A 63-year-old elderly female was admitted to our hospital with a lump in her right breast, first noticed two months ago. On clinical examination, a 6x4 cm lump was seen involving the central quadrant, firm to hard in consistency with palpable ipsilateral axillary lymph node. Mammography was suggestive of breast imaging-reporting and data system (BIRADS) category V lesion of the breast. Fine needle aspiration cytology indicated it as ductal malignancy. Furthermore, biopsy confirmed it as grade III intra-ductal carcinoma with ER/PR and HER2-Neu positive malignancy. Eighteen (18)-flurodeoxyglucose positron emission tomography (18-FDG PET) demonstrated a hypermetabolic lobulated soft tissue mass involving outer quadrant of right breast measuring approximately [4.8 x 3.3 x 5 cm SUV max 21.1]. In addition, hypermetabolic right axillary nodes [SUV max 23.8], right internal mammary node [6SUV max 6], mediastinal/hilar and upper abdominal lymphadenopathy [SUV max 17.9] were also seen (Figure 1). Diffuse splenic hypermetabolism was also seen. The patient was planned for neoadjuvant chemotherapy. She received 4 cycles of chemotherapy with AC (Adriamycin and cyclophosphamide) regimen at 3 weeks interval. She tolerated the chemotherapy well. After the fourth cycle, the lump showed a reduction in size to 2 x 2 cm with no palpable axillary lymph nodes. Repeat 18-FDG PET showed near complete metabolic and significant morphologic resolution of previously seen lobulated soft tissue mass involving right breast, now measuring 1.8 cm [SUV max 2.1] and right axillary lymph nodes [SUV max 2.5] was seen. However, there was no gross interval change in size and metabolism of previously seen small supraclavicular, internal mammary, multistation mediastinal/hilar, upper abdominal lymphadenopathy and splenic hypermetabolism. This raised the possibility of an alternate diagnosis. Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) was performed to rule out metastasis. Histopathological examination showed epithelioid histiocytes and langerhans type of giant cell suggestive of granulomatous inflammation (Figure 2). No atypical/malignant cells were seen. Interferon gamma release assay (IGRA) for tuberculosis was negative. On further evaluation, angiotensin converting enzyme (ACE) level were found to be elevated (52 IU/L). As she had no pulmonary symptoms, she was not treated for sarcoidosis. Thus, effective management via histopathological examination made sure she did not receive further cycles of unnecessary chemotherapy.