Pathological and radiological correlation in an autopsy case of combined pulmonary fibrosis and emphysema

Figures & data

Figure 1 HRCT images of the case.

Notes: (A) HRCT image from right upper lobe: there are mainly paraseptal emphysematous changes in both upper lobes. Note the fine reticulations and limited ground glass opacification which are adjacent to the low attenuation areas (arrows). Some areas of emphysema are admixed with reticulation (arrowheads). (B, C) HRCT images from right middle to lower zone: there is both paraseptal and centrilobular emphysema. In the middle lobe, emphysema admixed with reticulation (C, arrows) is seen as well as in the upper zone (A). Compared to paraseptal emphysema without reticulation in the upper lobe, they show signs of interstitial abnormality (B, arrows). At the top of the right lobe, a lobulated solid mass is known lung cancer (B, asterisk). In the right lower lobe, there is fine and coarse reticulation with some cystic changes. The irregularly dilated airway, traction bronchiectasis (C, arrowhead), makes it possible to recognize the presence of pulmonary fibrosis (C).
Abbreviation: HRCT, high-resolution computed tomography.

Figure 2 Gross appearance of the right lung.

Notes: Right lung was horizontally cut into eight slices. Top row is from upper lung areas showing emphysematous cystic spaces along with brown, normal-appearing area, while lower lung areas showed honeycomb changes. Arrowheads indicate pulmonary adenocarcinoma showing well circumscribed white, solid mass without remarkable necrosis.

Figure 3 Computed tomography images and their corresponding histological images of right lower lobe.

Notes: (A) Computed tomography image shows coarse reticulation with honeycomb-like clustered cystic airspaces. Squared area corresponds to microscopic observation (C). (B) A gross picture of the same lesion. Squared area corresponds to microscopic observation (C). (C) Microscopic observation revealed cystic spaces and interstitial fibrosis. Arrowheads indicate areas corresponding to honeycomb cysts.

Figure 4 Computed tomography images and their corresponding histological images of right upper lobe.

Notes: (A) Computed tomography image shows subtle fine reticulation (arrow) which can be identified with careful observations. (B) A gross picture of the same area. (C) Microscopic observation of squared area in (A, B). (D) Close-up of the squared area in (C) revealed significant interstitial fibrosis.

Figure 5 Computed tomography images and their corresponding histological images of left upper lobe.

Notes: (A) Computed tomography image shows mainly paraseptal and centriacinar emphysema. Note that the marginal zone of the emphysema tous area is clear and irregular than usual emphysema (arrow). (B) Gross appearance of the same area shows corresponding emphysematous-looking cystic spaces. (C) Histologically, significant fibrotic changes of usual interstitial pneumonia can be identified in the same area. (D) Higher magnification of image C. Formation of honeycomb cysts are found in the upper lobe. (E) Honeycomb cysts are covered by mixture of bronchiolar epithelia (arrow), type II pneumocytes (arrowhead), and squamous metaplasia (asterisk). (F) Focal fibroblastic foci are found adjacent to dense fibrosis.