Acute Acalculous Cholecystitis associated with Cystic Duct Cancer Diagnosed after Endoscopic Ultrasonography

We present an interesting case of acute acalculous cholecystitis which was diagnosed as cystic duct cancer after endoscopic ultrasonography (EUS). A 63-year-old man visited to an emergency room (ER) because of right upper quadrant (RUQ) abdominal pain. The patient had fever up to 38.2℃ and tenderness at RUQ abdomen. The Murphy’s sign was positive. Laboratory tests showed elevated white blood cell count and abnormal liver function test. The computed tomography scan revealed a distended gallbladder with inflammation without gallstone. Emergent gallbladder drainage was performed at ER. The cholecystogram via percutaneous tube and EUS revealed hypoechoic intraluminal mass at cystic duct. Laparoscopic cholecystectomy was performed at first, and the frozen pathologic examination revealed adenocarcinoma in the cystic duct. The extended cholecystectomy was performed after a month and there was no residual tumor in the liver bed and lymph nodes. The final staging of GBC was revealed as pT2N0M0.