segment right upper lobe nodule.
The patient subsequently underwent right upper lobe resection and lymph node dissection which showed a 2.2 cm acinar predominant adenocarcinoma with no lymph node metastases. Spread through the air spaces and visceral pleural invasion were noted. Mixed dust deposition was also found in the lung parenchyma and resected lymph nodes.
Diagnosis: Slow growing adenocarcinoma, initially non-18FDG – PET avid, possibly related to previous scar
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