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Diffuse steatonecrosis secondary to acute / gangrenous pancreatitis presenting as vague abdominal mass is difficult to diagnose and requires special method / techniques for demonstration of fatty acid crystalloids. We report a case of acute abdomen with palpable lump. On emergency exploratory laprotomy a large thick jumbled up omental mass was revealed adhered to parietal wall along with complete pancreatic necrosis. Biopsy show diffuse fat necrosis of pericolic fat, omentum / mesentry with involvement of gut submucosa and birefringent saponified fatty acid crystalloids were demonstrated. Steatonecrosis may cause diagnostic dilemma and should be considered as differential diagnosis in appropriate clinical setting.

Gastrointestinal stromal tumor is biologically heterogeneous in both morphological appearance and clinical behavior. Immunohistochemical analysis and literature review was done to explore the necessity of mutation study. We present a case study of a 40 year old male presented with upper abdominal lump, exploratory laprotomy done and a large cystic mass involving transverse colon, omentum, stomach along with gross hemoperitoneum was found. Ruptured large cystic tumor mass measuring 19X16 cms was received for histopathological examination. Grossely the cystic mass show variegated outer nodular surface with attached piece of stomach and a segment of colon. Bright field microscopy show striking perivascular arrangement of tumor cells and geographical necrosis and the report signed out as undifferentiated carcinoma stomach. Battery of immunohistochemical markers was done. Tumor cells displayed diffuse positivity for CD117, DOG1, and pan-CK along with more than focal positivity for CD34 and negative for SMA, desmin, S-100, synaptophysin, chromogranin, Bcl-2, Ki-67. Tumor turned out to be Cytokeratin positive epithelioid gastric GIST. Cytokeratins may be expressed in high grade GISTs rarely and CK positive GISTs must be differentiated from carcinomas, melanomas and a range of CK-positive sarcomas. A panel of immunohistochemistry markers is required for diagnosis and prognostication of the tumor.