Given the possible history of asbestos exposure as a roofer, asbestos-associated pleural plaques and mesothelioma were also placed in the pathologic differential for our patient, particularly given the exacerbating factor of his smoking history. Diffuse pleural fibrosis is a known manifestation of asbestos exposure. The woven, uniform, and fibrous histology of the lesion did not fit the classic description of mesothelioma; however, the dense fibrous morphology of the desmoplastic variant of mesothelioma was considered. Pleural plaques, also fibrous in nature, are generally focal nodules or plaques located on the parietal pleura, rather than a generalized diffuse lesion such as was present in our patient. Furthermore, the occurrence of pleural plaques and mesothelioma is strongly associated with the duration of exposure to the asbestos fibers, and the indefinite history of asbestos exposure provided by the patient makes asbestos-related plaques and desmoplastic mesothelioma less likely. Final histology revealed chronic fibrosing pleuritis, and no asbestos bodies or other evidence of asbestos exposure were present.