This 55 y/o female with a long smoking history presented with a new abnormality on her chest x-ray. A chest CT and CT guided lung biopsy were performed. There is a subtle calcification in the lesion. On pathologic evaluation a non-caseating granulomatous lesion was seen with multinucleated giant cells. GMS stain was negative for fungus/yeast, Ziehl-Neelsen stain revealed moderate numbers of acid fast bacilli.
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