A 66-Year-Old Man With Mediastinal Mass and Dyspnea Narendra Kumar Narahari, MD, FCCP, Paramjyothi K. Gongati, MD, Shantveer G. Uppin, MD, Anu Kapoor, MD, Bhaskar Kakarla, MD, Ramakrishna Dev Tella, MS, MCh  CHEST  Volume 150, Issue 4, Pages e109-e115 (October 2016) DOI: 10.1016/j.chest.2016.07.002 Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 1 A, Buccal mucosa. B, Inferior labial mucosa. C, Tongue showing white and violaceous lacy plaques, a few coalescing to form reticulate pattern on an erythematous base. A few erosions are also seen on the buccal mucosa. Plaque formation and brownish discoloration of teeth and gingivae also noted, indicating poor oral hygiene. CHEST 2016 150, e109-e115DOI: (10.1016/j.chest.2016.07.002) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 2 A, Chest radiograph shows a homogeneous opacity in right paracardiac region, with indistinct right cardiac border suggestive of an anterior mediastinal mass. In addition, faint nodularity is noted in both lung fields. B, Contrast-enhanced axial CT image of the chest shows a homogeneous soft-tissue lesion with calcification in right anterior mediastinum. C-E, High-resolution CT (HRCT) images in lung window settings reveal diffuse ground-glass attenuation of lung parenchyma with multiple tiny ill-defined randomly distributed nodules in both centrilobular and subpleural locations along the fissures (white arrows in C and D). CHEST 2016 150, e109-e115DOI: (10.1016/j.chest.2016.07.002) Copyright © 2016 American College of Chest Physicians Terms and Conditions

Figure 3 A and B, Section from the anterior mediastinal mass shows diffusely arranged monomorphous plump spindle cells admixed with lymphocytes. C, Section from lung biopsy sample shows peribronchiolar and interstitial lymphomononuclear infiltrates. D, Section shows thickened alveolar septa with infiltrates of predominantly lymphocytes and a few histiocytes. E and F, Interstitial aggregate of epithelioid cells and giant cells (arrow) forming ill-defined loose nonnecrotizing granuloma. G, CD3 positivity of lymphocytes in the interstitial infiltrate. H, Negative staining for CD20 in the interstitial lymphocytic infiltrate. I, CD68 highlights the histiocytes within the interstitial infiltrate. CHEST 2016 150, e109-e115DOI: (10.1016/j.chest.2016.07.002) Copyright © 2016 American College of Chest Physicians Terms and Conditions