Background: Anthracosis has been recently identified as a cause of bronchitis and bronchial stenosis in both developing and developed countries in the world. However, its exact nature whether as an innocent bystander or pathogenic agent for parenchymal lung disease is unknown. Methods: We retrospectively analysed 384 transbronchial lung biopsies (TBLBs) received at Department of Pathology over a seven-year period (August 2010 to August 2016). Thirteen TBLBs showed normal lung parenchyma were taken as controls; 32 (8.3%) TBLBs showed deposition of anthracotic pigment, with or without fibrosis and were further studied. Masson-Trichrome and Ziehl-Neelsen stains were used to confirm the diagnosis of fibrosis and tuberculosis, respectively. Results: The TBLBs were histopathologically categorised into: Group 1 normal lung parenchyma, (controls, n=13, 3.4%); Group 2: pigment deposition with fibrotic parenchymal reaction (n=11, 34.4%); Group 3: pigment deposition with inflammatory parenchymal reaction (n=11, 34.4%); and Group 4: pigment deposition with granulomatous parenchymal reaction (n=10, 31.3%). In two cases of Group 2 and one case of Group 3, parenchymal deposits of silicate crystals were also identified by polarising microscopy. Conclusions: Anthracosis does not appear to be an innocent bystander and needs to be meticulously assessed for its role as pathogenic agent for parenchymal lung disease in all cases. Our observations suggest that identifying the pigment deposited and correlation with the underlying pathology in the limited tissue sample available can help in reaching a definitive diagnosis.