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We observed a rare case of invasive mucinous adenocarcinoma (IMA) with a lepidic-predominant patte accompanied by pulmonary tuberculosis.An 85-year-old man with repeated cough and sputum was admitted to Xinhua Hospital.T-SPOT test result was 212 pg/ml (reference value of negative is ＜ 14 pg/ml),Mycobacterium tuberculosis culture was positive,and tuberculin skin test (PPD) was negative (skin induration ＜ 5mm).The patient was treated with several courses of antibiotics and anti-tuberculosis treatments.Repeated chest CT scans showed disease progression.Bronchoscopy yielded negative results.PET-CT scans showed negative results.A percutaneous lung biopsy revealed mucin-secreting cells lining the alveolar walls.IMA with a lepidicpredominant patte was diagnosed after invasiveness was found after experimental treatments.Simultaneous occurrence of pulmonary tuberculosis and lung cancer are common;however,the present case of IMA having a lepidic-predominant patte and coexisting with active tuberculosis has not been reported yet.