CASE PRESENTATION: 32 year-old non-smoker female from Nepal with TB exposure previously was initially treated at Health Department with 10 days of antibiotics for suspected community acquired pneumonia. She had 3 weeks of cough, shortness of breath, pleuritic chest pain, hemoptysis, weight loss and fatigue but denied night sweats or fever and had a negative PPD in 2010. CXR showed a RUL cavitary lesion. When no improvement was seen; IGRA, sputum AFB smears and cultures were taken and she was referred for TB induction therapy in isolation. Later IGRA and sputum AFB x 3 were reported negative. CT chest revealed a cavitary lesion with right mediastinal adenopathy. Patient was placed on airborne isolation and started on RIPE therapy. After 2 weeks patient reported no significant improvement. AFB cultures and Urine histoplasma antigen came out to be negative. Repeat CT chest showed bilateral mediastinal adenopathy with cavitary lesion. Bronchoscopic biopsy revealed malignancy but was indeterminate due to lack of sample size. MRI brain was negative and PET scan showed FDG avidity in right lung lesion and mediastinal nodes. A CT guided core biopsy of the RUL lesion initially indicated a Primary Synovial Sarcoma however FISH for SYT-SXT translocation was negative. EBV testing done was positive and re-review indicated LELC. Chemo-radiation was started with clinical improvement and she remains in treatment.