CASE PRESENTATION: The patient is a 64 year old man with history of a right upper lobe T2N2 squamous cell carcinoma treated with chemotherapy and radiation therapy (6000 cGy) two years ago, bladder cancer treated surgically, HTN, CKD, and prior tobacco dependence presenting with recurrence of a right upper lobe mass. He denied weight loss, fever, dyspnea, cough, or hemoptysis. A surveillance CT chest revealed a growing 3.3 x 2.7cm mass in the right upper lobe that was not present on post-radiation imaging. PET/CT revealed the mass to have an SUV of 5.6 without uptake in lymph nodes. A BAL was negative for malignancy, fungal, and mycobacterial infection. A wedge resection of the mass revealed small, non-caseating granulomas and modest lymphocytic infiltration. Stains for acid-fast bacilli and fungi were negative and there was no evidence of malignancy. The post-operative course was complicated by pneumothorax that resolved with chest tube drainage.