Journal of Evolution of Medical and Dental Sciences

Primary Central Nervous System Lymphoma Masquerading as Multiple Sclerosis - A Case Report

Sunidhi Kumari S., Syed Areeb Yazdani, Nagarjuna Chary, Naval Kishore Bajaj — Fri, 31 Jul 2026 00:00:00 +0000

Primary central nervous system lymphoma represents a rare and aggressive variant of non-Hodgkin lymphoma that remains confined to the central nervous system without systemic involvement at the time of diagnosis.^[1] We present a case of a 48-year-old immunocompetent male who initially received a diagnosis of multiple sclerosis but was subsequently found to harbor PCNSL (Primary Central Nervous System Lymphoma) of the diffuse large B-cell type.^[2] This case highlights the considerable clinical and radiological similarities between PCNSL and demyelinating disorders, demonstrating the critical importance of obtaining tissue diagnosis through biopsy and comprehensive immunohistochemical evaluation for accurate diagnosis and timely therapeutic intervention.^[1]

Primary central nervous system lymphoma accounts for approximately 3.3% of all primary brain tumors. In immunocompetent patients, the vast majority of PCNSL cases originate from germinal center B-cells and develop within the brain parenchyma, spinal cord, cerebrospinal fluid compartment, or intraocular structures without evidence of systemic disease. The diagnosis of PCNSL poses significant challenges due to its non-specific clinical presentation, ambiguous neuroimaging characteristics, and often unrevealing cerebrospinal fluid findings, leading to frequent misdiagnosis. Through this case presentation, we aim to emphasize the importance of including PCNSL in the differential diagnosis when magnetic resonance imaging demonstrates non-enhancing, diffusely infiltrative lesions.^[1]

Psammomatoid Ossifying Fibroma/Juvenile Psammomatoid Ossifying Fibroma

R. P. Sushma Kumari, Naval Kishore Bajaj, Mogulla Mamatha, Govindu Sai Bhavishya — Fri, 31 Jul 2026 00:00:00 +0000

Juvenile psammomatoid ossifying fibroma is a rare benign fibro-osseous neoplasm with locally aggressive behaviour and a high propensity for recurrence. We report a case of a 13-year-old female who presented with a painless right cheek swelling of 15 days' duration. Computed tomography revealed an expansile lesion involving the anterior wall of the right maxillary sinus with a ground-glass matrix, initially suggesting fibrous dysplasia. Histopathological examination demonstrated a cellular fibrous stroma containing numerous psammoma-like ossicles and irregular bony trabeculae with osteoblastic rimming, consistent with JPOF. Complete surgical excision was performed. JPOF may mimic other fibro-osseous lesions clinically and radiologically; therefore, histopathological evaluation remains essential for definitive diagnosis. Early recognition and complete excision are crucial because of the lesion's aggressive local growth and risk of recurrence. This case highlights the importance of considering JPOF in the differential diagnosis of expansile craniofacial lesions in pediatric patients.

JPOF (Juvenile Psammomatoid Ossifying Fibroma) is a rare benign fibro-osseous neoplasm characterised by aggressive local growth and a high tendency for recurrence despite its non-malignant nature. It is recognised as a distinct clinicopathological entity in the recent

WHO classification of head and neck tumours and predominantly affects children and young adults, with a predilection for the craniofacial bones, particularly the paranasal sinuses, orbit, and maxilla.^[1,2] Clinically and radiologically, JPOF may mimic other fibro-osseous lesions such as fibrous dysplasia, making histopathological examination essential for definitive diagnosis. We report a case of JPOF involving the right maxillary sinus in a 13-year-old female, highlighting its clinicopathological features and diagnostic challenges.

A Rare Case of Soft Tissue Sarcoma Dermatofibrosarcoma Protuberans (DFSP)

Jyothi U. S., B. P. Sanganal, Sangeetha K., Ajay — Mon, 31 Aug 2026 00:00:00 +0000

A 58 year old female presented with swelling over the upper abdomen for 8 months. The patient was apparently alright 8 months ago when she noticed a painless swelling,approximately the size of a lemon, which gradually progressed to the present size. There was no history of trauma, fever, discharge or bleeding from the swelling. There was no history of change in size of the swelling on exertion or straining. There were no aggravating or relieving factors. On examination, a solitary swelling of approximate size 5×3 cm was noted over the epigastric region. Skin over the swelling was smooth, shiny, and tense with surrounding erythema. There was no discharge from the swelling. The swelling was ill defined with irregular border. A healed ulcer of 1 cm was noted over the summit of the swelling. Inspectory findings were confirmed by palpation. The swelling was non tender .There was no local rise of temperature. The swelling was firm in consistency, non compressible and immobile. Skin was not pinchable.It did not change in size on valsalva manoeuvre.

An ultrasound examination of the abdomen was performed, which was suggestive of slow flow AV malformation. Hence, a CT angiogram was performed which showed a lobulated,isodense lesion measuring 5.6x3 cm in the epigastric region.On post contrast study the lesion showed homogeneous enhancement with superior epigastric artery as the feeding artery.

Primary Glottic Aspergillosis in an Immunocompetent Host - A Diagnostic Challenge

Mon, 31 Aug 2026 00:00:00 +0000

Laryngeal aspergillosis is an uncommon fungal infection. Primary involvement of the larynx is particularly rare. Aspergillus infection of the larynx most often occurs as a secondary manifestation of infection elsewhere in the respiratory tract. However, isolated primary laryngeal disease can occur, as demonstrated in the present case. The infection may affect the vocal folds alone or extend to other laryngeal subsites Its clinical appearance can closely resemble a malignant or premalignant lesion. Recognition of this rare condition is therefore important, as confirmation of the diagnosis may prevent unnecessary extensive surgical intervention. Treatment with appropriate antifungal therapy, together with correction of identifiable predisposing factors, is generally associated with a favourable response. Primary laryngeal aspergillosis should consequently be considered among the differential diagnoses of suspicious laryngeal lesions, especially in patients without obvious immunosuppression. Here, we present a case of primary aspergillosis of the larynx in a 42-year-old immunocompetent male patient who was cured by oral Itraconazole.

Cases of aspergillosis of the larynx are very rare. Like other cases of mycosis, the larynx is generally involved secondarily by aspergillosis. In fact, the larynx is only involved in advanced stages of broncho-pulmonary aspergillosis. In a few extremely rare cases, however, the larynx happens to be the primary site of lesion. It is an opportunistic fungal infection affecting immunocompromised patients. In an immunocompromised patient, aspergillus infection is usually necrotising, invasive, and associated with poor prognosis. In immunocompetent patients, laryngeal aspergillosis may represent colonisation rather than invasion. The diagnosis of aspergillosis is important as the presenting symptoms are suspicious of malignant laryngeal disease. A patient with laryngeal aspergillosis can present with hoarseness, throat pain, dysphagia, severe paroxysmal cough, tachypnea or even stridor. We report a case of primary Aspergillus infection confined to the vocal cords and highlight the clinical manifestations, diagnosis and management.

A Rare Case of Grade I Duodenal Neuroendocrine Tumor Presenting with Upper Gastrointestinal Bleeding and Severe Iron Deficiency Anemia

Sai Keshava Reddy Atla, Aparna Korisetty, Vijay Kumar Naik Banavath — Mon, 31 Aug 2026 00:00:00 +0000

BACKGROUND

Duodenal neuroendocrine tumors (D-NETs) are rare neoplasms accounting for approximately 2–5% of gastroenteropancreatic neuroendocrine tumors. They are commonly asymptomatic and incidentally detected; however, ulcerated lesions may rarely present with vert gastrointestinal bleeding and severe iron deficiency anemia.

CASE PRESENTATION

Despite taking oral and parenteral iron supplements, a 62-year-old woman developed recurring melena and severe iron deficiency anemia that required transfusions. Microcytic hypochromic anemia with hemoglobin of 7.5 g/dL, decreased mean corpuscular volume, and peripheral smear results indicative of chronic blood loss were found in the laboratory assessment. Erosive pangastritis, a Helicobacter pylori-associated gastric ulcer, and over eight sessile and sub-pedunculated polypoidal lesions extending from the first to third parts of the duodenum were discovered during upper gastrointestinal endoscopy. Several of these lesions showed deep ulceration with active bleeding. Four bigger lesions underwent endoscopic band ligation. Several modestly hyper-enhancing duodenal polyps were seen on contrast-enhanced CT enterography; the biggest one was around 15 × 15 mm. Brunner gland hyperplasia with questionable neuroendocrine foci was revealed by histopathological analysis, however, a well-differentiated Grade I neuroendocrine tumor with widespread synaptophysin positivity and a Ki-67 proliferation index of 2% was verified by immunohistochemistry. With SUVmax values of 5.0 on early imaging and 10.0 on delayed imaging, Ga-68 DOTATOC PET-CT showed somatostatin receptor-positive multifocal duodenal lesions up to 1 cm in size. There was no indication of solid organ involvement, distant metastases, or locoregional lymphadenopathy.

CONCLUSION

This case illustrates a rare manifestation of multifocal Grade I duodenal neuroendocrine tumors linked to overt upper gastrointestinal hemorrhage, severe iron deficiency anemia, and Brunner gland hyperplasia. Accurate staging and prompt care are made possible by early detection employing a multidisciplinary approach that includes endoscopy, histology, immunohistochemistry, and somatostatin receptor imaging. This improves clinical results.

Factors Affecting the Tumor Volume Reduction Rate During Adjuvant Radiation Therapy (RT) in Patients with Glioblastoma Multiforme (GBM)

Fri, 31 Jul 2026 00:00:00 +0000

BACKGROUND

Glioblastoma multiforme is the commonest primary brain tumor in adults, responsible for 45.2% of primary brain tumors. It is considered a highly aggressive brain tumor with a grave prognosis. Standard treatment for GBM (Glioblastoma Multiforme) consists of maximal safe resection, adjuvant RT (Radiation Therapy), and temozolomide chemotherapy. Despite all the treatments, survival for GBM remains 15-18 months post-diagnosis. Several studies have demonstrated the prognostic significance of different factors, including age, performance status, extent of surgery, and status of molecular markers such as tumor MGMT promoter methylation and IDH mutation. Among the various factors, studies have shown that delaying the start of radiation therapy decreases survival in these patients.

METHODS

This retrospective study was conducted from January 2020 to June 2024 on 47 patients diagnosed with GBM. All these patients underwent surgical resection followed by adjuvant chemoradiation therapy and 6 cycles of maintenance temozolomide. Patient demographics, tumor, and treatment-related details were extracted from retrospectively collected, prospectively curated data. The patients who had been previously treated for a primary brain tumor or for whom pre-RT and follow-up scans were not available were excluded.

RESULTS

The median age at presentation was 45 years. The extent of surgical resection was subtotal in 91.5% of patients. Following surgery, tumor size greater than 4 cm was noted in 63.8% of the patients. The course of adjuvant and maintenance chemoradiation therapy could be completed by 86% of the patients. Among the factors influencing the tumor volume reduction during adjuvant RT, a delay in initiating RT beyond 3 weeks and a residual tumor greater than 4 cm were significantly associated with reduced mean percentage volume change.

CONCLUSIONS

This study provides an important insight into the various prognostic factors affecting the tumor volume reduction rate in GBM patients. We found that greater residual tumor volume following surgery and prolonged interval to RT significantly negatively influenced the rate of tumor volume reduction in GBM patients. Our study strengthens the fact that adjuvant RT should be started as early as possible after surgery. Future studies are warranted to elucidate the impact of the extent of surgical resection and the interval before initiating RT on patient survival.