Chronic rhinosinusitis with nasal polyps (CRSwNP) frequently induces the formation of intracellular stress granules (SGs). This study aims to identify key genes linked to both CRSwNP and SGs, offering novel perspectives for improving CRSwNP treatment and management. Data from GSE136825, GSE179265, and SG-related gene sets were retrieved from public databases. Key genes were identified via machine learning, ROC analysis, and expression validation. Subsequently, nomogram construction, Gene Set Enrichment Analysis (GSEA), immune infiltration analysis, and drug prediction were performed to explore the regulatory mechanisms of these genes. Three candidate genes-ANG, CRYAB, and FBP1-passed ROC and expression validation and were ultimately identified as key players. GSEA revealed that these genes collectively participate in the cell cycle pathway. Immune infiltration analysis showed 23 differentially abundant immune cell types between the CRSwNP and control groups, with ANG, CRYAB, and FBP1 all exhibiting significant positive correlations with Type 2 T helper cells. Furthermore, estradiol, copper sulfate, and trichostatin A were identified as drugs interacting with all three key genes. These findings provide valuable insights for advancing CRSwNP diagnosis.

Multiple myeloma (MM) is a hematologic malignancy characterized by clonal proliferation of plasma cells in the bone marrow. It represents approximately 10% of hematologic malignancies and is the most common primary bone malignancy. This disease usually occurs between the ages of 40 and 70, although it is more frequently seen in patients over 65 years of age. On the other hand, extramedullary plasmacytoma-related diseases have a global annual incidence of three per 100,000 people. Orbital involvement in MM is considered rare. Orbital plasmacytomas represent less than 1% of all orbital lesions, and their incidence in relation to MM is approximately 3%. Only 35% of cases present the initial manifestations of MM.  In the following case we present a 63-year-old male patient who presented with left ocular proptosis of one month's duration, along with intermittent thoracic and lumbar back pain as well as weight loss of 12 kg in five months. A non-contrast cranial CT scan revealed a 31 x 31 x 36 mm extraconal orbital mass in the left orbit, with invasion of the paranasal sinuses and intracraneal extension, in addition to multiple lytic skull lesions. Laboratory results included severe normocytic normochromic anemia, mild thrombocytopenia, chronic kidney disease stage G3b, hypocalcemia, hyperphosphatemia, and elevated alkaline phosphatase. Immunohistochemistry demonstrated infiltration by clonal plasma cells (CD138 + and kappa +), findings consistent with MM.

BackgroundNo prior meta-analysis has directly compared restenosis or revision rates between Draf IIb and Draf III in chronic rhinosinusitis (CRS) or evaluated how Type 2 versus non-Type 2 endotypes influence these outcomes.MethodsFollowing PRISMA guidelines, PubMed, MEDLINE, Embase, and ClinicalTrials.gov were searched on 5 January 2025 for studies reporting restenosis or revision after Draf IIb or Draf III in adults with CRS. Random-effects meta-analyses of proportions (Freeman-Tukey transformation; Hartung-Knapp CIs), pooled restenosis and revision rates, with subgroup analyses by procedure type and endotype.ResultsThirty-eight studies met inclusion criteria (restenosis n = 1550; revision n = 1305). The pooled restenosis proportion across procedures was 9% (95% CI: 5-14%) and the pooled revision proportion was 9% (95% CI: 5-13%). Restenosis was lower after Draf IIb than Draf III (0.8% vs. 12%), with revision rates showing a similar pattern (2% vs. 10%). Type 2 CRS demonstrated higher pooled rates of restenosis (8% vs. 1%) and revision (12% vs. 3%) compared with non-Type 2 CRS.ConclusionsDraf IIb is associated with lower pooled restenosis and revision rates than Draf III in CRS. Type 2 inflammatory endotype confers substantially higher risk of adverse frontal sinus outcomes. Incorporating endotype into procedural decision-making may improve prognosis. Prospective, endotype-stratified studies are needed to refine indications for Draf IIb versus Draf III and optimize adjunctive management strategies.

Chronic sinonasal mucoceles are benign expansile lesions caused by obstruction of sinus drainage, resulting in mucus accumulation and potential complications including nasal obstruction, facial pain, and visual disturbances. While their clinical aspects are well-characterized, detailed histopathologic descriptions remain limited. We conducted a retrospective clinicopathologic analysis of six patients treated for chronic sinonasal mucoceles between 2014 and 2024. Clinical data, imaging studies (computer tomography (CT) and magnetic resonance imaging (MRI)), endoscopic findings, and histopathologic features were reviewed. The cohort included four male patients and two female patients (age range: 31-85 years, mean: 61 years). Five patients presented with rhinologic symptoms; one was asymptomatic, with the lesion discovered incidentally. Anatomically, four muoceles (67%) involved the frontal-ethmoidal sinuses; the remaining two affected the sphenoid and maxillary sinuses, respectively. CT imaging revealed sinus opacification in five patients, with one showing marked mucosal and bony thickening. Histologically, all specimens exhibited collapsed fibrous walls with hyalinized stroma, sparse cellularity, and absent or denuded epithelium-finding consistent with late-stage changes from chronic pressure and reparative remodeling. Immunohistochemistry confirmed myofibroblastic differentiation of stroma cells. All patients underwent successful endoscopic management without recurrence. Chronic sinonasal mucoceles may present as pseudotumors with distinctive collapsed, hyalinized fibro-membranous walls, distinguishing them from early-stage lesions. Recognition of these characteristic histopathologic features, in conjunction with clinical and radiologic findings, is essential for accurate diagnosis and to avoid overtreatment. Endoscopic surgical management remains an effective treatment with excellent outcomes.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a prevalent inflammatory disease of the sinuses that significantly diminishes patients' quality of life. Endoplasmic reticulum stress (ERS) is strongly associated with the initiation and progression of numerous inflammatory diseases. This study aimed to identify ERS-related hub genes in CRSwNP using bioinformatics approaches. We combined the GSE136825 and GSE179265 datasets. Subsequently, we performed differential expression analysis and weighted gene co-expression network analysis. The genes identified were then cross-referenced with those associated with ERS, allowing us to identify ERS-related differentially expressed genes in CRSwNP. We employed 4 machine learning algorithms: support vector machine, random forest, extreme gradient boosting, and least absolute shrinkage and selection operator. These methods facilitated the identification of hub genes, which were then used to construct a nomogram for disease prediction. Twenty-eight genes related to ERS showed significant expression differences (P < .05). By overlapping the genes selected from 4 machine learning algorithms, we identified 3 hub ERS-differentially expressed genes: ATP2A3, ACTC1, and DES. The nomogram prediction model built on these pivotal genes demonstrated strong predictive performance. This study offers new insights into the molecular mechanisms of CRSwNP and suggests potential new avenues for early diagnosis and targeted treatment in future clinical practice.

The aim of this study was to demonstrate the application of preoperative three-dimensional (3D) computed tomography (CT) reconstruction in the surgical management of paranasal sinus (PNS) osteomas.Osteomas are the most common benign PNS tumors and can lead to significant symptoms, including chronic rhinosinusitis, frontal pressure, and orbital or intracranial complications. Surgical excision is recommended for symptomatic cases or those with potential complications, with endoscopic and external approaches being the primary techniques. A 74-year-old patient presented with symptoms of chronic rhinosinusitis, including nasal obstruction and anosmia. CT revealed osteomas in the left ethmoid and frontal sinuses, measuring 27 × 21 × 28 mm and 15 × 17 mm, respectively. The patient was qualified for surgical excision of lesions. Preoperative planning included 3D CT reconstruction to assess the osteomas' size, location, and surgical access, particularly for a planned osteoplastic flap (OPF). During surgery, an endoscopic approach was initially utilized, resulting in frontosphenoethmoidectomy and removal of ethmoid osteoma. The other osteoma extended from the anterior to the posterior wall of the frontal sinus and required conversion to an external approach using the preplanned OPF. The surgery was successfully completed, with intraoperative findings being consistent with imaging. Postoperative complications were limited to frontal sinus outflow stenosis, managed endoscopically during follow-up. PNS osteomas may require complex surgical planning, especially when endoscopic and external approaches are combined. Preoperative 3D CT reconstruction provides valuable insights into tumor characteristics and aids in precise surgical planning. This case highlights the utility of 3D imaging in safe and effective management of challenging PNS osteomas.

Background/Objectives: AA amyloidosis is a serious complication of chronic inflammation, which may arise in the setting of inborn errors of immunity (IEIs) due to recurrent or persistent infections. Common variable immunodeficiency (CVID) is the most frequent symptomatic IEI in adults, yet its association with secondary AA amyloidosis remains rarely reported. Case presentation: We describe a 37-year-old male with a history of recurrent pneumonia, chronic sinusitis, and osteomyelitis with sepsis since childhood. At age 33, he developed bilateral pneumonia after COVID-19, followed by repeated lower respiratory tract infections. At age 36, nephrotic syndrome (proteinuria 10.69 g/day, hypoalbuminemia) led to kidney and gastric mucosa biopsies, which confirmed AA amyloidosis. Immunological workup revealed panhypogammaglobulinemia (IgG 0.1 g/L, IgA 0.01 g/L, IgM 0.28 g/L), markedly reduced switched memory B cells, and an inverted CD4+/CD8+ ratio. Chest CT showed bronchiectasis, bronchiolitis, and mediastinal lymphadenopathy. Whole-exome sequencing excluded known monogenic IEIs, autoinflammatory, or hereditary amyloidosis genes; a heterozygous likely pathogenic variant in ODAD2 (associated with primary ciliary dyskinesia) was considered incidental. A diagnosis of CVID with secondary AA amyloidosis was established. Conclusions: This case illustrates that CVID may remain undiagnosed for decades and present with secondary AA amyloidosis as the first major complication. In any patient with nephrotic syndrome and a history of recurrent or unusual infections, an IEI should be actively excluded. Early recognition of CVID and appropriate immunoglobulin replacement therapy can prevent infectious exacerbations and potentially halt amyloid progression.

BackgroundChronic rhinosinusitis (CRS) comprises heterogeneous eosinophilic (type-2) and neutrophilic (type-1/3) endotypes, yet existing murine models rarely distinguish them or compare their therapeutic responsiveness.MethodsSeven-week-old female C57BL/6N mice received intranasal instillations three times weekly for 4 or 12 weeks with either (1) a clinically relevant airborne allergen cocktail (house dust mite [HDM], Aspergillus fumigatus, Alternaria alternata, and Staphylococcus aureus protease) to induce eosinophilic CRS (ECRS) or (2) an innate stimulus mixture (lipopolysaccharide, β-1,3-glucan, and S. aureus protease) to induce neutrophilic CRS (NCRS). A parallel cohort received weekly dexamethasone administration (2 mg/kg). Endpoints included flow cytometry, enzyme-linked immunosorbent assays, quantitative PCR, histology, and immunofluorescence assays.ResultsFour-week allergen exposure produced a pure ECRS phenotype characterized by robust tissue eosinophilia, type-2 cytokines, and marked responsiveness to dexamethasone. Extending allergen delivery to 12 weeks generated mixed CRS with superimposed neutrophilia, upregulation of Il1b/Tgfb1, mucus hypersecretion, and attenuated steroid efficacy. Innate stimulus treatment yielded a steroid-resistant NCRS phenotype dominated by neutrophils, elevated Ifng/Il17a expression, and minimal type-2 biomarkers. Systemic eotaxin and HDM-specific immunoglobulin E mirrored those found in local eosinophilia, whereas circulating granulocytes remained unchanged across groups.ConclusionsBy adjusting the stimulus type and duration, we established tunable murine models that recapitulate pure ECRS, mixed CRS, and steroid-resistant NCRS within a single genetic background. These paired models provide a versatile platform for dissecting endotype-specific mechanisms and evaluating tailored interventions, highlighting the potential importance of early, phenotype-directed CRS therapy.