A man in his 50s being treated for bilateral angiomyolipomas with everolimus underwent a routine follow-up abdominal CT, which revealed a lung lesion. A dedicated chest CT confirmed the presence of a 2.5-cm cavitary nodule in the lower lobe of the left lung (Figure 1). The lesion was hypermetabolic (SUV 2.5). He was a current smoker (>40 pack years). There was no other significant history.

A CT-guided core needle biopsy of the nodule revealed a necrotizing granuloma, but no organisms were found. A wedge resection of the nodule was performed, along with mediastinal lymph node dissection. Images from the wedge resection are shown in Figures 2-6. Figure 2 is a low magnification view of the nodule (H&E). Figure 3 shows the periphery of the nodule at high magnification. Figures 4 and 5 show high-magnification views of the necrotic center (H&E). A Grocott methenamine silver (GMS) stain is shown in Figure 6.

Click here to see more.