One needle, two diagnoses: a dual finding of adenocarcinoma and granulomatous reaction after EBUS-TBNA in lung cancer staging - a case report.

Introduction and importance: Coexistence of malignant and granulomatous pulmonary lesions can represent a diagnostic and therapeutic challenge. Distinguishing between tumor recurrence, infectious, or iatrogenic conditions is crucial for guiding appropriate management. Case presentation: We report the case of a 69-year-old woman referred to our center for evaluation of a 6-mm solid nodule in the left lower lobe, incidentally discovered during a coronary computed tomography scan. Endobronchial ultrasound-guided transbronchial needle aspiration confirmed invasive adenocarcinoma, whereas granulomatous inflammation was identified exclusively in the postoperative surgical specimen. The postoperative course was uneventful, and the patient was discharged in good condition. Clinical discussion: This case highlights the importance of considering differential diagnoses when encountering granulomatous changes adjacent to malignant tumors. The overlap between iatrogenic, infectious, and tumor-related findings can complicate the diagnostic process. Our experience underscores the importance of histopathological confirmation to avoid misinterpretation, ensure adequate oncological treatment, and prevent overtreatment. Conclusion: Granulomatous lesions concomitant with lung cancer are rare but clinically relevant. Awareness of this possibility is essential for accurate diagnosis and optimal patient management.