Abstract Introduction Pleomorphic adenoma is a rare benign tumor of the lung that arises from bronchial submucosal glands and histologically resembles its salivary gland counterpart. These lesions are often discovered incidentally and can mimic malignancy or chronic infection radiographically. We report a case of pleomorphic adenoma of the lung in a patient with severe chronic obstructive pulmonary disease (COPD) and chronic respiratory failure, initially suspected to represent a chronic infection. Case Presentation A 72-year-old woman with severe COPD (FEV1 34%), chronic respiratory failure on 2 L/min supplemental oxygen, and bronchiectasis underwent serial imaging for pulmonary nodules. She had a greater than 30 pack-year smoking history and continued to smoke five cigarettes daily. A low-dose CT in September 2023, revealed multiple right upper lobe nodules up to 5 mm. A repeat CT in May 2025, demonstrated interval enlargement of a dominant right upper lobe nodule to 10 mm. Decision was made to follow up with a repeat CT in 3 months. A follow-up CT showed stability with multiple mediastinal and hilar lymphadenopathy. Given persistent concern for an indolent infection or low-grade malignancy, navigational bronchoscopy was performed on August 27, 2025. Transbronchial biopsies of the right upper lobe lesion and needle aspirations from mediastinal lymph node stations (7, 4R, 11R) were obtained. Discussion Histopathologic evaluation of the right upper lobe lesion demonstrated a biphasic proliferation of epithelial and myoepithelial cells within a chondromyxoid stroma, consistent with pleomorphic adenoma. Cytology from lymph node stations was negative for malignancy, and cultures were negative for mycobacterial infection. The findings confirmed a diagnosis of primary pulmonary pleomorphic adenoma. Surgical resection was recommended; however, given the patient’s poor pulmonary reserve and comorbidities, she declined surgery and oncology consultation. Conservative management with close radiologic surveillance was chosen. Conclusions Primary pleomorphic adenoma of the lung is an exceedingly rare entity that can mimic both neoplastic and infectious processes. Diagnosis requires tissue confirmation, often achievable with advanced bronchoscopic techniques such as navigational bronchoscopy. This case emphasizes the importance of considering benign glandular neoplasms in the differential diagnosis of solitary enlarging pulmonary nodules and highlights the need for individualized, multidisciplinary management in patients with significant comorbidities. This abstract is funded by: None
Sakaleshpur et al. (Fri,) studied this question.