title: Acute acalculous cholecystitis due to breast cancer metastasis to the cystic duct.
abstract: BACKGROUND
  Acute acalculous cholecystitis (AAC) is a relatively rare disorder of the gallbladder. Breast cancer recurrence more than 10 years after curative surgery is also infrequent.
  
  
  METHODS
  Here, we report a case of a 59-year-old woman who presented with right flank pain. Her medical history included a lumpectomy for cancer of the left breast 12 years prior. Laboratory tests showed a severe inflammatory reaction and mild liver function abnormalities. Ultrasonography and computed tomography revealed an enlarged gallbladder and inflammation of the surrounding tissues; however, no gallstone was present. She was diagnosed with AAC. We performed an emergency laparoscopic cholecystectomy, and histopathological examination revealed a poorly differentiated adenocarcinoma in the cystic duct. Both metastatic and primary tumor cells were positive for estrogen and progesterone receptors on immunohistochemistry. The final pathological diagnosis was acute cholecystitis due to breast cancer metastasis to the cystic duct.
  
  
  CONCLUSIONS
  Although AAC secondary to metastatic breast cancer is rare, it should be included in the differential diagnosis for abdominal pain in patients with a previous history of breast cancer.
authors.affiliation: Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan. oita521@yahoo.co.jp.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Hashimoto
authors.affiliation: Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Koide
authors.affiliation: Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
authors.forename: Michinori
authors.initials: M
authors.lastname: Arita
authors.affiliation: Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Kawaguchi
authors.affiliation: Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
authors.forename: Masakazu
authors.initials: M
authors.lastname: Tokunaga
authors.affiliation: Department of Surgery, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mikuriya
authors.affiliation: Department of Pathology, Chuden Hospital, 3-4-27 Otemachi, Naka-Ku, Hiroshima, 730-8562, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Iwamoto
keywords: Acute cholecystitis; Biliary metastasis; Breast cancer; Late recurrence