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When a Rare Tumor Hides Behind a Chronic Ear Infection
Ear infection is often ignored .Chronic ear disease happens because of refusal to treat acute or subacute ear infection on time.The worse part is surgery when mentioned to the patient,is the fastest way for poor patient follow up.Unfortunately surgery is often the mainstay of chronic ear disease
The Story
A 52-year-old woman had intermittent ear discharge since childhood and gradually worsening hearing.She was advised surgery in 2020 which she finally agreed to get done in 2025.
Routine ear surgery was planned to repair the eardrum. After surgery, her hearing improved โ but her biopsy report revealed something unexpected: a rare tumor called Biphenotypic Sinonasal Sarcoma (BSNS), found in her middle ear.
What Is Biphenotypic Sinonasal Sarcoma?
Itโs a rare, slow-growing cancer that usually starts in the sinuses or nasal passages. It shows two different cell types under the microscope โ one resembling nerve cells and another resembling muscle cells.
The tumorโs cause is a genetic change (PAX3 gene fusion) that makes cells grow abnormally but slowly.
Why Itโs So Rare
Most BSNS tumors are found in the nose or sinuses.
Finding one in the middle ear is almost unheard of.
Symptoms like ear discharge and hearing loss mimic chronic infections, making diagnosis tricky.
How We Found It
During surgery, a small tissue sample (biopsy) was sent for testing. Under the microscope, pathologists found spindle-shaped cells โ and special tests called immunohistochemistry (IHC) showed specific markers (S100 and SMA).
This confirmed it was a biphenotypic sinonasal sarcoma โ a low-grade tumor that rarely spreads but can come back locally.
Treatment & Outlook
Surgery is the main treatment.Patient was referred to a specialized higher centre both Government and Private for further opinion regarding best course of management.
Radiotherapy may be used if the tumor canโt be fully removed.
Regular follow-up is important to monitor for recurrence.
The good news: itโs low-grade, meaning it grows slowly and is often manageable if detected early.
๐ฟ Takeaway for Readers
1. Chronic ear infections need evaluation โ sometimes they hide more complex issues.
2. A biopsy during surgery can uncover rare diseases early.
3. Early diagnosis and expert pathology make all the difference.
I first wrote about this case report here.
Usually this type of malignancy is rare and reported in the sinonasal region
https://www.academia.edu/124909400/Biphenotypic_sinonasal_sarcoma_European_multicentre_case_series_and_systematic_literature_review?
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Wadhwani AI and AIIMSโ MadhuNetrAI Wins Top Recognition at India AI Impact Summit 2026 Under โAI for ALL: Global Impact Challengeโ
Wadhwani AI and AIIMSโ MadhuNetrAI Wins Top Recognition at India AI Impact Summit 2026 Under โAI for ALL: Global Impact Challengeโ-Press Release
New Delhi, India | 19th February 2026: Wadhwani AI, in collaboration with AIIMS New Delhi, today announced that its AI-powered diabetic retinopathy screening solution, MadhuNetrAI, has won the โAI for ALL: Global Impact Challengeโ at the prestigious India AI Impact Summit 2026.
The AI for ALL Global Impact Challenge attracted over 4,600 applications from more than 60 countries, recognising scalable, high-impact artificial intelligence solutions addressing critical societal challenges. MadhuNetrAI was recognised for its demonstrated ability to strengthen early detection of diabetic retinopathy (DR) within Indiaโs public healthcare system and for its real-world deployment in collaboration with leading public institutions.
India faces one of the worldโs largest diabetes burdens, with over 101 million people living with the condition. Diabetic retinopathy remains a leading cause of preventable blindness, particularly when screening is delayed or specialist access is limited. MadhuNetrAI directly addresses this gap by enabling AI-assisted analysis of retinal fundus images to classify DR severity and identify patients requiring timely referral and intervention.
Developed by Wadhwani AI in collaboration with AIIMS Delhi and under the aegis of the Ministry of Health and Family Welfare, the solution has been clinically validated and designed specifically for deployment within public health settings. It supports frontline healthcare providers, including optometrists, nurses, and community health officers, by assisting with image assessment, standardising grading based on internationally recognised benchmarks, and triaging referable cases. Importantly, the solution enables community based screenings even in under resources environments where specialist ophthalmologists may not be readily available.
To date, MadhuNetrAI has processed approximately 20,000 retinal images and supported screening of over 10,000 patients across 40 facilities spanning 21 districts in 11 states. The system has identified more than 3,000 referable cases and flagged over 1,000 instances of vision-threatening diabetic retinopathy requiring urgent attention, thereby helping reduce the risk of irreversible vision loss through earlier intervention.
Commenting on the recognition, Doctor from AIIMs, associated with the project said, โ.Eye Specialists from R P Center of Ophthalmic Sciences, AIIMS Delhi associated with the project said, โFrom a clinical standpoint, the strength of MadhuNetrAI lies in its ability to support early detection and consistent grading at scale. When integrated thoughtfully into screening workflows, AI can enhance efficiency without compromising clinical standards, allowing specialists to focus on patients who need urgent intervention.โ
Adding to this, Vipin Garg, National Program Lead (Health, Wadhwani AI) from Wadhwani AI said, โMadhuNetrAI is ready for scaled deployment, and our next step is deeper integration with national NCD screening frameworks under MoHFW. We are committed to ensuring no Indian living with diabetes loses their sight to a condition that is preventable.”
The recognition at the India AI Impact Summit 2026 underscores Indiaโs growing leadership in building AI solutions that are clinically validated, ethically designed, and deployable at scale across public systems. It reinforces the potential of collaboration among technology institutions (AI for Social Impact) premier medical bodies and the government to address systemic healthcare challenges through innovation and prevent valuable assets.
About Wadhwani AI
Wadhwani AI is a cross-domain, Indian not-for-profit institute, developing and deploying AI solutions with a mission to create impact at scale and improve lives and livelihoods. The organization works with governments and cross-sectoral partners to build trusted and responsible last-mile solutions that strengthen Indiaโs core development indicators across agriculture, health, and education. Using datasets that reflect Indiaโs varied and rich population matrix, supported by engineering, program, and domain expertise, MEL and user design experience, Wadhwani AI makes technology accessible and available to local communities and individuals, helping drive equity and impact where it matters most.
For further information, please contact:
Nishtha Gorke, nishtha@wadhwaniai.org
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We are the Art by Brandon Sanderson
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Khesari Dal :Did you know it was banned in India in 1961?
Khesari a cheap dal consumed in many drought prone areas of India was banned for storage or sale by the Indian Government in 1961 .But its farming is still allowed as animal feed.Many people grow this dal and eat both the dal and greens as part of their diet.I became interested in asking history of Khesari dal consumption in people, who talked about vague lower limb pain with pain causing sleeplesness .Two such patients also had associated history of burning mouth syndrome.
Since these are just observations and there are no biochemical test for checking Khesari dal toxin,and the type of neuropathy is different ,I make no claims, but mention the narrative history for documentation.
The raging debate of whether Khesari is safe or not is serious.It needs transparent reporting,testing and ethical considerations of quality of life affected by consumption of the item.There are many safer options of cheap edible grains which don’t carry risk of serious neurological damage.
In the interest of Education I am sharing a few insights from a session with AI on this topic.
Lathyrism โ How to Diagnose (Practical Clinical Guide)
Lathyrism is a neurological disorder caused by chronic consumption of Lathyrus sativus (kesari dal / grass pea), leading to toxic spastic paraparesis. Diagnosis is mainly clinical, supported by dietary history and exclusion of other causes.
โ Clinical Diagnosis of Lathyrism
1๏ธโฃ Key Diagnostic History (Most Important)
Dietary History
Ask specifically about:
- Chronic consumption of Lathyrus sativus (Kesari dal / grass pea)
- Duration: >2โ3 months continuous intake
- Quantity: Large proportion of daily protein intake
- Circumstances:
- Poverty
- Famine
- Drought
- Food insecurity
- Migration labor camps
๐ Classic scenario: Rural poor populations relying heavily on Kesari dal as staple food
2๏ธโฃ Typical Clinical Features
Motor Symptoms
- Gradually progressive spastic paraparesis
- Stiffness and weakness of both lower limbs
- Scissoring gait
- Toe walking
- Frequent falls
Neurological Signs
- โ Tone (spasticity) โ lower limbs
- โ Deep tendon reflexes (knee, ankle)
- Clonus
- Extensor plantar response (Babinski +)
- No sensory loss
- No bladder or bowel involvement (early)
Upper Limbs
- Usually normal
Cranial Nerves
- Normal
๐ Pure upper motor neuron syndrome affecting lower limbs
3๏ธโฃ Typical Demographic Pattern
- Adolescents & young adults (15โ40 yrs)
- Predominantly males
- Endemic regions:
- India (MP, Chhattisgarh, Bihar, Odisha, UP, WB)
- Bangladesh
- Ethiopia
๐ง Diagnostic Criteria (Practical)
Essential Features
- Chronic kesari dal ingestion
- Slowly progressive spastic paraparesis
- Pure UMN signs
- No sensory, bladder, or cognitive involvement
Supportive
- Epidemic clustering
- Similar cases in family/community
๐งช Investigations (Mainly to EXCLUDE other causes)
There is NO specific diagnostic lab test for lathyrism.
Basic Workup
Test Purpose CBC, ESR Rule out infection Vitamin B12 Exclude subacute combined degeneration MRI spine Rule out compressive myelopathy, MS, tumor HTLV-1 serology Exclude tropical spastic paraparesis HIV If risk Copper levels If Wilson / myelopathy suspected
๐ MRI spine is usually normal
๐ Differential Diagnosis to Rule Out
Condition Differentiation Tropical spastic paraparesis (HTLV-1) Bladder symptoms, sensory changes Cervical/thoracic myelopathy MRI changes Multiple sclerosis Sensory + visual symptoms B12 deficiency Sensory loss, posterior column signs ALS LMN signs + UMN Hereditary spastic paraplegia Family history, childhood onset
๐งฌ Pathophysiology (For understanding)
Kesari dal contains ฮฒ-ODAP (beta-oxalyl amino alanine) โ excitotoxic injury to corticospinal neurons โ irreversible upper motor neuron damage
Source
๐ฉบ Field Diagnosis Algorithm (Simplified)
Young adult + poor socio-economic background + chronic kesari dal intake + pure spastic paraparesis โ Lathyrism until proven otherwise
๐ Important Public Health Note (India)
Kesari dal is banned for human consumption in India, but still used illegally.Fresh green khesari contains lower levels of the neurotoxin ฮฒ-ODAP compared to mature dry seeds; however, significant toxin levels persist, and chronic consumption can still result in neurolathyrism, especially in nutritionally vulnerable populations.
Source: FSSAI https://www.fssai.gov.in/upload/advisories/2020/12/5fcdc37736f65Direction_Presence_Khesari_Gram_Dal_04_12_2020.pdf
The research is AI generated as direct experience with lathyrism is rare.
Reference
๐ฌ Key PubMed Sources for Khesari Toxicity & Lathyrism
1๏ธโฃ Core Review: Grass Pea & Human Lathyrism
Yan ZY et al. (2006)
Lathyrus sativus (grass pea) and its neurotoxin ODAP
Phytochemistry. 2006;67(2):107โ121.
PMID: 16332380
Comprehensive review of ฮฒ-ODAP toxicity, clinical neurolathyrism, dietary exposure, epidemiology, and prevention.
2๏ธโฃ Mechanism of Neurotoxicity (ฮฒ-ODAP โ Neuronal Injury)
Spencer PS et al. (1991)
Gliotoxic properties of ฮฒ-ODAP
Neurotoxicology. 1991.
PMID: 1802342
Demonstrates excitotoxic & gliotoxic mechanisms of ฮฒ-ODAP โ basis of irreversible spastic paraparesis.
3๏ธโฃ ฮฒ-ODAP Variation in Plant Development (Green vs Mature Seeds)
Addis G & Narayan RKJ (1994)
Developmental variation of ODAP in Lathyrus sativus
Annals of Botany. 1994;74(3):209โ215.
Shows ODAP varies with plant maturity โ young green tissues contain lower but significant toxin levels.
4๏ธโฃ Environmental & Growth Factors Affecting Toxin Content
Xu Q et al. (2017)
Factors affecting ฮฒ-ODAP content in Lathyrus sativus
Int J Mol Sci. 2017;18(3):526.
PMID: 28264526
Explains how drought, stress, and plant maturity affect toxin accumulation.
5๏ธโฃ Public Health Evidence โ India (Human Consumption & Risk)
Khandare AL et al. (2014)
Grass pea consumption & neurolathyrism in Maharashtra
Indian J Med Res. 2014.
PMID: 25222783
Field data showing doseโrisk relationship between grass pea intake and neurolathyrism.
6๏ธโฃ Indian Epidemiology โ Consumption Patterns & Declining Cases
Rao GS et al. (2018)
Current scenario of Lathyrus sativus consumption in Chhattisgarh
Food Chem Toxicol. 2018.
PMID: 29908260
Demonstrates lower consumption โ reduced lathyrism prevalence.
๐ข Key Evidence Summary
Khesari causes irreversible spastic paraparesis Yan 2006; Spencer 1991
ฮฒ-ODAP is neurotoxic excitatory amino acid Spencer 1991
Green khesari has lower toxin but not zero Addis & Narayan 1994
Toxin increases with maturity & stress Xu 2017
Chronic dietary exposure causes lathyrism in India Khandare 2014; Rao
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Books I have read but will not be rereading (Canon event)
*Flies out of literal nowhere after not writing a post for over a month*
Why hello there!! I have actually read a whole lot of books over this time but keep forgetting to write reviews becauseโฆschool! Homework! Exams!
Anyway, as we can clearly see, I have no actual intro today, so letโs just dive in.
If you havenโt guessed from the tittle yet, today Iโm going to be listing a few books I have read either:
- Recently
- In recent past
- So long ago my short term memory barely remembers it.
And why I didnโt reread it or ever plan to do it in the future.
Most of what Iโve read in these last few months has been all awesome. Iโve finished all of the โAnne of Green Gablesโ series, started Alex Rider, read โthe secret gardenโ etc etc. I plan to read The fourth wing series and then eventually โThe folk of the airโ series (in other terms, the cruel prince trilogy) after finishing Alex Rider.
The genre change is incredible, if you look at it. I went from the most wholesome series possible (because Anne is such a sweetheart) to a book written 50% in broad Yorkshire that had me questioning English (If you havenโt understood, itโs the secret gardenโ) to a spy series in which the main character nearly dies every chapter.
And then moving on to a fantasy series with dragons in it (!!) and a political fiction piece.
#diversity.
Anyway back to the point!
Here is the promised list:
- The Girl Who Drank the Moon:: Incredible read, Luna is forever one of my favourite characters because of how sweet she is and also the plot twist was great but something in it prevented me from rereading it. Itโs probably the fact that there is little to NO humour in it, the plot is so deeply made that once you read it you canโt forget it or gaslight yourself into reading it again just to feel the thrill once more. Still 5 stars though.
- FrostHeart series: I think somebody gifted me the first book and then I bought the other two. I was really hooked onto it because the plot was actually very unique and Ashโs ups and downs with songweaving were very fascinating. I really have no idea why I didnโt reread it, but most likely itโs because there is very little dialogue between the characters. It;s all in 3rd person and it makes it hard to connect to Ash himself.
- Five Survive: Pretty sure itโs the only Holly Jackson book I didnโt like. Six friends, one camper van, and one sniper. Only 5 will survive. It should be good, but honestly, it was unrealistic and didnโt meet my hopes. Oliver was traumatising, Red (the female lead) was pretty boring, Maddy was weak and Simon, despite being drunk, was the most level-headed. Ironic but not in the way I like. I have not dared to touch it again in fear it will traumatise me again.
- The Hunger Games: Now, donโt get me wrong, The Hunger Games was awesome.
- โThe Very Secret Society of Irregular Witchesโ: This was a find during vacation, and I borrowed it from the hotel library. Itโs about a witch called Mika who belongs to a society of witches blending in with humans, and itโs, as you can tell, secret. However the lore is not provided at all! There are no details in it and we can just see a little bit of information. Most of the book goes by in Mikaโs personal struggles and decisions, and how she attempts to teach 3 young girls witchcraft and โhow to control their powersโ but the plot is basicallyโฆlike non existent. It started off with almost no plot, got a little interesting, then BOOM, all gone. At the end we see a bit of action but nothing else. Alot of it was just her fangirling over the librarian and smiling โher sunshine smileโ and the rest was just meh.
- The Rosewood Hunt: This was a take on the Inheritance Games series, but itโs a standalone. Great book, the protagonist was actually very sensible and grounded (rare). Even though the plotline is a little typical it was a pretty good read. The only reason I didnโt reread it was because I didnโt get invested enough. The characters were very well written but again, I could pretty much predict what was going to happen next. And now whenever someone brings up gray eyes Iโll always think of Leo from this book (Seriously, itโs mentioned so many times) or Grayson Hawthorne. Anyway!
Why am I writing this post instead of an actual review?
โฆโฆ
Good question.
I have no idea.
I just had an inspiration like โoh hey letโs list books I liked but wonโt reread because why notโ
And the reason itโs such a canon event is that most books I have in my shelfs, I actually like and reread quite a few times.
Anyway, if we shall meet again the next time I am struct with a random idea!
Goodbye!
