OBJECTIVE To obser ve t he histopathological features and immunohistochemical expression of IgG4 in nasal granulomatosis with polyangiitis(GPA) and to study the relationship between GPA and IgG4-related disease(IgG4-RD). METHODS A total of 12 nasal GPA patients were collected from the Department of Pathology, Beijing TongRen Hospital during January 2012 to December 2016. EnVision immunohistochemical technique was used to detect the expressions of CD38, CD138, IgG and IgG4. RESULTS Nine cases were found pulmonary abnormalities. Elevated titer of anti-neutrophil cytoplasmic antibody was presented in 8 cases in this study. On histopathologic evaluation, 8 of 12 cases were graded as pathologic score 3, one as score 2, and the remaining 3 as score 1. Eight cases showed increased number of IgG4+ cells higher than 10/HPF, 2 of which showed the ratio of IgG4+/IgG cells were more than 40％. CONCLUSION IgG4+ cells can be increased in biopsies of nasal GPA. Since the morphologic and clinical manifestations of GPA and IgG4-RD may overlap, it could be a significant diagnostic pitfall in the differential diagnosis of these two entities. The diagnosis of GPA should combine clinical manifestations, imaging findings, serological examinations and pathological features.

This paper described the application of WeChat public platform and WeChat groups in hospital culture development.As proposed by the authors,WeChat can be used by the hospitals to strengthen media integration,cultivate medical personnel′s media literacy,improve the supervision mechanism of WeChat,take tide of the new media trend,and adhere to the cultural development,thus leading the reform and development of the hospital.

AIM: To investigate the significance of NAD (P)H-quinone oxidoreductase 1 (NQO1) protein overexpression for prognostic evaluation of ovarian mucinous cystadenocarcinoma .METHODS:NQO1 protein was detected in 162 cases of ovarian mucinous cystadenocarcinoma , 35 cases of ovarian mucinous cystadenoma and 29 samples of normal ovarian epithelial tissues by the method of EnVision immunohistochemical staining .The correlation between high expression of NQO1 protein and clinicopathological features of ovarian mucinous cystadenocarcinoma was also evaluated .Overall sur-vival and disease-free survival rates of ovarian mucinous cystadenocarcinoma patients were calculated by Kaplan -Meier method.RESULTS:The positive rate and strongly positive rate of NQO 1 protein were 85.8%and 64.2%in ovarian mu-cinous cystadenocarcinoma , respectively , which are significantly higher than those in ovarian mucinous cystadenoma , and normal ovarian epithelial tissues ( P <0.01 ) .NQO1 expression was significantly correlated with the histological grade (P<0.05) and clinical stage (P<0.01) of ovarian mucinous cystadenocarcinoma .Kaplan-Meier survival analysis showed that the overall survival rate and disease-free survival rate were significantly higher in ovarian mucinous cystadenocarcinoma patients with high NQO1 expression than those with low NQO1 expression (P<0.01).CONCLUSION:NQO1 expression is closely correlated with the progression and prognosis of the patients with ovarian mucinous cystadenocarcinoma .High ex-pression of NQO1 protein may be used as an important indicator for the patients with poor prognosis of ovarian mucinous cystadenocarcinoma .

Objective:To evaluate the CT characteristics of ossifying foci in sinonasal inverted papilloma (IP) and to compare with the tumor root shown intraoperatively.Methods:The clinical and CT imaging data of 127 patients with IP, which were proved by histopathology, were reviewed retrospectively from Beijing Tongren Hospital, Capital Medical University, during the period from January 2012 to December 2018. The number, location, shape, density of ossifying foci in sinonasal IP and the relationship with the wall of sinus were observed. The sites of ossification on CT scans were compared with the root of the tumors described in the corresponding patient′s operative records.Results:In 127 IP patients, 51 (40.2%) patients showed the ossification in the tumor on CT. Single ossifying foci were found in 35 cases and multiple in 16 cases. The ossification affected single site of the sinonasal tract ( n=16) or distributed diffusely ( n=35). In the 50 cases, the ossifying foci extended along the long axis of the affected sinus appearing as branched ( n=19), striped ( n=16), linear ( n=7), lumpy ( n=2) or mixed type ( n=6), and 1 case was located at the edge of the maxillary sinus. Totally 66.7% (34/51) of the ossifying focis contained peripherally hyperdense bone tissue and centrally hypodense adipose tissue, which corresponded to bone cortices and fatty marrow of the trabecular bone. And 96.1% (49/51) of the ossifying focis were attached to the adjacent bone of the sinus, and the sites of attachment were concordant with the actual origin of tumor confirmed in operation . Conclusions:Ossification can be seen in some sinonasal IPs. Tracing along ossifying focus to the site of attachment with sinus might facilitate preoperative prediction of the originating site of tumor.

Objective To explore the application and effect of enterprise WeChat in improving hospital staff satisfaction. Methods Medical staff from Beijing Tongren Hospital were randomly recruited, and divided into an observation group and a control group according to whether they keep track of WeChat enterprise account prior to the first survey. In December 2016, a satisfaction survey was conducted, followed by the increased frequency and content of WeChat service, as well as 7 newly introduced service applications. The second survey was made in December 2017. Propensity score matching was applied to the respondents of the two questionnaires, to eliminate such differences as gender, age, and education between the two surveys. Chi-square test was used to analyze the difference of satisfaction between the observation group and the control group before and after improving the WeChat service. Results Compared with the control group, the observation group has made significant improvement in 8 items, including "efforts made by the hospital to improve the practice environment of medical staff","current work intensity and pressure","complaint handling", "performance bonus distribution", "administrative and logistical staff's clinical front-line service", " continue to work in our hospital", " consciously safeguard the reputation of the hospital","overall satisfaction with the hospital". There was no significant difference between the 11 items, and none of them decrease (P<0. 05). Conclusions Enterprise WeChat can improve staff satisfaction in 6 dimensions:working environment, workload, welfare and pay, service guarantee, identification and honor, and overall evaluation.

OBJECTIVETo study the clinicopathologic characteristics of IgG4-related sialodacryoadenitis and chronic rhinosinusitis (CRS).

METHODSA total of 13 patients (patient group) were evaluated clinically and biopsy specimens from the lacrimal/salivary glands (n=12) and nasal mucosa (n=8) were reviewed and immunohistochemistry was performed to assess IgG-and IgG4-positive cells. Similarly, nine patients with IgG4-related sialodacryoadenitis without CRS and 10 patients with common CRS were included as controls.

RESULTSThere were 8 male patients and 5 female patients. The age of patients ranged from 32 to 71 years (mean 50.2 years). The patient group had higher serum IgG4 concentration than that of the control group (P<0.05). Lymphoplasmacytic infiltration, lymphoid follicle formation and sclerosis were prominent in lacrimal/salivary glands in both groups; however the magnitude of IgG4-positive plasmacytic infiltration in the patient group was significantly higher than that of the control group (P<0.05). Similarly, evaluation of nasal mucosa revealed greater lymphocytic and plasmacytic infiltration, and lymphoid follicle formation, together with significantly higher amount of IgG4-positive plasma cell infiltration in the patient group compared to the common CRS group (P<0.05).

CONCLUSIONSIgG4-related disease (IgG4-RD) simultaneously involving lacrimal/salivary glands and nasal cavity/paranasal sinuses is rare and characterized by a combination of IgG4-positive plasma cell infiltration involving lacrimal/salivary glands and nasal mucosa along with an increased serum level of IgG4. As a systemic disease, early and accurate diagnosis is therefore of great importance, and unnecessary surgery should be avoided.

Adult ; Aged ; Chronic Disease ; Female ; Humans ; Immunoglobulin G ; blood ; Immunohistochemistry ; Lacrimal Apparatus ; pathology ; Male ; Middle Aged ; Nasal Mucosa ; pathology ; Paranasal Sinuses ; pathology ; Rhinitis ; diagnosis ; immunology ; Salivary Glands ; pathology ; Sialadenitis ; diagnosis ; immunology ; Sinusitis ; diagnosis ; immunology

Objective:To investigate the clinicopathological characteristics, diagnosis, differential diagnosis and prognostic factors of SMARCB1 (INI1)-deficient sinonasal carcinoma (SDSC).Methods:Sixteen cases of SDSC diagnosed in the Department of Pathology, Beijing Tongren Hospital from January 2016 to September 2020 were enrolled. Ninety-nine cases of small round cell malignant tumors of the head and neck were selected as the control, including poorly-differentiated squamous cell carcinoma ( n=10), poorly-differentiated adenocarcinoma ( n=5), undifferentiated carcinoma (SNUC, n=4), NUT carcinoma ( n=5), neuroendocrine carcinoma ( n=10), and other non-epithelial tumors [olfactory neuroblastoma ( n=10), rhabdomyosarcoma ( n=10), NK/T-cell lymphoma ( n=10), malignant melanoma ( n=10), Ewing′s sarcoma/primitive neuroectodermal tumor (EWS/PNET, n=5)] and non-keratinizing undifferentiated nasopharyngeal carcinoma ( n=20). The clinical and pathologic characteristics of SDSC, and immunohistochemical (IHC) expression of broad-spectrum CKpan, CK7, CK8/18, CK5/6, p63, p40, p16, INI1, NUT and neuroendocrine markers (Syn, CgA, CD56) were evaluated. In situ hybridization (ISH) was used to detect EBER and fluorescence in situ hybridization (FISH) to detect INI1 gene deletion. Results:The 16 cases of SDSC accounted for 1.3% (16/1 218) of all malignant sinonasal tumors in the author′s unit during this time period, and 2.4% (16/657) of all malignant epithelial tumors. Microscopically, there was no clear squamous and adenomatous differentiation, but "rhabdoid-like" cells, are often seen. All SDSC cases were positive for CKpan and CK8/18, negative for INI1; Epstein-Barr virus was not detected by ISH; and INI1 gene deletion was observed in all 11 SDSC patients with FISH. Twelve cases were followed up for 3-47 months. One died of tumor-related diseases half a year after diagnosis, and the remaining patients were alive with tumor, the longest survival time was 47 months.Conclusion:SDSC should be differentiated from a variety of poorly-differentiated tumors in the sinonasal area. Histologically, SDSC has no clear differentiation, but the tumor cells are characteristically basal-like or rhabdoid-like, with non-specific vacuoles, translucent or vacuolar nuclei, prominent nucleoli and necrotic foci. They are negative for INI1 IHC staining, and FISH demonstrates INI1 gene deletion. The clinical prognosis is still unclear, further studies on its biologic behavior and treatment methods are warranted.

Objective:To study clinicopathological features and differential diagnosis of IgG4-related diseases (IgG4-RD) in nasal cavity and paranasal sinuses.Methods:A retrospective analysis was performed in patients presenting initially with rhinosinusitis or a nasal mass, who also underwent nasal mucosa biopsy in Beijing Tongren Hospital Affiliated to Capital Medical University, from March 2016 to March 2021. According to the latest international classification diagnostic criteria of IgG4-RD published by the American Society of Rheumatology (ACR)/European Association for Rheumatology (EULAR) in 2019, 10 cases of nasal cavity and paranasal sinuses IgG4-RD were diagnosed and included in the study. The clinical features, histopathology and immunohistochemical expression of IgG and IgG4 were analyzed.Results:Among the 10 patients, five patients were male and five female. The age ranged from 30 to 71 years (median 52.7 years). Nasal polyp/nasal masses were seen in six cases, and lacrimal gland swelling was found in four cases. The serum IgG and IgG4 level was increased in four cases. Microscopically, all 10 cases showed intense lymphoplasmocytic infiltration and varying degrees of fibrosis in nasal or sinus mucosa, while four cases showed occlusive vasculitis. The number of IgG4 positive plasma cells in nasal mucosa was more than 10/high power field (HPF), with a mean of 67/HPF. The number of IgG4 positive plasma cells in the cases with severe fibrosis was significantly lower than in those without. The ratio of IgG4 +/IgG +plasma cells was higher than 40% in six cases. Conclusions:IgG4-RD in nasal cavity and paranasal sinuses is a local manifestation of a systemic disease, while nasal cavity and paranasal sinuses are rarely involved by IgG4-RD. The diagnosis is based on clinical symptoms, imaging, IgG4-related serology and histopathologic scores. Histopathology has a core diagnostic value. IgG4 serology and imaging have important diagnostic values in the cases without biopsy.

OBJECTIVE To analyze the differences in clinical and imaging characteristics of patients with respiratory epithelial adenomatoid hamatoma(REAH)and nasal polyps(NP)whose lesions are located in bilateral olfactory cleft regions,so as to provide evidence for clinicians in the preoperative differential diagnosis of REAH and NP.METHODS Patients with bilateral olfactory cleft REAH,who underwent nasal endoscopic surgery from June 2006 to August 2023 in Beijing Tongren Hospital,were retrospectively analyzed as the REAH group.Patients with bilateral olfactory cleft NP who underwent nasal endoscopic surgery from January 2023 to October 2023 in Beijing Tongren Hospital were included and set as the NP group.The demographic and clinical characteristics,as well as the sinus CT data were analyzed to explore the intergroup differences.RESULTS Both the REAH group and the NP group included 155 patients.The REAH group was dominated by older men,and the prevalence of comorbid asthma was lower than that in the NP group(P<0.05).In the REAH group,the middle turbinate width,the superior turbinate width,the ratio of middle turbinate width/orbital board width,the ratio of superior turbinate width/middle orbital board width,and the maximum angle between the middle turbinate and nasal septum were significantly higher than those in the NP group(P<0.05).CONCLUSION Sinus CT examination can help clinicians identify REAH lesions before surgery,which is conducive to the formulation and implementation of treatment plans.

OBJECTIVE To investigate the diagnostic value of BRAFV600E gene detection for the benign and malignant nature of TBSRTC categories Ⅰ and Ⅱ thyroid nodules.METHODS Cases with ultrasound-guided fine-needle aspiration cytology(FNAC)results of TBSRTC categories Ⅰ and Ⅱ thyroid nodules with concomitant BRAFV600E gene detection results were retrospectively collected from August 2021 to June 2024 in Beijing Tongren Hospital,Capital Medical University(176 patients with 182 nodules in category Ⅰ,492 patients with 503 nodules in category Ⅱ).The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of BRAFV600E gene detection on the benign and malignant nature of TBSRTC categories Ⅰ and Ⅱ thyroid nodules were analyzed using nodules with surgical histopathological results as the'gold standard'(26 category Ⅰ and 37 category Ⅱ nodules).RESULTS Twenty-two of the 26 category Ⅰ nodules were papillary thyroid carcinoma(PTC)and 4 were benign lesions;18 of the 37 category Ⅱ nodules were PTC and 19 were benign lesions.The sensitivities of BRAFV600E gene detection on the benign and malignant nature of TBSRTC categories Ⅰ and Ⅱ thyroid nodules were 100％(22/22)and 83.3％(15/18),the specificities were 100％(4/4)and 94.7％(18/19),the positive predictive values were 100％(22/22)and 93.7％(15/16),the negative predictive values were 100％(4/4)and 85.7％(18/21),and the accuracy rates were 100％(26/26)and 89.2％(33/37).There was a 0％(0/3)concordance of FNAC results for the 3 thyroid nodules with repeat puncture and a 100％(1/1)concordance of BRAFV600E gene detection results.CONCLUSION BRAFV600E gene detection is an effective diagnostic method for the differentiation of benign and malignant nature of TBSRTC categories Ⅰ and Ⅱ thyroid nodules.In addition to BRAFV600E gene detection for TBSRTC categories Ⅲ-Ⅴ nodules,it is recommended that TBSRTC categories Ⅰ and Ⅱ nodules also be included in routine BRAFV600E gene detection to minimize the need for repeat puncture in patients and to reduce the rate of missed diagnosis of PTC.