A 63-year-old man, a 100–pack-year smoker, presented with a 2-month history of cough, hoarse voice, anorexia, and weight loss. Radiologic studies showed a large, solid, left parahilar mass with mediastinal adenopathy (Fig 1
). Bronchoscopy revealed paralysis of the left vocal cord, but was otherwise nondiagnostic on two occasions; “random” bronchial biopsies and cytology specimens were unremarkable. The patient rejected the suggestion of mediastinal exploration. Staging investigations were negative for metastatic disease.