We report a rare case of INH-resistant tuberculosis developing two years after INH monotherapy for latent tuberculosis infection（LTBI）．The patient was in the mid-forties, working as a medical technologist specializing in pathology. He was exposed to Mycobacterium tuberculosis when he conducted autopsy of a tuberculosis patient. Three months later he became positive for interferon-gamma release assay and received INH monotherapy for six months to treat LTBI. During the course of treatment no tuberculous lesion was observed by chest CT.

Two and half years after the diagnosis of LTBI, abnormal shadows were noted on chest radiograph in regular check-up. Sputum smears were positive for Mycobacterium, and PCR for tuberculosis was positive. He was hospitalized to Yamaguchi-Ube Medical Center to start chemotherapy with INH, PZA, RFP and EB. Although there was no side effect, his Mycobacterium tuberculosis was found to be resistant to INH, SM, and PAS by drug sensitivity test. After leaving hospital, he was treated with RFP and EB for 9 months until completion of treatment. Since then, no recurrence was noted. Thus, when considering treatment for LTBI, it is important to check the regimen for the person who have caused LTBI and the drug sensitivity of the source of LTBI.

A 80-year-old woman was admitted to another hospital because of a right breast tumor about 5 years ago. She received muscle preserving partial mastectomy of the right breast and axillary lymph node dissection. The pathological diagnosis revealed papillotubular carcinoma of the right breast（pT2N1M0：p-stageⅡB, HER2-R（1+），ER1+<10%, PgR-）．She had been administered anastorozole after the surgery, but CT revealed lung metastases and bilateral axillary lymph node metastases 2 years after the surgery. 7 monthes later, these metastases were getting progress in size, so the medicine was changed from anastrozole to capecitabine.

3 years and 4 monthes after the surgery, a local recurrence of the breast was found and was considered to have rapid progression, so she visited our hospital December in 2014. Though there were multiple lung metastases and multiple lymph nodes in PET/CT, we considered these metastases as non life treadning disease.

We performed a right modified radical mastectomy January in 2015. Histlogically the tumor was mixed squamous cell carcinoma and papillotubular carcinoma of the breast. There were over lying epidermis between squamous cell carcinoma and papillotubular carcinoma.

It suggested the possibility that squamous cell carcinoma occurred in de novo pattern in this case. With good clinical course, the patient discharged on 14 post operative day. S-1 was administered, but was withdrawn after 1 month due to severe nausea, so we are observing her carefully without chemotherapy.

We had better consider the squamous cell carcinoma when the patient have a local recurrent mass with rapid growth in size.

Cystic Artery Pseudoaneurysm of the Gallbladder（CAPG）is rare disease, and Japanese journals reported only 13 cases in the past. We report the case of a 59-year-old Japanese man, complicated CAPG with acute cholecystitis on January 2015. The patient was referred by his private doctor because of experienced melena, and he was diagnosed cholecystitis and anemia. An abdominal computed tomography（CT）scan clearly revealed a cystic mass about 3.0cm in diameter in the neck of gallbladder. We diagnosed that his melena was cause of bleeding from the gallbladder with CAPG. During the hospitalization, he received blood transfusions and antibiotics, while after 5days, his total bilirubin level was up to 3.4mg/dl. We suspected obstructive icterus resulting from hematoma in biliary tract, and inserted a pigtail catheter to biliary tract. Since then, his total bilirubin level returned rapidly to normal. On the 8th day from hospitalization, we operated cholecystectomy. Pathological examination revealed cholecystitis and fibrotic hematoma. We diagnosed CAPG derived from severe cholecystitis. Although CAPG is rare disease, it should be considered in cases with hematemesis and melena.