Objective:To investigate the genomic profiles and immune microenvironment of olfactory neuroblastoma (ONB).Methods:Nineteen ONB cases diagnosed in the Beijing Tongren Hospital from May 2018 to October 2022 were divided into low-grade and high-grade groups according to the Hyams grading system, including 7 low-grade and 12 high-grade ONB. Whole exome sequencing and multiplex immunofluorescence analyses were performed on tissue samples of these ONB.Results:A total of 929 nonsynonymous alterations were identified in 18 of the 19 ONB (18/19) cases. The most commonly altered cancer-related genes were CTNNB1 (3/19) and ZNRF3 (3/19). The most mutated oncogenic pathways were the WNT and RAS pathways. The median tumor mutation burden (TMB) was 0.45/Mb, ranging from 0 to 3.25. The median tumor neoantigen load (TNB) was 9.39 neoantigens/Mb, ranging from 0 to 38.30. The median allelic mutation tumor heterogeneity (MATH) score was 16.95, ranging from 3.05 to 117.47. Only one of the 19 cases expressed PD-L1 (composite positive score, CPS>1) in the tumor cells. The median percentage of CD8 + tumor-infiltrating lymphocyte (TIL) in the tumor region was 1.08%. No significant differences were observed between the low-and high-grade groups for mutant genes, mutant pathways, TMB, TNB, MATH, PD-L1 expression levels, or CD8 + TILs percentage( P>0.05). However, the low-grade group showed significantly more CD68 + macrophages in both the tumor and total region than the high-grade group. Notably, CD68 +CD163 - macrophages accounted for an average of 80.52% of CD68 + macrophages. Conclusions:CTNNB1 and ZNRF3 are the most commonly altered cancer-related genes. The low expression of PD-L1 and the low percentage of CD8 + TIL indicate that ONB might not be sensitive to immunotherapy. The percentage of M1-type macrophages in low-grade ONB is significantly higher than that in high-grade ONB, suggesting that M1-type macrophages may be involved in the progression of ONB from low-grade to high-grade.

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.

BACKGROUND: To compare the efficacy and safety of dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, and doxorubicin plus rituximab (DA-EPOCH-R) with standard rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) in Waldeyer's ring diffuse large B-cell lymphoma (WR-DLBCL) at a single institution. METHODS: This retrospective study included 115 newly diagnosed patients with WR-DLBCL, of whom 68 patients received R-CHOP, and 47 patients received DA-EPOCH-R as their first-line treatment. The baseline features of the two groups were well balanced using a 1:1 propensity score matching method, and a total of 84 cases were obtained, including respective 42 cases in the R-CHOP and DA-EPOCH-R groups, for further survival and prognosis analysis. The primary objectives included progression-free survival (PFS) and overall survival (OS). RESULTS: During a median follow-up of 45 months, there were nine (21.4%) deaths in the R-CHOP group and two (4.8%) in the DA-EPOCH-R group. Kaplan-Meier analysis showed statistically significant improvements in PFS and OS in patients with DA-EPOCH-R compared with those treated with R-CHOP (log-rank test, P  = 0.025 and P  = 0.035, respectively). The 2-year PFS and OS rates in the DA-EPOCH-R group were 90.1% (95% confidence interval [CI]: 81.4-99.8%) and 95.2% (95% CI: 89.0-100.0%), respectively, and 80.5% (95% CI: 69.3-93.6%) and 90.5% (95% CI: 52.8-99.8%) in the R-CHOP group. Patients without B symptoms and elevated lactate dehydrogenase levels had a higher PFS in the DA-EPOCH-R group, with P values of 0.038 (hazard ratio [HR]: 0.11; 95% CI: 0.01-0.88) and 0.042 (HR: 0.19; 95% CI: 0.04-0.94), respectively. There were no statistically significant differences in clinical responses and treatment-related toxicities between the two groups. CONCLUSION Compared with patients received R-CHOP, those treated by DA-EPOCH-R had superior PFS, OS, and controlled toxicity in patients with WR-DLBCL.
Humans ; Rituximab/therapeutic use* ; Vincristine/therapeutic use* ; Retrospective Studies ; Prednisone/therapeutic use* ; Etoposide/therapeutic use* ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use* ; Lymphoma, Large B-Cell, Diffuse/drug therapy* ; Cyclophosphamide/therapeutic use* ; Doxorubicin/therapeutic use*

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 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 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.

IgG4 related disease (IgG4-RD) is an independent clinical pathological entity which is different from common chronic inflammation and other autoimmune diseases in recent years. It often appears in the form of tumor like tissue-destructive lesions and may be accompanied by the increase of concentration of serum IgG4. Histopathology is characterized by a large number of lymphocytes and plasma cells infiltration, storiform fibrosis and occlusive phlebitis. The characteristics of IgG4-RD in nose and sinuses have not been widely investigated. The aim of the present study is to review the advances in IgG4 related sinonasal diseases from four aspects including pathogenesis, clinical features, treatment and future research directions.

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.

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.