Malignant Insulinoma with Hepatoid Differentiation: A Unique Case with Alpha-Fetoprotein Production

Lam, Alfred King‐Yin; Lo, Chung‐Yau; Wat, M. S.; Fan, Sheung‐Tat

doi:10.1385/ep:12:3:351

Cited by 25 publications

(34 citation statements)

References 11 publications

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“…This is typical of HCC with noninsulinoma hypoglycemia, 9 but is occasionally observed in patients with malignant insulinomas. 13,14 Yet, in most patients with metastatic insulinoma, we did not observe similar elevations of AFP, thus the predicative value of AFP level is low. Elevations of human chorionic gonadotropin or its ␣ or ␤ subunits sometimes occur but have not proved to be a consistent indication of malignancy.…”

Section: Discussioncontrasting

confidence: 54%

Malignant insulinoma

Hirshberg

Cochran

Skarulis

et al. 2005

Cancer

146

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BACKGROUNDMalignant insulinoma occurs in a few patients with insulinoma. Due to the small sample of patients, there are little data regarding their clinical manifestation as well as the preferred treatment modalities. The aims of the current study were to summarize the National Institutes of Health experience during the last two decades and to conduct a critical review of the current literature.METHODSThe authors identified 10 patients with metastatic insulinoma.RESULTSThe patients presented with four patterns of clinical behavior. First, four patients presented with lymph node metastasis and, after surgical excision, maintained a prolonged tumor‐free survival. Second, four patients presented with metastatic disease to the liver, which appeared years after the initial diagnosis and presumed curative surgery. Third, one patient presented with a large α‐fetoprotein‐secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival. Various treatment modalities were used to control hypoglycemia. Short‐term benefits were most often achieved with embolization and diazoxide. Less successful modalities included radiofrequency ablation, radical debulking surgery, verapamil therapy, octreotide therapy, and chemotherapy.CONCLUSIONSThe current study, as well as others, suggested that metastatic insulinoma may have a variable natural history. After the initial surgical resection, the biology of the tumor, rather than any treatment modality, was most likely the major determinant of long‐term survival. Cancer 2005. © Published 2005 American Cancer Society.

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Section: Discussioncontrasting

confidence: 54%

Malignant insulinoma

Hirshberg

Cochran

Skarulis

et al. 2005

Cancer

146

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“…Of particular interest, 2 patients (9.1%) complained of clinical symptoms referable to a concomitant pancreatic neuroendocrine tumor (1 insulinoma and 1 glucagonoma, respectively), underlining the possible association of pancreatic HC with other pancreatic neoplasms. Elevated AFP serum levels might be present at time of diagnosis in all HCs, despite tumor primary site [7,8,11,12,28,29,30,31,32,33,34]. Our review of pancreatic forms indeed reports a rate of 54.5% (12 out of 22 cases), bearing in mind that 3 papers did not report or did not assess AFP levels of their cases.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 71%

“…The admixed were as follows: 4 cases with neuroendocrine carcinoma [25,26,30,45], 1 case associated with malignant glucagonoma [33], 1 with malignant insulinoma [28], 1 case with acinar [36] and 4 with ductal adenocarcinoma [33]. Cuilliere et al [46] documented the only reported case of a benign hepatocellular neoplasm arising in the pancreas, which was an encapsulated solid adenoma in the pancreas that showed exclusively hepatocellular differentiation.…”

Section: Discussion and Review Of The Literaturementioning

confidence: 99%

Pancreatic Hepatoid Carcinoma: A Review of the Literature

Marchegiani¹,

Gareer²,

Parisi

et al. 2013

Dig Surg

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Background: Hepatoid carcinomas (HCs) are extrahepatic neoplasms exhibiting features of hepatocellular tumors in terms of morphology and immunohistochemistry. They have been described in several organs, most notably in the stomach and ovary. They can present in pure forms or in association with other morphological aspects, such as endocrine tumors or ductal adenocarcinomas. The aim of this review is to describe aspects of hepatoid adenocarcinoma of the pancreas with regard to epidemiology, diagnosis, and treatment. Methods: The PubMed database was searched for publications addressing hepatoid adenocarcinoma of the pancreas. We have searched for articles including the following keywords: ‘pancreatic hepatoid carcinoma', ‘ectopic liver cancer' and ‘rare pancreas neoplasm' published to date. As references, we used case reports and review articles. Results: Pancreatic forms of HCs are extremely uncommon: only 22 cases have been reported. Conclusions: The possibility of an HC of the pancreas should be considered in the differential diagnosis of an uncommon pathological mass of the pancreas. Treatment seems to be related to the association with other neoplasms, tumor extension at the time of diagnosis and the possibility to perform a radical resection. The common embryologic origin of the pancreas and liver, together with peculiar environmental factors, may explain the development of pancreatic HCs.

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“…In the literature, one case with malignant glucagonoma, one with malignant insulinoma, and three with neuroendocrine carcinoma have been reported. (2,3,(13)(14)(15) The neuroendocrine components in these cases were all intermingled intimately with hepatoid areas. In contrast, our case contained two separate lesions exhibiting different morphological and immunohistochemical profiles.…”

Section: Discussionmentioning

confidence: 89%

Hepatoid microcarcinoma of the pancreas: A case report and review of the literature

Huang¹,

Chang²,

Yeh³

et al. 2012

Biomed J

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Hepatoid differentiation in pancreatic carcinoma is a rare phenomenon. It occurs either as a pure form or as a component with other subtypes. Herein, we report a 52-year-old man with an ampullary large cell neuroendocrine carcinoma presenting with obstructive jaundice for 2 months. A 0.5-cm nodule was found in the pancreatic head. Morphologically, the nodule was composed of exclusively hepatocytic tumor cells and sinusoids with dysplastic cytology and capsular invasion. The patient did not have a hepatic mass or ectopic normal liver tissue. This is the first reported case of ampullary large cell neuroendocrine carcinoma coinciding with a pancreatic hepatoid microcarcinoma. The clinicopathological features of pancreatic hepatoid carcinomas and their histogenesis are discussed. (Chang Gung Med J 2012;35:285-91)

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Malignant Insulinoma with Hepatoid Differentiation: A Unique Case with Alpha-Fetoprotein Production

Cited by 25 publications

References 11 publications

Malignant insulinoma

Malignant insulinoma

Pancreatic Hepatoid Carcinoma: A Review of the Literature

Hepatoid microcarcinoma of the pancreas: A case report and review of the literature

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