[A case of acalculous gangrenous cholecystitis due to artery dissection].

A 62-year-old male presented with right intercostal muscle pain. Clinical examination revealed muscular defense in the same area. Abdominal ultrasonography revealed a distended gallbladder and ascites effusion, but no gallstones or polyps were present. Contrast-enhanced computerized tomography was performed, which revealed luminal obstruction due to arterial dissection of the celiac artery and intrinsic hepatic artery. This finding suggested gangrenous cholecystitis; thus, urgent cholecystectomy was performed. Only a few cases of celiac artery dissection and only one case of gangrenous cholecystitis without stones have been reported. We report here an extremely rare case of celiac artery dissection.

Long-term survival after surgical resection of liver metastasis from lung cancer.

Lung cancer metastasis to the liver indicates a poor prognosis, and the majority of patients with metastatic disease to the liver are not indicated for surgery because of the number or distribution of metastases or the presence of extrahepatic disease. We herein describe a case of long-term survival after a surgical resection of liver metastases from lung cancer. Six months after surgery for Stage IB primary lung adenocarcinoma, a 71-year-old male was found to have a metastatic tumor in his liver. A hepatic resection for the metastatic tumor and another small metastatic foci found intraoperatively was carried out, and the tumors were pathologically diagnosed as liver metastases from lung cancer. The patient is presently alive and well without recurrence, as of 5 years and 2 months after the liver resection. This is the first report of the successful surgical treatment of liver metastasis from lung cancer.

Visceral pleural involvement in nonsmall cell lung cancer: prognostic significance.

BACKGROUND: A tumor of any size that invades the visceral pleura is classified in the T2 category; however, the definition of the visceral pleural involvement has remained somewhat ambiguous. It is unclear whether the T2 category includes the p2 status alone or incorporates the extent of the p1 status. METHODS: We retrospectively analyzed the survival of 474 patients with T1 and T2 nonsmall cell lung cancer to evaluate the influence of the degree of visceral pleural involvement (p0, p1, and p2) on the prognosis and to clarify the definition of the visceral pleural involvement. RESULTS: The 5-year survival rates according to the degree of visceral pleural involvement were 68.0% in p0 (n = 345), 43.9% in p1 (n = 110), and 54.9% in p2 (n = 19; p0 versus p1, p = 0.0004; p0 versus p2, p = 0.013; and p1 versus p2, p = 0.61). The degree of visceral pleural involvement (p0 versus p1/p2) was a significant independent prognostic factor from tumor size and lymph node involvement, by multivariate analysis (relative risk = 1.47, p = 0.033). The prognosis of pN0 patients with p1 and tumor size 3 cm or less was significantly poorer than that of those with p0 and tumor size 3 cm or less (p = 0.0004), and the prognosis of patients with p1 and tumor size more than 3 cm was significantly poorer than that of those with p0 and tumor size more than 3 cm (p = 0.024). CONCLUSIONS: The degree of visceral pleural involvement (p0 versus p1/p2) is an important component of the lung cancer staging system. Tumors with p1 and p2 status should be regarded as representing visceral pleural involvement and T2 disease.