PMC5790665_01
Coronal (A) and axial (B, C, and D) CT scans of the chest showing intense pleural and subpleural fibrosis, as well as septal thickening, predominantly located in the upper lobes and a spiculated nodule in the left upper lobe.
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Chest CT scans showed intense pleural and subpleural fibrosis, as well as septal thickening, predominantly located in the upper lobes (Figure 1).
Photomicrographs of a surgical lung biopsy specimen from the left upper lobe. In A, clearly delineated areas of pleural/subpleural fibrosis in nonfibrotic parenchyma (arrow; H&E, magnification: x28). In B, pleural/subpleural fibrosis and scarce mononuclear cell infiltrate (arrow; H&E, magnification: x28). In C, compact fibrosis with elastosis, with no evidence of malignancy (arrow; H&E, magnification: x40). In D, an increase in elastic fibers in the areas of pleural fibrosis (arrow; Verhoeff staining for elastic fibers, magnification: x28).
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Microscopic examination revealed compact fibrosis with elastosis, with no evidence of malignancy in the resected nodule, as well as clearly delineated areas of pleural/subpleural fibrosis in nonfibrotic parenchyma and little scarce mononuclear cell infiltrate (Figure 2).
PMC5790665_02
Upper lobe explant histological findings. In A and B, presence of fibrous thickening of the visceral pleura and subpleural lung parenchyma, with little dense collagen deposition and abundant elastic fibers that are evident on Verhoeff staining. In C, signs of small airways disease, either by obliteration or by distortion of the bronchial wall, accompanied by malformed granulomas and multinucleated giant cells containing cholesterol crystals, located interstitially or intra-alveolarly.
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