This is a good learning case - both practical and for fellowship examinations.

1. One could easily miss the chest x-ray findings. Review areas are highlighted for a purpose.
2. A biopsy however well done is invasive and comes with risks. Reserve biopsy for when one's intelligence and full range of diagnostic tests have been exhausted. A CT guided biopsy was requested after the diagnostic CT and the radiologist advised MRI cervical spine first.
3. Not every apical mass is in the lung and not every mass is cancer. Have a differential.
4. The MRI illustrates this is a neurogenic and almost certainly benign nerve sheath tumor.
5. Clinicoradiological discussion almost always adds positively to patient care

No biopsy was undertaken. The differential for this neurogenic tumor includes schwannoma, neurofibroma and ganglioneuroma.