Journal of Evolution of Medical and Dental Sciences

Papillomatous Lesion of the Hard Palate - A Clinical Image

2026-04-30T05:52:46+00:00

A 62-year-old male presented to our ENT outpatient department after having noticed a growth in the oral cavity for the past 2 months. No bleeding or difficulty in swallowing was seen. There was no history of tobacco or alcohol intake. He was known to be hypertensive on medication. A solitary, well-circumscribed exophytic, pedunculated lesion of size approximately 1.5 cm x 1.5 cm over right side of the hard palate was seen (Fig.). The surface was irregular with a pinkish white appearance. It was firm in consistency and did not bleed on touch. After workup, he underwent excision of the lesion with bipolar cautery of the base under local anaesthesia. After excision, the base was cauterised. Post-operative period was uneventful. Histopathological examination revealed papillary projections of stratified squamous epithelium supported by fibrovascular cores, consistent with squamous papilloma. No epithelial dysplasia or malignancy was noted. No recurrence was observed on follow-up.

Correlation of Ultrasonographic Ovarian Parameters and Hormonal Parameters in Polycystic Ovarian Disease

2026-05-30T05:02:04+00:00

BACKGROUND

Polycystic Ovarian Disease (PCOD) is an endocrine disorder affecting women of reproductive age, characterised by hyperandrogenism, ovulatory dysfunction, and PCOM (Polycystic Ovarian Morphology). It has a global prevalence of 4–10%. PCOD often presents during adolescence and is diagnosed using the Rotterdam criteria, which require at least two of the following: oligo/anovulation, clinical or biochemical hyperandrogenism, or PCOM on ultrasound.

METHODS

This cross-sectional study involved 135 female patients clinically suspected of having PCOD, referred from the Department of Obstetrics and Gynaecology for pelvic ultrasonography. Inclusion criteria included clinical features such as oligomenorrhoea, infertility, hirsutism, and obesity. Pelvic ultrasound was performed to assess ovarian volume, follicle count and size, and stromal echogenicity. Hormonal profiles (LH, FSH, LH/FSH ratio) were also evaluated.

RESULTS

The majority of participants (70.4%) were aged 18–25 years. Menstrual irregularities were reported in 88.8% of cases, subfertility in 42%, hirsutism in 35.5%, and obesity in 3.7%. Ovarian volume >10 cc was seen in 85.9% of participants. Follicle count >20 per ovary was observed in 88.8%, and 90.3% had follicles measuring 2–9 mm. Elevated LH levels were seen in 89.47% of patients with an ovarian volume >10 cc. A borderline significant association was found between ovarian volume and FSH levels.

CONCLUSIONS

While many patients were overweight or pre-obese, lean PCOD cases were also noted. Key ultrasound features, such as increased ovarian volume and peripheral follicle arrangement, showed strong correlations with hormonal imbalances, supporting the need for integrated and personalised approaches to diagnosis and management.

Analysis of Internalising and Externalising Behaviours in Children with Autism Spectrum Disorder and Their Relationship with Severity and Gender in a Tertiary Care Hospital

2026-06-30T07:11:01+00:00

BACKGROUND

Children with autism spectrum disorder exhibit significantly higher levels of both internalising and externalising behaviours compared to typically developing peers. The severity of autism is associated with increasing internalising and externalising problems, i.e., more severe autism correlates with higher behavioural difficulties. Gender also plays a role in behavioural problems, females with ASD (Autism Spectrum Disorder) tend to exhibit more of internalising behaviours and males with ASD exhibit more externalising behaviours. There are limited Indian studies focussing on these areas. This study explores internalising and externalising behaviours in children with ASD and examines their relationship with the severity of autism and gender.

METHODS

A cross sectional analytical study of 60 children and adolescents between 7 and 18 years of age who are diagnosed with ASD is included in the study. The Indian Scale for Assessment of Autism scale was used to assess the severity of the autism and the CBCL (Child Behaviour Checklist) scale was used to assess the internalising and externalising behaviours. The association between the clinically significant behavioural problems and the severity of autism was analysed. The gender differences in the behavioural patterns are also analysed.

RESULTS

This study examined 60 children with ASD, revealing a predominance of males and with most of the cases classified as mild to moderate severity. Higher rates of behavioural and emotional problems were identified. About 40% had clinical-range internalising behaviours, 36.7% externalising problems and 66.7% showed elevated total CBCL scores. Externalising behaviours were significantly associated with autism severity (p = 0.02) and male gender (p = 0.04), whereas internalising behaviours showed no significant association.

CONCLUSIONS

This study highlights the need to address behavioural issues in children with ASD through a multidisciplinary approach.

Sinonasal Malignant Melanoma - A Rare and Aggressive Entity

2026-04-30T09:52:00+00:00

Sinonasal malignant melanoma (SNMM) accounts for less than 1% of melanomas and less than 4% of sinonasal tumors. They are uncommon, aggressive tumors originating from mucosal melanocytes.^[1] Elderly individuals often experience nonspecific symptoms, such as obstruction or epistaxis, which can lead to a delayed diagnosis. . In order to stop the tumor from spreading locally and regionally, an early and precise diagnosis is crucial because the tumor is extremely aggressive. The number of sinonasal malignant melanomas that have been reported and published has increased recently.

Primary Lymphoepithelial Carcinoma of the Parotid Gland- A Case Report

2026-04-30T09:51:59+00:00

LEC (Lymphoepithelial Carcinoma) arising in the salivary glands is extremely rare; it was originally described by Hilderman in 1962 and comprises only 0.4% of salivary carcinomas.^[1,2] It is identified by histopathological features of undifferentiated malignant epithelial cells within lymphoid stroma cells.^[3]It has a female preponderance. It is associated with Epstein-Barr virus infection; the Arctic Inuit, Japanese, and Southern Chinese populations have a strong association with EBV infection.^[4]The histology is closely related to nasopharyngeal carcinoma; hence, it has to be ruled out. Commonly found in foregut derivatives, salivary glands, thymus, stomach and liver. However, other anatomical locations, such as the bladder, lacrimal glands, ovaries, cervix, and skin, were also reported.^[5]The mainstay of treatment of parotid LEC is surgical resection with adequate safety margins for patients with resectable tumours.^[2] LEC is highly radiosensitive; hence, surgery with adjuvant radiotherapy improves the patients' long-term survival compared to those treated with surgery alone. We present this rare case of primary lymphoepithelial carcinoma of the left parotid gland, which was treated with superficial parotidectomy followed by adjuvant radiotherapy.

Our case report describes an 85-year-old female diagnosed with primary lymphoepithelial carcinoma of the left parotid, treated with left superficial parotidectomy with adjuvant radiotherapy. There were no recurrences noted during one year of follow-up; currently, the patient is under regular follow-up.

We present this rare case of primary lymphoepithelial carcinoma of the left parotid gland, which was treated with superficial parotidectomy followed by adjuvant radiotherapy.

A Giant Sublingual Dermoid Cyst Masquerading as a Plunging Ranula

2026-05-30T05:12:52+00:00

Dermoid cysts are benign congenital tumors of ectodermal origin that typically arise along the midline where embryonic structures fuse but can also occur as acquired lesions. Dermoid cysts rarely occur in the oral and maxillofacial region. They are mostly asymptomatic swellings that are slow and progressive. They are often misdiagnosed as a plunging ranula and thus require differention from one another as they have different treatment strategies. Here, we present a rare presentation of a sublingual dermoid cyst that poses a significant diagnostic challenge.

Dermoid cysts are benign congenital tumors of ectoderm origin. A ranula is a type of mucocele, a disease of the sublingual salivary gland. Here we report a case of submental dermoid mimicking ranula that was treated by complete surgical excision via transcervical approach.

Hypertriglyceridemia Induced Acute Pancreatitis in Pregnancy Leading to Maternal Complications with Fetal Demise

2026-05-30T05:12:51+00:00

Acute pancreatitis causes include alcoholism, gall stones and drugs, but rarely it can be caused by severe hypertriglyceridemia. Hypertriglyceridemia is usually multifactorial. The mechanism of hypertriglyceridemia may be due to genetic factors, increased production and/or impaired clearance of TRLP (Triglyceride-Rich Protein). Familial hypertriglyceridemia is an autosomal dominant disorder associated with moderate elevations in the serum triglyceride (200-500mg/dl). Pregnancy can cause an exponential rise in triglyceride levels (>1000mg/dl) in patients having mutations with the lipoprotein lipase gene. HIAP (Hypertriglyceridemia-Induced Acute Pancreatitis) accounts for 4% of all cases of acute pancreatitis in pregnancy. Though rare, hypertriglyceridemia-induced pancreatitis may lead to maternal and fetal complications. A multi-disciplinary team approach is very crucial as maternal and fetal needs must be addressed.

HTG (Hypertriglyceridemia) is one of the rare causes of acute pancreatitis in pregnancy. Hypertriglyceridemia in pregnancy is multifactorial; among them familial chylomicronemia syndrome is the most severe form.^[1]Delay in recognition and proper management, is associated with high maternal and fetal mortality rates.

As the duration of pregnancy increases the risk of pancreatitis associated with HTG also rises to 19% in first trimester, 26% in the 2^nd trimester, 53% in the 3^rd trimester, and 2% in the post-partum period.^[2]

Years Later, Vision Fades – Late Calcification of a Hydrophilic Acrylic Lens Explored

2026-06-30T07:11:00+00:00

PURPOSE

To report a case of late calcification of a hydrophilic acrylic IOL (Intraocular Lens) eight years after uncomplicated cataract surgery, highlighting its clinical presentation, management, and histopathological features.

CASE REPORT

A 54-year-old female presented with a three-year history of progressive, painless diminution of vision in the right eye. She had undergone bilateral cataract surgery eight years earlier, with no systemic comorbidities or additional ocular procedures. Best-corrected visual acuity (BCVA) was 2/60 in the right eye and 6/9 in the left eye. Slit-lamp examination revealed complete opacification of the right eye IOL with absent red reflex, while the left IOL was clear. Routine systemic investigations were normal.

RESULTS

The patient underwent right eye IOL exchange. A 6-mm scleral tunnel was created, and the opacified hydrophilic IOL was explanted intact. A rigid PMMA IOL was implanted in the capsular bag. Postoperatively, the patient was treated with topical corticosteroids, non-steroidal anti-inflammatory drugs, and intraocular pressure–lowering agents. On day one, BCVA improved to 6/9 in the operated eye. Histopathological analysis of the explanted IOL revealed calcium deposits on both anterior and posterior surfaces, consistent with late calcification.

CONCLUSION

Late IOL calcification is a rare but significant cause of postoperative visual decline, particularly with hydrophilic acrylic lenses. Diagnosis requires clinical suspicion and histopathological confirmation. Since no medical treatment is effective, the definitive management involves surgical explantation and exchange. Case documentation is essential to enhance understanding of risk factors and inform IOL material selection in cataract surgery.

Acute Pyelonephritis with Acute Kidney Injury Complicated by Pott’s Spine: Diagnostic and Therapeutic Considerations

2026-06-30T07:10:59+00:00

The development of acute kidney injury (AKI) in patients with acute pyelonephritis (APN) is relatively uncommon in the absence of structural urinary tract abnormalities or other known risk factors. With timely diagnosis and appropriate treatment, the condition is usually reversible and associated with a favorable renal outcome. This case report describes a 51-year-old male presenting with acute pyelonephritis (APN) associated with acute kidney injury (AKI) in the setting of underlying tuberculosis and the subsequent identification of Pott’s spine, highlighting the diagnostic complexity encountered in tuberculosis-endemic settings.

Acute pyelonephritis (APN) is a well-documented disease with a long clinical history. Although its earliest description dates back to ancient Egypt, where the destruction of kidney parenchyma was recognized, the nomenclature of APN remains controversial, leading to semantic ambiguities that may cause confusion.^[1] APN is a bacterial infection that causes inflammation of the kidney. Certain populations, including paediatric patients, renal transplant recipients, and pregnant women, require special attention due to their increased susceptibility to and risk of complications. Common symptoms of APN include fever, flank pain, nausea, vomiting, a burning sensation during urination, increased urinary frequency, and urinary urgency. Despite its prevalence, the incidence of APN varies across different countries. A Danish study reported an incidence of 6.8% in women and 2.7% in men affected by APN.^[2] Urinary tract infections (UTIs) occur more frequently in young, sexually active women, making them more susceptible to conditions such as acute pyelonephritis. In contrast, men often experience poorer outcomes and a higher risk of mortality, largely due to the presence of comorbidities including diabetes mellitus, renal calculi, chronic kidney disease, and older age.^[3,4] Pott disease, or spinal tuberculosis, is a form of extrapulmonary tuberculosis that primarily affects the vertebral column. If not diagnosed and treated promptly, it can lead to serious complications such as spinal cord compression, paraplegia, chronic back pain, joint involvement, and abscess formation.^[5] Among skeletal manifestations of tuberculosis, spinal involvement is the most common, accounting for nearly half of all cases. According to the World Health Organization (WHO), an estimated 10.4 million new tuberculosis cases were reported worldwide in 2016, with almost half occurring in the Southeast Asian region. India contributes a substantial proportion of the global tuberculosis burden, representing approximately 23% of all reported cases. Spinal tuberculosis typically arises from hematogenous dissemination of Mycobacterium tuberculosis from a primary focus, most often the lungs. Due to the vascular supply of the subchondral bone adjacent to the intervertebral disc, the paradiscal region is the site most frequently affected by vertebral tuberculosis.^[6] Acute pyelonephritis and Pott’s disease are two separate medical conditions; however, when they occur together, the clinical presentation may become complex and pose significant diagnostic difficulties, especially in regions where tuberculosis is highly prevalent. Determining whether these conditions are manifestations of disseminated tuberculosis or represent independent coexisting diseases requires thorough clinical, laboratory, and radiological evaluation. Prompt and accurate diagnosis is crucial to ensure timely management and to reduce the risk of adverse outcomes. Here, we report the case of a 51-year-old man who presented with acute pyelonephritis complicated by acute kidney injury (AKI), in whom concurrent Pott’s spine was also identified.