Five lung nodules, four different pathologic findings: not all lung lesions are the same.

A patient with a history of colon adenocarcinoma was referred for resection of two lung lesions suspect for metastases. Three additional nodular areas were removed by wedge excision. Pathologic examination revealed four different diagnoses. This particular case demonstrates that the number of lesions may be underestimated on preoperative imaging, even on high-resolution computed tomography and positron emission tomography. Equally, pathologic examination of all detected lesions is vitally important to decide optimal treatment and to determine prognosis. This should be taken into account when discussing alternative treatment options to surgery such as stereotactic radiotherapy and radiofrequency ablation.