A 58 year-old female was referred to our Division for a right central pulmonary mass strongly suggestive of central lung cancer (Fig. 1) .
Computed tomography scan of the thorax showing a right hilar dishomogeneous mass, infiltrating the right main bronchus.
An endo-bronchial biopsy was undertaken. Histology showed a granulomatous lesion (Figs. 2A,B) . Fine needle aspiration cytology (Figs. 2C,D) showed an epithelioid aggregate and giant multinucleated cells.
(A) granulomatous lesion made of epithelioid istiocytes with rich granulocytic infiltrate; (B) monocytes and granulocytes infiltrate surrounding the thickened wall of a small caliber vessel (arrow); (C) epithelioid istiocytes aggregate, eosinophilic granulocytes and scattered epithelial cells without atypias (arrow); and (D) multinucleated giant cells observed in cytology but not in bioptic specimen.
The final diagnosis, supported by elevated serum perinuclear antineutrophilic cytoplasmic antibodies (p-ANCA) levels is consistent with Wegener disease.
