The biopsy shows lung in which there is interstitial fibrosis and prominent intra-alveolar aggregates of cells. Some areas of lung appear to have preserved architecture but there are also areas with early honeycomb change. Within the alveolar spaces there are closely packed, almost cohesive appearing groups of alveolar macrophages, multinucleate giant cells and scattered admixed eosinophils, lymphocytes and neutrophils. This is associated with patchy organising pneumonia. There are also cellular areas of loose, myxoid-appearing stroma beneath air spaces in keeping with fibroblastic foci. Blood vessels appear thick walled. This thickening appears to be predominantly intimal. Within the interstitium there is a mild patchy chronic inflammatory cell infiltrate including lymphocytes with very occasional lymphoid follicles. Some of the bronchi and bronchioles appear to have a normal mural architecture but there are scattered bronchioles in which there is peribronchiolar metaplasia. No significant inflammation is identified within the pleura. Although giant cells are identified within alveolar spaces, no well-developed interstitial granulomata are seen. There is no evidence of malignancy.
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