Application of Leslie’s Pattern and Clinicopathological Correlation in Explant Lungs. A Simplified Approach in Diagnosing Pulmonary Pathology

Interstitial lung abnormalities (ILAs), frequently detected incidentally on high-resolution computed tomography (HRCT), are increasingly recognized as early indicators of fibrotic lung disease. However, correlating imaging with histopathology remains challenging due to heterogeneous disease distribution. This case series examines explanted lung specimens using Leslie’s six-pattern histologic classification within a multidisciplinary framework. To assess the diagnostic utility of Leslie’s six-pattern model in interstitial and vascular lung diseases. To analyze concordance between HRCT findings, histopathology, and pattern classification across cases. Ten explanted lungs from patients with interstitial or vascular lung disorders were reviewed. Each case underwent HRCT, detailed histopathological evaluation, and classification using Leslie’s six dominant histologic patterns. Radiologic-pathologic concordance was recorded. Six cases showed complete agreement across imaging, pathology, and classification. Two demonstrated discordance due to overlapping acute and chronic changes or fungal infection obscuring fibrosis. Two additional cases showed partial mismatches, possibly from sampling or interpretive difficulties. Pulmonary hypertension cases revealed significant radiologic abnormalities with minimal histological correlates. Leslie’s model helped categorize complex presentations and clarify disease progression. Integration with clinical data and temporal review improved interpretative accuracy. Applying Leslie’s pattern-based approach with HRCT and clinical context enhances diagnostic precision in ILD and ILA, supporting better disease management.