Male 70 years

Interstitial lung shadowing more towards bases. Wedge biopsy of lung. What is the distribution of the pathology? Is it predominantly fibrotic or cellular or a mix? What compartment is the pathology predominantly in (interstitial vs airspace)? What is the term used for the slightly myxoid areas containing plump spindle cells beneath the alveolar surface (look slightly pale and purple)? What are these spindle cells laying down?

Male 43 years

Increasing shortness of breath 2years. Peripheral eosinophilia

Female 40 years

Arthritis and shortness of breath

Male 54 years

Shortness of breath 3 years initially steroid responsive. Wedge biopsy of lung. What is the distribution of the pathology? What is the predominant pathological abnormality (cellular vs fibrotic)? What compartment is the pathology in predominantly (airspaces vs interstitium)? From these 3 questions how could you summarise what pattern of lung disease we see here?

Female 35 years

Smoker. Shortness of breath. CT looks emphysematous. Wedge biopsy of lung. At low power: where are the abnormalities? how would you describe them? At 35 yrs old are they more likely to related or unrelated? (Loaded question alert!) If related what might link them?

Female 32 years

Smoker with recurrent pneumothoraces. Wedge biopsy of lung. What is the predominant distribution of the pathology? How would you describe the cells in the nodular lesions? What might they stain with immunohistochemically? One nodule looks slightly different - how would you describe it? What are the background bronchioles like?

Male 25 years

Smoker with recurrent pneumothoraces. Wedge biopsy of lung. Is this normal? (loaded question!) If not where is the abnormality? What are the main cell types involved?

Female 35 years

Works in aviary. Upper zone predominant ground glass lung infiltrates on CT with some air trapping. Wedge biopsy of lung. Is this predominantly a cellular or fibrotic process? What compartment is the main abnormality (interstitium vs alveolar)? What is the distribution?

Female 31 years

Rash on face and joint problems. Lung infiltrates on imaging. Wedge biopsy of lung. Questions to consider initially, with a potential interstitial lung disease, are: What compartment/s is the pathology in (ie airspaces / interstitium)? What is the distribution on low power (eg patchy / widespread / subpleural / paraseptal / peribronchiolar)? Is the abnormality mainly cellular, mainly fibrotic or a combination? (If fibrotic, is it established or ongoing (ie organising pneumonia/fibroblastic activity?))

Male 40 years

Migratory fluffy infiltrates on xray. Lung wedge biopsy. What are the main pathological abnormalities? What is their location and distribution?

Male 75 years

Large area of lung consolidation excised ?tumour in lobectomy specimen. 2 blocks of subpleural sampling provided. What basic pathological patterns can be seen? What is the distribution of the pathology?

Male 65 years

Consolidated lungs and mediastinal lymphadenopathy - white cheesy material exuded from cut surfaces of nodes and lungs. Section of Lung and of an enlarged node taken at autopsy. What is the distribution of the pathology in the lung tissue?

Male 37 years

Mediastinal lymphadenopathy and nodular lung infiltrates. What is the distribution of the pathology?

Male 30 years

Consolidated lungs at autopsy

Male 36 years

Acute onset shortness of breath