Here is the anatomopathological report for the removed native left lung:
Macroscopy: A. Labelled "Left native lung". The specimen is an uninflated left pneumonectomy, weighing 889g post fixation. The visceral pleural surfaces are firm and have a diffusely micronodular appearance. Thin fibrous septa connect the left upper and lower lobes. A large air-filled bulla measuring protrudes from the base of the left lower lobe. Serial slicing reveals almost solid lung parenchyma, with greenish grey fibrosis present diffusely throughout both lobes. There are no honeycomb-like changes seen in any of the sections. The hilar lymph nodes are enlarged and anthracotic. There is relative sparing of the apical portions of the left upper lobe, which shows diffuse dark red congestion. In this area, the fibrosis is limited to the perivascular and peribronchial spaces. The pulmonary arterial branches show atherosclerosis distally. B. Labelled "Station six lymph node". An enlarged, firm rubbery grey lymph node, 42 x 24 x 8mm.
Microscopy: A. Sections of lung show extensive change extending from the pleural surface within which variably sized bronchiolised spaces, are present with intervening areas of smooth muscle hypertrophy, fibrosis and chronic inflammatory cells. Within some foci, plump reactive fibroblastic plugs are still seen, deep to bronchial alveoli. More medially, the changes appear less marked but there is still increased interstitial fibrosis. There is no evidence of any in situ or any invasive malignancy. Pulmonary thromboemboli are not seen. Vessels show myointimal thickening. There is no active infection. B. The sections of lymph node, show reactive dermal features, with central sinus histiocytosis, with histiocytes containing increased carbon and some fine silica particles also seen. No evidence of any metastatic malignancy.
Conclusion: A. Left native lung - endstage pulmonary fibrosis, with features supportive of a diagnosis of usual interstitial pneumonia (UIP). No malignancy, no evidence of pulmonary thromboemboli. B. Station six lymph node - anthrasilicosis and sinus histiocytosis with reactive germinal centres. No evidence of malignancy.