Lung Biopsy
Also written as VATS.
Bronchoalveolar lavage (lymphocytosis in sarcoid and hypersensitivity pneumonitis), transbronchial or surgical lung biopsy when HRCT is not diagnostic.
What our notes say
- Bronchoalveolar lavage (lymphocytosis in sarcoid and hypersensitivity pneumonitis), transbronchial or surgical lung biopsy when HRCT is not diagnostic. (Interstitial Lung Diseases)
- | Lung biopsy (VATS) | What is the definitive histopathology? | Silicotic nodules with birefringent silica; asbestos bodies (Ferruginous) in tissue; non‑caseating granulomas in HP. | (Occupational Lung Disease)
- A transbronchial lung biopsy is performed, and microscopic examination shows no viral inclusions, no fungi, no acid fast bacilli, and no atypical cells. (Respiratory system pathology mcqs — Past Paper Questions & Answers)
- | Iatrogenic | Central line insertion, lung biopsy, pleural aspiration, mechanical ventilation (barotrauma) | (Pneumothorax)
- A transbronchial lung biopsy reveals microscopic findings consistent with an extrinsic allergic alveolitis with interstitial infiltrates composed of lymphocytes along with a few neutrophils and eosinophils. (Immunopathology complete mcqs — Past Paper Questions & Answers)
- 30-year-old farmer, cough and dyspnoea after exposure to mouldy hay; lung biopsy shows interstitial granulomas. (End Sem Cat: Respiratory Pathology: Emphysema, ARDS, Pneumoconiosis)
Study material on Lung Biopsy
- Respiratory Pathology
- Respiratory System Pathology 1A — Practice Questions
- Respiratory System Pathology 1A — Practice Questions
- Respiratory System Pathology 1A — Practice Questions
Practice questions on Lung Biopsy
In examining a lung biopsy from a patient with sarcoidosis, noncaseating granulomas are seen. What distinguishes noncaseating from caseating granulomas?
- Noncaseating granulomas lack epithelioid macrophages
- Noncaseating granulomas have absent central necrosis
- Noncaseating granulomas contain more neutrophils
- Noncaseating granulomas lack giant cells
- Noncaseating granulomas indicate bacterial rather than immune etiology
Answer: B. Caseating vs noncaseating refers to the presence/absence of central necrosis. Caseating granulomas (TB, some fungi) have central caseous necrosis surrounded by epithelioid macrophages and Langhans giant cells. Noncaseating granulomas (sarcoidosis, Crohn disease, foreign body reactions) have collections of epithelioid macrophages and often giant cells BUT lack the central necrotic zone. BOTH types contain epithelioid
A lung biopsy shows cells growing in a monolayer along alveolar septa without invasion (2.8 cm). What is the diagnosis?
- Adenocarcinoma in situ (AIS)
- Minimally invasive adenocarcinoma
- Lepidic predominant adenocarcinoma
- Squamous cell carcinoma
Answer: A. AIS (formerly BAC) is defined by growth along pre-existing alveolar structures (lepidic growth) without any stromal or vascular invasion.
A 35-year-old presents with hemoptysis, anemia, diffuse pulmonary infiltrates, and rapidly progressive glomerulonephritis. Lung biopsy shows linear IgG deposition. The target antigen is
- α3 chain of collagen IV
- Double-stranded DNA
- Neutrophil proteinase-3
- Myeloperoxidase antigen
Answer: A. Goodpasture syndrome is caused by antibodies targeting the noncollagenous domain of the α3 chain of collagen IV, affecting both pulmonary and glomerular basement membranes.
A 50-year-old male develops progressive dyspnea over 2 years. Lung biopsy shows honeycomb fibrosis, fibroblastic foci, and temporal heterogeneity. Mean survival from diagnosis is approximately
- 8–10 years with treatment
- 5–7 years with steroids
- 3 years or less
- 1–2 years only without transplant
Answer: C. IPF has a mean survival of 3 years or less from diagnosis, with relentless progression despite medical therapy. Lung transplantation is the only definitive treatment.
A young man uses intravenous drugs and develops pulmonary hypertension. Lung biopsy shows granulomas with birefringent crystals under polarized light. The likely substance is
- Silica particles from contaminated needles
- Asbestos fibers from environmental exposure
- Magnesium trisilicate (talc) from IV drug mixture
- Coal dust from occupational inhalation
Answer: C. IV drug abuse introduces magnesium trisilicate (talc) as a filler in drug mixtures into the pulmonary microvasculature. Talc elicits a granulomatous response; vascular involvement leads to pulmonary hypertension. Talc crystals are visible by polarized light.
Which of the following differentiates NSIP from IPF on lung biopsy?
- Presence of fibroblastic foci and honeycombing in NSIP
- Absence of temporal heterogeneity in NSIP
- Lower lobe predominance only seen in NSIP
- Noncaseating granulomas present only in NSIP
Answer: B. NSIP lacks the temporal heterogeneity of UIP/IPF. In NSIP, fibrosis is uniform (all the same age). Fibroblastic foci and honeycombing are typically absent in NSIP but present in IPF.