The presence of intrathoracic lymphadenopathy in patients with suspected malignancy remains concerning, often prompting further evaluation with tissue sampling. The presence of nodal granulomatous inflammation in patients with underlying malignancy is well reported. However, review of 3 recent large trials of endobronchial ultrasound-guided transbronchial needle aspiration in patients with granulomatous inflammation and malignancy did not identify the presence of coexisting, intranodal malignancy, and granulomatous inflammation, rather these diagnoses remained nodally exclusive. We present a case of coexisting granulomatous inflammation and metastatic carcinoma within the same lymph node aspirates, reviewing the potential diagnostic pitfalls and implications of this rare occurrence.
*Swedish Cancer Institute/Swedish Medical Center, Division of Thoracic Surgery and Interventional Pulmonology, Seattle, WA
†Department of Pathology, Penn State College of Medicine-Milton S. Hershey Medical Center, Hershey, PA
‡The Johns Hopkins University School of Medicine, Division of Pulmonary and Critical Care Medicine, and Interventional Pulmonology, Baltimore, MD
C.R.G.: guarantor of the manuscript, taking responsibility for the integrity of the work as a whole, from inception to published article. C.R.G., C.A., L.Y.: contributed to data collection, data review, manuscript writing, and review.
Disclosure: There is no conﬂict of interest or other disclosures.
Reprints: Christopher R. Gilbert, DO, MS, Swedish Cancer Institute/Swedish Medical Center, Division of Thoracic Surgery and Interventional Pulmonology, 1101 Madison St., Suite 900, Seattle, WA 98117 (e-mail: firstname.lastname@example.org).
Received March 18, 2015
Accepted September 8, 2015