Insulinoma with Subsequent Association of Zollinger-Ellison Syndrome.

Abstract

Wereport a patient with insulinoma associated with Zollinger-Ellison syndrome. A67-year-old womanwas first admitted to our hospital for an abdominal mass. Abdominal computed tomography (CT) revealed a large pancreatic tumor, which was then diagnosed as an unresectable pancreatic adenocarcinoma. At the age of 71, she presented symptoms of hypoglycemia. Fasting blood glucose was 21 mg/dl and plasma immunoreactive insulin level was 846 (xU/ ml. Plasma gastrin, glucagon, vasoactive intestinal polypeptide and somatostatin levels were all normal. At the age of 73, hypoglycemic attacks occurred more frequently and she was admitted to our hospital. Abdominal CTscan showed multiple liver metastases. Chemotherapy with 5-fluorouracil and doxorubicin was performed. Three months later, she had an emergency laparotomy because of a perforated duodenal ulcer. Plasma gastrin level was 1,960 pg/ml at that time. Gastric hypersecretion was well controlled with a proton pump inhibitor (lansoprazole) but she died of widespread cancer dissemination 8 years after her first admission. Onautopsy, histologic examination revealed a mixed acinar-endocrine carcinoma of the pancreas. Immunohistochemical stains were positive for insulin, gastrin, and axantitrypsin. (Internal Medicine 40: 386-390, 2001)

A case of malignant insulinoma: successful control of glycemic fluctuation by replacing octreotide injections with octreotide LAR injections

“…In general, insulin and gastrin are rarely secreted from the same tumor simultaneously as we observed in this patient, although the combination of insulinoma and gastrinoma in 1 individual has been reported in multiple endocrine neoplasia type 1 cases which account for approximately 6 to 8 % of all insulinomas [5,18,19].…”

Pancreatic mixed acinar‐neuroendocrine carcinoma, a unique diagnostic challenge on FNA cytology: A small series of two cases with literature review

“…Our search of the English‐language literature yielded 44 (including our own) well‐documented cases of MANEC (see Supporting Information, Table). Patient age ranged from 6 to 89 years; excluding the pediatric outlier, the average age was 60.5 years. The male to female ratio was 1.75:1, and no clear predilection in primary tumor location was identified.…”

“…The male to female ratio was 1.75:1, and no clear predilection in primary tumor location was identified. The liver was the most common site of metastasis (19 of 44), with distant or disseminated metastases occurring in eight of these cases . A Kaplan–Meier plot based on the available reported follow‐up data (see Supporting Information, Figure) gives a median overall survival of 17 months (Microsoft Excel).…”

Mixed acinar-endocrine carcinoma of pancreas: a case report and brief review of the literature

“…In fact, the variable clinical behaviors of MAEC of the pancreas lack a reliable indicator so that we can detect the tumor early. In addition, all patients but one who presented with Zollinger-Ellison syndrome 12 did not exhibit hormone excess syndrome. Jaundice is relatively uncommon since MAEC is a well-circumscribed tumor and rarely invades surrounding tissue like the common bile duct, which could also be found in ACC.…”