Gastrointestinal stromal tumors (GIST) are a rare and unique group of mesenchymal tumors arising from the gastrointestinal tract, omentum, mesentery, and retroperitoneum. Though they have certain typical radiological features that can differentiate them from epithelial tumors, it is often difficult to differentiate them from other non-epithelial tumors. Their features also vary depending on their size, site of origin, etc. When differentiation from other mesenchymal tumors on histopathology is difficult, receptor tyrosine kinase (C-KIT proto-oncogene/CD117) and gastrointestinal stromal tumor (GIST-1) discovered on GIST1 (DOG-1) expression are confirmatory. The concurrent presence of other primary cancers with GISTs has been described in the literature, among which most have been of gastrointestinal origin. Few cases of primary breast cancer in GIST have been described. Lymph nodal metastasis is rarely encountered in GIST, and metastasis to the breast is even rarer. We present a case of a 39-year-old female with non-specific symptoms who was referred for ultrasonography (USG) and computed tomography (CT) that showed a small intestinal GIST along with a breast lump and axillary lymphadenopathy that were labeled as metastases from the GIST on frozen sections; however, they were later diagnosed as primary breast cancer with axillary metastases on the histopathology and immunohistochemistry of the excision biopsy specimens postsurgery. The patient underwent surgical resection and chemotherapy.
Rib caries with a cold abscess is a rare presentation of tuberculosis (TB) and is tricky to diagnose. It is rarer in young patients, especially in conjunction with active miliary TB. We present one such case of a 23-yearold male patient who presented with swelling over the left lower chest. Rib caries and cold abscess were initially detected by ultrasonography and elastography. The rib involvement and the extent of the cold abscess were further evaluated on a computed tomography scan, which also showed active pulmonary miliary TB. The patient was treated by aspiration of the cold abscess and anti-tuberculosis therapy. The fact that the patient had no history of diabetes, alcoholism, human immunodeficiency virus infection, or immunodeficiency disorder increases the rarity of this case. This case highlights the role of imaging in diagnosing rib caries, cold abscess, and miliary TB.
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