The percentile volumes VA, VB and VD of A, B and D cells in the islets of Langerhans were histometrically estimated in the pancreases from 59 autopsy cases including maturity-and growth-onset diabetics and nondiabetics.Volumetry was performed microscopically by point counting method using a square-lattice eyepiece, then the total A, B and D cell volumes VA, VB and VD were calculated from the total islet volume V; of the pancreas estimated separately.The measurement disclosed a prominent difference in VB between the three groups. Namely, it was only 0.156 and 0.388 cm3 in the growth-and maturity-onset diabetics, much smaller values than 0.636 cm3 in nondiabetics.The simultaneous investigation on clinical records revealed a negative correlation between VB and the maximum blood sugar level during GTT, showing that VB reflects grossly the degree of glucose tolerance of the individual.The smaller VB in diabetes was attributed to the diminution of V, because VA, VB and VD were almost the same regardless of the presence or absence of diabetes.These results strongly suggested a failure of insulin produc tion in diabetes due to quantitative deficiency of B cells. pancreatic islets; A, B and D cells; volumetry; diabetes mellitus In our foregoing paper, diabetic cases were subjected to islet morphometry, in which the results were interpreted in relation to some of the important clinical data (Saito et al. 1978b). Among several morphological indices examined, the total islet volume of the pancreas revealed special functional significance, reflecting glucose tolerance in individual cases. We have further to examine whether or not the insular cell composition undergoes a considerable change in diabetes mellitus.It has been stated by many authors, on a morphometrical basis, that the numerical ratio of B to A cells was smaller in diabetes than in control, causing an absolute reduction of B cells in the former (Maclean and Ogilvie 1955;Gepts 1958). Practically, however, it seems rather awkward to count exactly the number of cells on islet sections. When one observes a group of B cell sections, for example, strict determination of the boundaries for individual cell sections appears

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AKIRA OHNEDA, MASAO OTSUKI, HIROSHI FUJIYA, NOBUHISA YAGINUMA, TAKESHI KOKUBO, AND HARUO OHTANI SUMMARY A 55-yr-old man was admitted to the Hospital of Tohoku University in 1970, when physical examination and laboratory findings revealed malignant insulinoma with metastases to the liver. Streptozotocin treatment, totaling 79.5 g for 1 yr, improved his clinical symptoms. After discharge he was well until 1977, when he complained of palpitation and dyspnea, and he was hospitalized in September 1977 because of anorexia and a loss of body weight. Laboratory findings revealed anemia, with a decrease both in serum albumin and iron. His fasting blood glucose was 74 mg/dl and plasma insulin (IRI) 25 ^U/ml. His plasma IRI increased slightly after the stimuli of glucose, arginine, and glucagon. In contrast, his plasma glucagon (IRG) increased at fasting (3372 pg/ml) and became markedly elevated after arginine or glucose was administered. After his final admission, diazoxide improved his symptoms temporarily; streptozotocin could not be administered because of dyspnea and palpitation. On 24 January 1978, he fell suddenly into a coma and 2 days later he died. An autopsy revealed a large pancreatic tumor and metastases to the liver. Measurement of hormones from the tissues revealed a smaller amount of IRI in the pancreatic tumor and liver metastases compared with that in the uninvolved pancreas. In contrast, IRG contents had increased in the pancreatic tumor and hepatic metastases. In addition to the insulin cells, numerous cells with glucagon and somatostatin were observed in morphologic examinations. This indicated a mixed endocrine pancreatic tumor exhibiting typical symptoms of insulinoma initially and a glucagonoma syndrome later. DIABETES 28:962-969, November 1979.