6 Patterns > Fibrosis Pattern > Additional Features > w/ Granulomas

Fibrosis w/ Granulomas

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Chronic Hypersensitivity Pneumonitis

Sarcoidosis/Berylliosis

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Certain Chronic Infections

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Chronic Aspiration

Sample Signout

If no additional specific histologic features are identified, consider the following approach to signing the case out:

Fibrosing Interstitial pneumonia with granulomas (see comment).

Comment:  The biopsy shows advanced fibrosis with architectural distortion and scattered (necrotizing or nonnecrotizing) granulomas. The differential diagnosis includes chronic hypersensitivity pneumonitis, sarcoidosis/berylliosis, chronic infection, and chronic aspiration. Because of the presence of granulomas in this case, usual interstitial pneumonia of idiopathic pulmonary fibrosis is not favored. The diagnosis of ILD requires a multidisciplinary approach.  Correlation with imaging studies and clinical history is suggested.