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A 36-year-old man who complained of epigastric pain was transferred to the emergency room. We performed contrast enhanced computed tomography (CT) but were unable to confirm a diagnosis at that time. Because this patient had symptoms of gallbladder inflammation following hospitalization, we reviewed the CT images. We found luminal obstruction between the celiac artery and proper hepatic artery due to celiac artery dissection in the images. Gangrenous cholecystitis was suspected based on the findings;therefore, the patient underwent emergency cholecystectomy. To the best of our knowledge, there are only a few reports on cases with celiac artery dissection and none of those with acalculous gangrenous cholecystitis. Here, we report an exceptionally rare case with celiac artery dissection.

A liver tumor 35 mm in diameter was found incidentally in a 40-year-old woman who had no history of liver diseases or the use of oral contraceptives. Radiological diagnostics showed the typical findings of liver cell adenoma (LCA). Dynamic computed tomography revealed that the tumor showed a homogenous enhancement in the arterial phase and almost the same enhancement as the surrounding liver parenchyma in the delayed phase. The tumor was found to contain fat on magnetic resonance imaging. A benign fat containing liver tumor was suggested. However, radiological findings altered, which caused us to suspect that a well-differentiated hepatocellular carcinoma (HCC) containing fat was becoming dedifferentiated. Partial hepatectomy was performed and the pathological findings showed the typical findings of LCA. This case was an extremely rare LCA, which had no background of risk for LCA and developed the sequential alteration of the radiological findings to suspect well-differentiated HCC.

Here we report a rare case with perforation of gastric cancer responding to chemotherapy. The patient was a 74- year-old male who underwent abdominal ultrasonography and contrast CT because of body-weight lost and poor appetite in June, 2004 and whose lymph node(LN)swelling was seen in the level from the hepatic to the renal hilum. A gastric wall irregularity was also seen. We suspected gastric cancer with LN metastasis and carried out upper gastrointestinal endoscopy. Then it demonstrated type 2 advanced gastric cancer from the upper to the middle body. The pathological diagnosis of gastric tumor was poorly-differentiated adenocarcinoma containing por 2, tub 1, and pap. The patient was treated with S-1, CDDP and CPT-11 and remained ambulant. After completion of 1 course of chemotherapy, he complained of intense abdominal pain, so we carried out upper gastrointestinal endoscopy and found perforation in the stomach at the same location as the gastric cancer. Emergency total gastrectomy was performed at once. The histopathological finding showed disappearance of the cancer cell not only in the stomach but also accessory LN. Because the remnant LN metastasis was seen in the hepatic hilum at abdominal contrast CT after operation, S-1 was administered to the patient as 60 mg/m2/day in ambulant. Now, over 40 months after the operation, the patient has been alive with good performance status and disappearance of LN metastasis.