Q. A 62 year-old woman was admitted through the emergency department yesterday with a diagnosis of lobar pneumonia. A review of her chart indicates appropriate initial therapeutic interventions including oxygen therapy for mild hypoxemia, sputum and blood cultures, and broad-spectrum IV antibiotics. Along with a right lower lobe consolidated pneumonia, a chect CT with and without contrast performed on admission showed a radiodense 1.5 cm single perifissural nodule with lentiform morphology in the left lower lung field. The patient denies any recent weight loss, occupational exposure, or recent travel. She reports a 20-pack year history of smoking. On physical examination, she is afebrile and in no acute distress. Her heart rate is 65/min, respiratory rate 18/min, and her blood pressure is 130/80 mmHg. She is breathing comfortably on 2L of oxygen via nasal cannula, and her oxygen saturation is 98 percent. Which of the following, if present, is suggestive of a malignancy?