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1.您注意过胸膜穿刺活检中的这种梭形细胞和脂肪细胞之间生长的微妙关系了吗？
2.在胸膜穿刺活检，您如何把握机化性胸膜炎中梭形细胞的脂肪假浸润和促纤维增生性恶性间皮瘤之间的诊断标准？
3.即使在大体标本切下时，您又是如何定位其二者鉴别的诊断标准的？
4.再者，中间夹杂一些良善的TTF-1(+)的腺体样结构时，您又是如何面对这一报告？The Fake Fat Phenomenon in Organizing Pleuritis:A Source of Confusion With Desmoplastic Malignant
Mesotheliomas    (Am J Surg Pathol 2011;35:1823–1829)
Abstract: We report 9 patients with pleural biopsies referred
because of concern about infiltration of what appeared to be
chest wall fat by pan-keratin-positive spindled cells, a finding
that led to a consideration of desmoplastic mesothelioma. All
patients showed pleural effusions/pleural thickening on computed
tomographic scan. Pleural biopsy showed a greatly
thickened and fibrotic paucicellular pleura with circular fat-like
spaces and, sometimes, adjacent oblate spaces mostly deep in the
fibrotic area. Indistinct, keratin-positive, spindle cells arranged
parallel to the pleural surface coursed between these fat-like
spaces. S-100 stains were negative around the fat-like spaces.
Vimentin stains showed that the spaces did not have a cellular
lining of any kind. Sometimes the spaces contained faintly
hematoxyphilic material that was Alcian blue positive, and
similar material was seen in the fibrotic stroma. Follow-up with
periods ranging from 6 to 30 months revealed that 8 cases had
stable disease on chest imaging or by clinical findings. One case
had slowly progressive pleural thickening. These observations
suggest that spaces resembling fat may be encountered in
fibrotic pleurae and that horizontally oriented keratin-positive
spindled cells between the fat-like spaces deep in the fibrotic
portion of a thickened pleura represent a benign finding seen in
some cases of organizing pleuritis/fibrothorax. The spaces
themselves are probably artifacts derived from the biopsy
procedure and/or cutting artifacts. In contrast, in true desmoplastic
mesotheliomas there is downward, rather than horizontal,
growth of keratin-positive spindled cells running between
clearly definable fat cells.