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A 48-year-old woman with a history of hysterectomy for uterine leiomyomas on 28 March 2019, presented with a chronic cough and a right lower lobe lesion identified since 2019. Contrast-enhanced CT on 26 February 2020 at our centre demonstrated a well-demarcated mass measuring 18×11 cm, containing solid soft-tissue components with progressive enhancement, air-containing cystic structures and scattered calcifications (figure 1A–D). Video-assisted thoracoscopic wedge resection of the tumour was performed on 6 March 2020. During the operation, a firm, well-encapsulated mass (figure 1E) located anterior to the right hilum with a pedicle arising from the right upper anterior segment was observed with dense adherence to the right middle lobe and the parietal pleura. A spindle cell neoplasm with fascicular arrangements of spindle cells interspersed with epithelial components and hyaline stromal matrix was confirmed, and the immunohistochemical staining was positive for both spindle cell components (figure 1F) and epithelial components, indicating fibroleiomyomatous hamartoma (FLH), and low Ki-67 proliferation index (<5%) was observed. Chest CT 3 months later showed complete resection without evidence of recurrence or metastasis.