Granular cell tumor of the lung

A 46-year-old female with history of asthma, active smoking (20 pack-years), and schizophrenia was evaluated for a persistent asymptomatic pulmonary nodule. Her past medical history was notable for hypertension, obesity, polycystic ovary syndrome, abnormal uterine bleeding, multinodular thyroid gland, and vitamin D deficiency. Seven months before presentation, a chest radiograph (CXR) was obtained to evaluate unintended weight loss, and showed a 3 cm spiculated mass in the left lower lobe concerning for a primary lung malignancy. Follow-up computed tomography (CT) suggested that the left lower lobe mass corresponded to rounded atelectasis; however, at 6 month follow-up, low-dose chest CT scan revealed a 2.1 × 1.2 cm nodule within the central portion of the left lower lobe, with pleural thickening, and arising from or extending into the left lower lobe bronchus. The patient had no recent history of appetite change, exertional dyspnea, chronic cough, wheeze, fever, or other chest complaints. Her examination showed normal vital signs, oxygen saturation of 98% while inspiring room air, and an entirely normal lung and general physical examination, except for diminished breath sounds at the left base with no wheeze. An endobronchial ultrasound (EBUS) with fine-needle aspiration (FNA) and endobronchial biopsy was performed.