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Abstract
Malignant insulinomas are very rare endocrine tumours with a variable clinical course. Here, a case of a malignant insulinoma, resected from the tail of the pancreas 10 years previously, which was found to have hepatic metastasis, is reported. A pancreatic mass, without evidence of metastasis, has been found using an abdominal CT scan and intra-operative ultrasonography 10 years previously. Recently, the patient has suffered from dizziness, sweating and an altered mentality. Hyperinsulinemia was diagnosed from the biochemical laboratory finding. An abdominal CT scan and intra-operative abdominal sonography showed multiple hepatic metastasis, without local recurrence in pancreas. Therefore, a partial hepatic segmentectomy was performed. Immunohistochemical staining of the postoperative specimen was strongly positive for insulin. The postoperative biochemical response was normalized, and the patient experienced no further hypoglycemic symptom.
Figures and Tables
Fig. 1
72 hours-fasting test after 75 g oral glucose loading. (A) 10 years ago. (B) The recent result.
Fig. 2
Abdominal CT shows two bull's eye masses in the liver with central arterial enhancement and peripheral thick ring in right anterior and left lateral segment (arrows in A and B). There was no abnormal mass in the pancreas (C).
Fig. 3
Somatostatin scintigraphy shows normal uptake of liver, kidneys, large intestine at 24 hour image. Hepatic masses at abdominal CT were not synchronized with uptake of liver at scintigraphy.
Fig. 4
The gross pathologic finding of the malignant insulinoma metastasized to the liver. The one tumor measuring 2.2 × 2 × 1.5 cm is located in the resected liver.
Fig. 5
(A) Section discloses portions of liver showing two foci of islet cell tumor with satellite nodules of microscopic sizes (arrow). Liver parenchyme shows mild fatty change and chronic inflammatory cell infiltration. (B)-(D) Sections disclose portions of liver showing islet cell tumor with positive immunohistochemical stain of insulin (B), Chromograninin (C), and Synaptophysin (D).
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