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Abstract: Malignant retroperitoneal fibrosis can be associated with variable kinds of cancers. But, malignant retroperitoneal fibrosis with gallbladder carcinoma has been rarely reported. Here we present a case report of malignant retroperitoneal fibrosis with gallbladder adenocarcinoma, causing bilateral ureteral obstruction, duodenal obstruction, and narrowing of inferior vena cava. [Copyright &y& Elsevier]

Abstract: Signet ring cell carcinoma of the gallbladder is a rare variant of adenocarcinoma of the gallbladder. CT findings of signet ring cell carcinoma have been rarely reported. However, to our knowledge, signet ring cell carcinoma of the gallbladder with intramural tumoral calcifications has not been reported. Here, we present a case of mucin-producing signet ring cell carcinoma of the gallbladder which appeared as low attenuated diffuse gallbladder wall thickening with intramural calcifications and metastatic conglomerated lymphadenopathy. [Copyright &y& Elsevier]

Abstract: Undifferentiated carcinoma of the liver is very rare. Undifferentiated carcinomas with osteoclast-like giant cells or neuroendocrine features have been reported. As far as we know, undifferentiated carcinoma of the liver with extensive choriocarcinoma component has not been reported. Here we present a case report of undifferentiated carcinoma of the liver with extensive choriocarcinoma component in an old man. US and multiphasic contrast-enhanced CT showed a heterogenous hypovascular mass in spite of the extensive choriocarcinoma component, probably due to necrosis and poorly differentiated portion of the tumor. [Copyright &y& Elsevier]

Abstract: Purpose: The purpose of this retrospective study was to determine what gives rise to the periportal free air, and ligamentum teres and falciform ligament signs on CT in patients with gastrointestinal (GI) tract perforation, and whether these specific air distributions can play a clinically meaningful role in the diagnosis of gastroduodenal perforation. Material and methods: Ninety-three patients who underwent a diagnostic CT scan before laparotomy for a GI tract perforation were included. The readers assessed the presence of specific air distributions on CT (periportal free air, and ligamentum teres and falciform ligament signs). The readers also assessed the presence of strong predictors of gastroduodenal perforation (focal defects in the stomach and duodenal bulb wall, concentrated extraluminal air bubbles in close proximity to the stomach and duodenal bulb, and wall thickening at the stomach and duodenal bulb). The specific air distributions were assessed according to perforation sites, and the elapsed time and amount of free air, and then compared with the strong predictors of gastroduodenal perforation by using statistical analysis. Results: All specific air distributions were more frequently present in patients with gastroduodenal perforation than lower GI tract perforation, but only the falciform ligament sign was statistically significant (p <0.05). The presence of all three specific air distributions was demonstrated in only 13 (20.6%) of 63 patients with gastroduodenal perforation. Regardless of the perforation sites, the falciform ligament sign was present significantly more frequently with an increase in the amount of free air on multiple logistic regression analysis (adjusted odds ratio, 1.29; p <0.001). The sensitivity, specificity, accuracy, and positive predictive and negative predictive values of each strong predictor for the diagnosis of gastroduodenal perforation were higher than those of specific air distributions. The focal wall thickening (accuracy, 95.7%) was the most useful parameter for the diagnosis of gastroduodenal perforation. Conclusion: The prediction of the perforation site of the GI tract on CT should be based on the presence of strong predictors of the site of bowel perforation, and the specific free air distribution should be regarded as complementary predictors. [Copyright &y& Elsevier]