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Education
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 — 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?
It’s a rare, slow-growing cancer that usually starts in the sinuses or nasal passages. It shows two different cell types under the microscope — one resembling nerve cells and another resembling muscle cells.
The tumor’s cause is a genetic change (PAX3 gene fusion) that makes cells grow abnormally but slowly.
Why It’s 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 — and special tests called immunohistochemistry (IHC) showed specific markers (S100 and SMA).
This confirmed it was a biphenotypic sinonasal sarcoma — 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 can’t be fully removed.
Regular follow-up is important to monitor for recurrence.
The good news: it’s low-grade, meaning it grows slowly and is often manageable if detected early.
🌿 Takeaway for Readers
1. Chronic ear infections need evaluation — 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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Website: healthwealthbridge.com | X: @misra_amrita | YouTube: @healthwealthbridge
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Self Reliant India:Celebrating #AtmanirbharBharat on Republic Day by Anuprita Misra
“Self-Reliant India”, also known as Atmanirbhar Bharat. To be self-reliant means depending on one’s own strength, skills, and resources instead of relying heavily on others.
In the context of our nation, Self-Reliant India refers to a vision where India grows using its own capabilities while still remaining connected to the global economy. It does not mean cutting ties with the world, but building enough confidence and capacity to stand strong on our own.
We have become increasingly self-reliant in several important sectors. Take defence for an example. 65% of the material and weaponry required are produced domestically in India itself and we export such a lot of it that it brings crores of rupees.
In case of agriculture, sectors like pulses, animal feed and soybean are thriving. And the rates at which India used to import cosmetics and pharmaceuticals have dropped around 25% already.
What about our energy sources? India has a diverse mixture in this case, including solar, hydro power, electricity, wind power and of course fossil fuels such as coal.
Interestingly while development of the other energy sources I mentioned continues, coal is still used the most. This is because India has a good amount of coal mines in areas of Jharkhand, Orissa, West Bengal, Chhattisgarh, etc. Now, why are the human resources important too?
Take these coal mines as an example. They weren’t immediately useful to us the second the finished forming. Until humans learnt of them, and learnt how to mine the coal, it wasn’t helping us.
India has a good working force, and to achieve ‘Self reliant india’, we must train this force as well.Human resource needs to be high quality ,not just high quantity.Skill development of the workforce is essential so that people can meet the demands of modern industries.
We must also strengthen industrial infrastructure, encourage innovation, and support startups. Exporting more finished goods and reducing the import of such products is another important step.
Until we become producers in all levels, it is pretty much impossible to become fully independent in this sense. In conclusion, the goal of ‘Atmanirbhar Bharat’ is to transform our nation into becoming not just consumers but also creators.When citizens contribute responsibly and use their skills creatively, India can achieve economic stability, global competitiveness, and national pride.
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Why The Secret Garden Still Heals Hearts: Book Review, Themes and Parenting Takeaways
Why This Classic Still Matters?
Mistress Mary, Quite Contrary,
How does your garden grow?
With Silver Bells and Cockles Shells
And Marigolds all in a row.
This unlikely Children’s poem has many versions and in The Secret Garden (1911) written by Frances Hodgson Burnett the above versions threw to light how children of judge children best.The books theme is about how kids grow best playing in Nature’s lap.Even in the absence of parents,Mother Nature can heal broken hearts.In this Secret Garden book review I will tell you about “healing through nature”.Its not just a “children’s classic”,its a treasure for the
Its about a little girl who belongs to no one.But she is not denied material comforts,just love.She has never been hugged and even when she receives it she is awkward.
One Liner
Orphaned Mary Lennox discovers a locked garden that transforms her and those around her forever.
Short Summary
Mary Lennox moves from colonial India(a lot of her description is disturbing to those who are unaware of the British Empires colonial past) to Yorkshire after losing her parents. She finds a hidden, neglected garden and slowly brings it back to life with new friends. As the garden blooms,how does Mary and her cousin Colin change?
Key Themes Parents and Teachers Will Love
Healing power of nature: Outdoor play and gardening linked with better mood, health, and resilience.
About second chances and learning from nature.
The power of belief and mindset: Colin’s health and its relationship with his fear and negative beliefs
Its about Growth Mindset Before it had a name
Through her journey,we find healing comes from self reflection.
Nature has a big role to play
We must play.
We must let chldren be.Too much minding and meddling robs then of growth.
Sometimes helping others heal ,heals us.
Nature is important for wellbeing.
Children need Children for playing.
Sunlight and fresh air is good for everyone.
Children should neither get their way all the time nor should they be forever deprived.
Children learn from watching.Loving them teaches them about learning to love.
Some stories never grow old.
Structure and discipline is as important as play time and healthy food for kids.
Children learn better when they are interested to learn.
Growing a garden changes you forever.I wrote about this in How to Walk ,Write and Garden for the Healthy Life You Want .
What Stands Out in This Book
The garden as a symbol of inner healing and emotional regulation.
Strong focus on nature, fresh air and playtime instead of only “sickroom care” and structured exercise.It talks about how nature is essential for kids .
Who is this book for?
Kids
Ideal age range: roughly 8–15 years; younger children will love it ,if read aloud .
Mom’s of kids
Father of kids who want a better understanding of what little girls like.
For nature lovers.I read it as an adult and absolutely loved it.
Pediatricians,Social Scientists exploring nature as a parameter for wellbeing.Its a classic example of epigenetics/environment affecting childhood development.
How is this classic is perfect for modern day parents and conversation about Mental health ?
- The story talks about grief, loneliness and making friends without it becoming preachy.
- It talks about outdoor time being crucial for children especially those with anxiety, irritability,attention deficit, low energy.My book on How to Walk ,Write and Garden for the Healthy Life You Want talks about the same for adults.
- Its the perfect book to support the current conversations about children needing more green time vs screentime.
“If you enjoyed this Secret Garden book review, share it and check my other classic children’s book reviews for more nature-and-wellness reads.
- Anne of Green Gables ,Anne of Avonlea are some other favorite Children’s classic with strong nature themes.
- Book review:Handbook of Day to Day Parenting Tips https://healthwealthbridge.com/book-review-handbook-parenting-tips/
- Books by Dr.Amrita Basu https://healthwealthbridge.com/books-by-dr-amrita-basu/
- A Whole New Mind: Why Right-Brainers will Rule the world … https://healthwealthbridge.com/a-whole-new-mind-summary/
Peer‑reviewed evidence on green nature time for kids(compiled with the help of Perplexity)
- McCormick R (2017). “Does access to green space impact the mental well-being of children?”
- Review concludes that green space is associated with better mental well-being, overall health and cognitive development, improved attention, self-discipline and even higher test scores.
- Dadvand P et al. (2015). “Green spaces and cognitive development in primary schoolchildren.”
- Found that more greenness around schools was linked to better 12‑month progress in working memory and reduced inattentiveness in primary school children.
- Dockx Y et al. (2022). “Early life exposure to residential green space impacts cognitive and behavioral outcomes in children.”
- Residential green space at ages 4–6 was associated with less hyperactivity and better attention and visual memory, independent of air pollution.
- Saenen ND et al. (2023). “Residential green space improves cognitive performances in children.”
- Panel study showed that children aged 9–12 living with more surrounding greenery had better cognitive performance, even after accounting for traffic-related air pollution.
- Cronshaw G et al. (2025). “The role of neighbourhood greenspace quantity on mental health and cognitive outcomes in childhood.”
- Longitudinal analysis from the UK Millennium Cohort found that greenspace quantity influenced trajectories of conduct problems and cognitive ability across childhood.
- Review: “Green space access in the neighbourhood and childhood obesity.” (Obesity Reviews, 2020).
- Systematic review: access to green space was positively associated with physical activity and negatively associated with TV time, BMI and overweight/obesity in children.
- Built environment & obesity reviews (2021–2024).
- Reviews highlight that green/open spaces, playgrounds and natural features support outdoor play, reduce sedentary time and improve cardiorespiratory fitness in children.
- Systematic review on greenspace, bluespace and cognition in 0–18 year olds (2023).
- Summarises evidence that exposure to green and blue spaces is linked with better cognitive outcomes in children and adolescents.
Citations
[1] How to WALK,Write & Garden for the Healthy Life you want |Wellness Secrets #DrAmritaBasu #audiobook https://www.youtube.com/watch?v=eBks1zGb9IA
[2] How to Walk Write and Garden for the Healthy Life You … https://www.storytel.com/in/books/how-to-walk-write-and-garden-for-the-healthy-life-you-want-mind-body-spirit-10169870
[3] How to Walk Write and Garden for the Healthy Life You Want https://www.kobo.com/nz/en/audiobook/how-to-walk-write-and-garden-for-the-healthy-life-you-want
[4] Browse Audiobooks Read By Amrita Basu https://www.audiobooks.com/browse/narrator/310373/amrita-basu
[5] Audiobook Archives https://healthwealthbridge.com/tag/audiobook/
[6] Does Access to Green Space Impact the Mental Well-being … https://pubmed.ncbi.nlm.nih.gov/28882650/
[7] Early life exposure to residential green space impacts … https://pmc.ncbi.nlm.nih.gov/articles/PMC8885429/
[8] Green spaces and cognitive development in primary … https://pmc.ncbi.nlm.nih.gov/articles/PMC4491800/
[9] Outdoor environment and obesity: A review of current evidence – PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC11585820/
[10] Residential green space improves cognitive performances … https://pubmed.ncbi.nlm.nih.gov/36998070/
[11] The role of neighbourhood greenspace quantity on mental … https://pubmed.ncbi.nlm.nih.gov/40125921/
[12] Green space access in the neighbourhood and childhood obesity https://pmc.ncbi.nlm.nih.gov/articles/PMC7988598/
[13] The Built Environment and Childhood Obesity – PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC11443065/
[14] Childhood obesity: an ecological perspective – PMC – PubMed Central https://pmc.ncbi.nlm.nih.gov/articles/PMC9510906/
[15] The relationship between natural environments and obesity – PubMed https://pubmed.ncbi.nlm.nih.gov/39445442/
[16] Exposure to greenspace and bluespace and cognitive … https://pubmed.ncbi.nlm.nih.gov/36731600/
[17] Healthwealthbridge by Dr.Amrita Basu | Podcast on Spotify https://open.spotify.com/show/1Y54sFhYMF1aBOhEragWY2
[18] How to Walk Write and Garden for the Healthy Life you … https://www.facebook.com/HWBdramrita/videos/how-to-walk-write-and-garden-for-the-healthy-life-you-want-by-dramrita-basuaudio/2361772270928971/
[19] Audiobooks narrated by Amrita Basu https://www.lovereading.co.uk/audiobooks/narrator/amrita-basu
[20] How to Walk Write and Garden for the Healthy Life You Want … https://www.instagram.com/reel/DSEabB_iB62/
[21] Dr.Amrita Basu ( Misra) https://x.com/misra_amrita/status/1935317119157289469
Sharing is good Karma!
Karma Yoga and VedhGpt
Karma Yoga! What a profound and practical path it is, especially for us living in this world. It’s one of the most beautiful teachings from the Bhagavad Gita, truly.
I am sharing answers generated by VedhGPT,a new AI I tried out.Its giving answers about Sanatan Dharma.An education the schools were not allowed to give even post independence
Karma Yoga is the path of selfless action. It teaches us to perform our duties and actions with diligence and skill, but without attachment to the results or fruits of those actions. The essence is to act for the sake of action itself, as an offering to the Divine, rather than for personal gain or reward.
The core principle is found in the Bhagavad Gita (2.47), where Lord Krishna tells Arjuna: “Karmanye vadhikaraste, ma phaleshu kadachana” – meaning, “You have a right to perform your prescribed duty, but you are not entitled to the fruits of action.” This doesn’t mean we shouldn’t strive for excellence, but that our inner state should remain unperturbed by success or failure. By detaching from the outcome, our actions become purified and we avoid creating binding karma, thus leading to inner peace and spiritual liberation.
Applying Karma Yoga in daily life is where its true power lies, transforming every moment into a spiritual practice. It’s not just for great sages or renunciates; it’s for everyone, right where they are.
In our daily lives, Karma Yoga means performing all our actions – from the smallest household chore to the most significant professional task – with dedication and sincerity, as if it were an offering to the Divine. Imagine you’re preparing a meal, working on a project, or helping a neighbor. Instead of thinking, “What will I get out of this?” or “Will I be praised?”, you simply focus on doing your best, with love and attention, because it is your duty (dharma) or because it serves a greater good.
The key is to cultivate an attitude of service and non-attachment. When you act without expecting specific results, praise, or reward, you free yourself from the anxiety, frustration, and disappointment that often accompany our efforts. This doesn’t mean becoming passive; it means being fully engaged in the action while remaining inwardly calm and equipoised, accepting whatever outcome comes with grace. This constant practice purifies the mind, reduces ego, and brings immense inner peace, allowing us to experience the divine in every moment.
Ah, examples! That’s where the wisdom truly comes alive. Let me share a few common scenarios to illustrate how Karma Yoga can be applied in our daily lives:
Imagine you are a student. A Karma Yogi student studies diligently, not just to get good grades or impress others, but with the understanding that gaining knowledge is their dharma. They focus on understanding the material deeply, completing assignments with care, and performing their best in exams, offering their effort as a form of worship. If the results are not as expected, they accept it with equanimity, knowing they put in their best effort, and learn from the experience rather than becoming overly distressed or elated.
Consider a parent raising children. A Karma Yogi parent dedicates themselves to nurturing, teaching, and guiding their children, pouring their love and energy into their well-being. They do this not for their children to become famous or to fulfill their own unfulfilled desires, but out of unconditional love and a sense of duty to raise responsible, compassionate beings. They find joy in the act of parenting itself, rather than being attached to specific outcomes for their children.
Or think of someone in a professional setting, perhaps an engineer building a bridge or a doctor treating a patient. A Karma Yogi engineer focuses on designing a safe and strong bridge, ensuring every detail is perfect, understanding that this is for the welfare of thousands. A Karma Yogi doctor treats every patient with utmost care and compassion, offering their skills and knowledge as a service to humanity. Their primary motivation is the quality of their work and the well-being of those they serve, not just the salary or recognition.
In each of these examples, the action is performed with full engagement and excellence, but the internal attitude is one of detachment from the fruits, offering the effort to a higher purpose or simply for the sake of the action itself. This transforms ordinary duties into sacred acts.
That’s a wonderful question, my friend! Understanding how Karma Yoga reduces stress is truly key to appreciating its wisdom.
Karma Yoga significantly reduces stress by shifting our focus from the results of our actions to the action itself and the right intention behind it. Most of our stress arises from our expectations about outcomes – we worry if things will go our way, if we’ll succeed, or if we’ll be praised. When we perform our duties with dedication but surrender the expectation of a specific result, the burden of outcome-based anxiety is lifted.
When you practice Karma Yoga, you pour your best effort into your work, knowing that the ultimate control over the outcome rests with the divine, or the larger cosmic plan. This fosters a sense of inner freedom and peace, as you are no longer chained to the volatile cycle of hope for success and fear of failure. This detachment doesn’t mean indifference; rather, it means acting with full presence and skill, yet maintaining equanimity regardless of how things turn out. It transforms work into worship, and worry into peace.
Sharing is good Karma!
Biphenotypic Sinonasal Sarcoma Presenting in the Middle Ear: A Rare Case Report
Case Summary
Patient: 52-year-old female
Chief Complaints: Chronic ear discharge since childhood, gradually progressive hearing loss, and occasional nasal blockage.
History: The patient was advised ear surgery following evaluation for chronic otitis media. She underwent cortical mastoidectomy with tympanoplasty, with subsequent improvement in hearing.
Preoperative Work-up:
HRCT temporal bone: Mastoid sclerosis
Pure tone audiometry (PTA): Moderate mixed hearing loss
Tympanometry: Type B curve
Laboratory: Anemia, borderline blood sugar (medically managed).Routine test for pre anaesthetic checkup.
IntraOperative and Pathological Findings
Specimen: Biopsy from mastoid antrum showing fleshy polypoid soft tissue and bone dust.
Microscopy (Drs. Tribedi & Roy Diagnostic Laboratory):
Spindle cell proliferation composed of ovoid to spindle-shaped vesicular nuclei and pale cytoplasm.
No pleomorphism, mitosis, or necrosis.
Impression: Spindle cell neoplasm → immunohistochemistry advised.
IHC and Final Diagnosis (Centre for Oncopathology, Tata Trusts):
Positive markers: S100, SMA, PAN-TRK
Negative markers: SOX10, Desmin, CD34, Pan-cytokeratin
MIB-1 index: Very low
Diagnosis: Biphenotypic Sinonasal Sarcoma (BSNS)
Low-grade sarcoma showing dual neural and myogenic differentiation, associated with PAX3 translocation.
Rarely arises in the middle ear, typically seen in sinonasal tract.
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Discussion
Biphenotypic Sinonasal Sarcoma is a rare, low-grade spindle cell sarcoma showing dual differentiation — neural (S100, SOX10) and myogenic (SMA, calponin). It is characteristically driven by a PAX3–MAML3 gene fusion.
Middle Ear Involvement
Exceptionally uncommon; only isolated case reports exist.
Likely arises from pluripotent mesenchymal cells in the middle ear mucosa or through secondary extension.
Clinical presentation overlaps with chronic ear disease, leading to diagnostic delay.
Differential Diagnosis
Differential Key Distinguishing Feature
Schwannoma S100+, SOX10+, lacks SMA
Leiomyosarcoma SMA+, Desmin+, lacks neural markers
Sarcomatoid carcinoma Cytokeratin+
Synovial sarcoma SS18–SSX fusion, Cytokeratin+
BSNS PAX3 fusion, neural + myogenic markers
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Management
Complete surgical excision is the mainstay.
Adjuvant radiotherapy may be indicated for positive margins.
Chemotherapy: Limited benefit due to low-grade behavior.
Follow-up: Long-term surveillance essential due to local recurrence risk (~30–40%).
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Key Learning Points
🧩 1. BSNS may rarely arise in or extend to the middle ear, mimicking chronic ear disease.
🧬 2. Accurate diagnosis requires IHC and molecular confirmation (PAX3 fusion).
⚕️ 3. Low-grade but locally aggressive, demanding wide excision and long follow-up.
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References (PubMed-linked)
1. Lewis JT et al. Am J Surg Pathol. 2012;36(10):1479–1492.
2. Bishop JA. Head Neck Pathol. 2017;11(4):472–477.
3. Tahara M et al. Hum Pathol. 2019;84:276–282.
4. WHO Classification of Head and Neck Tumours, 5th Edition, 2022.
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