Our patient demonstrated diffuse tree-in-bud opacities, mediastinal adenopathy, and increased metabolic activity seen on CT/PET scanning. He also had remote inguinal adenopathy that was not sampled. His surgical pathology after adjuvant chemotherapy followed by right upper lobectomy revealed no lymphatic or vascular invasion by his tumor. All 13 lymph nodes sampled during surgery demonstrated noncaseating granulomas without malignant cells; the pulmonary parenchyma not adjacent to the tumor also had diffuse noncaseating granulomas. The findings of mediastinal adenopathy, tree-in-bud opacities, and increased metabolic activity seen on CT/PET scanning remained stable and was present on all subsequent imaging studies. Repeat bronchoscopic lymph node sampling failed to reveal malignant cells. For these reasons, we feel our patient truly does have synchronous diagnoses of sarcoidosis and lung cancer, and not an SLR related to cancer. One should not be persuaded away from a diagnosis of malignancy when noncaseating granulomas are present. Also, one should employ thorough mediastinal lymph node sampling when there is increased lymph node metabolic activity with a known malignancy.