Mixed adenoneuroendocrine carcinoma (MANEC) of the biliary tract is rare. Here, the authors report a case of MANEC of the gallbladder, in which neuroendocrine carcinoma (NEC) exhibited collision and sharp separation from a moderately differentiated adenocarcinoma; these two tumor components made up of more than 30% of the entire tumor, respectively. The tumor metastasized to liver and one lymph node, and the hepatic metastatic component was from an neuroendocrine tumor (NET), while the lymphovascular invasion and lymph node metastasis was attributed to adenocarcinoma. Ki-67 im-munostaining (>50%) and numerous mitotic counts showed the NET exhibited high proliferative activity. Because the neuroendocrine component in biliary MANEC defines prognosis, its identification is of considerable importance.

The purpose of this study is to evaluate the changes of liver and gallbladder in patients with acute hepatitis A during transabdominal ultrasonography (US). In this study, we included 61 patients with acute hepatitis A and 50 controls. Wall thickness and lumen diameter of gallbladder were measured for determined the mural edema and hypertonicity of gallbladder. To evaluate the hepatic size and stiffness, two sagittal images of the left lobe of the liver were obtained during the resting state (resting image) and at full inspiration (stress image). The elongation rate was calculated by a formula: (L2-L1/L1)×100 (%); where L1 and L2 are the length of the liver for both the resting and stress image. The elongation rate was compared between controls and patients with acute hepatitis A. The wall thickness and lumen diameter of gallbladder were 7.0±3.5mm, 10.2±9.9mm, respectively. In 21 cases (34%), the lumen of gallbladder was collapsed. The mean diameter of left lobe in patients with acute hepatitis A (10.3±1.4cm)was larger than that of controls (8.2±1.1cm). The elongation rate in patients with acute hepatitis A (8.0±8.8%) was smaller than that of controls (25.5±13.4%). Robust US findings in patients with acute hepatitis A were edematous gallbladder with collapse and hepatomegaly with stiffness.

A 56 year-old women with a history of breast cancer underwent Tc-99m Hydroxymethylene Diphosphonate (HDP) bone scintigraphy at an annual follow-up, and abnormal focal uptake was observed in the right upper abdomen. However, subsequent single photon emission computed tomography/computed tomography (SPECT/CT) successfully delineated the uptake in a normal gallbladder. It was concluded that the abnormality had been caused by unusual Tc-99m HDP excretion and not by a metastatic lesion. Follow-up studies confirmed this diagnosis. This case demonstrates the usefulness of SPECT/CT in patients with unusual gallbladder uptake by bone scintigraphy.

Kaposi's sarcoma is a lympho-angioproliferative disease that primarily affects the skin and subcutaneous tissues. Most importantly, Kaposi’s sarcoma occurs in the immunocompromised, especially AIDS patients and organ transplant recipients being treated with immunosuppressants. The occurrence of classic Kaposi’s sarcoma after the diagnosis of any primary solid tumor has rarely been reported. We experienced a 70-year-old man, who had received surgery and chemoradiotherapy for the treatment of primary gallbladder cancer, that developed multiple tender deep purple papules on his trunk, back and feet which were proven to be pathologic symptoms of Kaposi’s sarcoma.