Fig. 13

A 54-year-old woman with a previous history of brain metastases from a small cell lung carcinoma, presented during follow-up with two lung nodules. Axial CT in lung window setting shows two nodules in the right middle lobe: a 17 mm spiculated and lobulated nodule (a) that only showed minor uptake on 18F-FDG-PET and a spiculated 22 mm pleural based nodule (b) with very intense uptake (c). The smallest nodule had been described in previous reports. The largest spiculated peripheral nodule was a new finding. Because of the high clinical suspicion of tumour recurrence and absence of extrathoracic disease on 18F-FDG-PET, thoracoscopic wedge excision of both nodules was performed. Histopathologic examination of the smallest spiculated nodule showed findings consistent with a typical carcinoid. The larger spiculated subpleural lesion was a tuberculoma. There were no signs on histopathology for small cell lung cancer recurrence. Even if imaging shows suspicious findings, new lesions in oncology patients are not always tumour recurrence. Depending on the clinical situation, histopathological proof may be mandatory in these cases