A 42 year old man comes to ENT OPD. He is a follow up case of recurrent sinus and ear infection from past 1 year. It is also associated with headache. He gives history of pollen allergy. Currently, he presented with complains of blood tinged sputum and cough. Chest x ray is done with B/L nodular infiltrates and cavitary infiltrates. CT SCAN is planned. CT guide biopsy is planned from the above x ray located mass and is shown below: Lab investigation reveal raised ESR and c ANCA positivity Which of the following is the least likely diagnosis?

X ray shows bilateral nodular shadow with cavitary lesion i/v/o clinical s/s and lab investigation-possibility of wegener granulomatosis exists. CT scan shows multiple bilateral cavitary lesions. HPE- Histiocytes and giant cells surrounding a central necrotic zone. Vasculitis: neutrophils and lymphocytes involving aeriole wall. Recurrent sinusitis with hemoptysis raises following differential diagnosis: Acute bronchitis Wegener granulomatosis Churg strauss syndrome Goodpasture syndrome Bronchogenic carcinoma Upper and lower respiratory symptoms. With significant cxr and HPE , elevated ESR and cANCA positivity is suggestive of WEGENER granulomatosis as the diagnosis.