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A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features

Malignant insulinoma in the beta cells of the pancreatic islet is rare and usually presented as hypoglycemia. We report a case of large malignant insulinoma in a 53-year-old Korean woman. A presumptive clinical diagnosis was made before surgery, based on the high plasma insulin-to-glucose ratio and...

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Autores principales: Lee, Chang Hwa, Lee, Goo, Kim, Dong Hoon, Kim, Nam, Kim, Sung Ja, Lee, Chang Woo, Song, Kuk Hyun
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Association of Internal Medicine 2003
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531604/
https://www.ncbi.nlm.nih.gov/pubmed/12760268
http://dx.doi.org/10.3904/kjim.2003.18.1.45
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author Lee, Chang Hwa
Lee, Goo
Kim, Dong Hoon
Kim, Nam
Kim, Sung Ja
Lee, Chang Woo
Song, Kuk Hyun
author_facet Lee, Chang Hwa
Lee, Goo
Kim, Dong Hoon
Kim, Nam
Kim, Sung Ja
Lee, Chang Woo
Song, Kuk Hyun
author_sort Lee, Chang Hwa
collection PubMed
description Malignant insulinoma in the beta cells of the pancreatic islet is rare and usually presented as hypoglycemia. We report a case of large malignant insulinoma in a 53-year-old Korean woman. A presumptive clinical diagnosis was made before surgery, based on the high plasma insulin-to-glucose ratio and a large solitary heterogeneous pancreatic mass by abdominal computed tomography and endosonography. The tumor measured 5.8×4.7×4.5 cm in dimension and showed capsular invasions and metastases in two of four peripancreatic lymph nodes. The tumor cells were strongly immunoreactive to insulin and had a high Ki-67 labeling index (13%) and atypical membranous electron-dense granules, ranging from 120 to 400 nm in diameter, in the cytoplasm on electron microscopy. The patient was treated by distal pancreatectomy with splenectomy and rapidly recovered without neurohypoglycemic symptoms. This case showed not only lymph node metastases, the most reliable parameter for malignancy in pancreatic endocrine tumors, but also other valid diagnostic clues, such as high Ki-67 labeling index, heterogeneous enodosonographic findings, capsular invasions with large tumor and pure atypical secretory granules.
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spelling pubmed-45316042015-10-02 A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features Lee, Chang Hwa Lee, Goo Kim, Dong Hoon Kim, Nam Kim, Sung Ja Lee, Chang Woo Song, Kuk Hyun Korean J Intern Med Case Report Malignant insulinoma in the beta cells of the pancreatic islet is rare and usually presented as hypoglycemia. We report a case of large malignant insulinoma in a 53-year-old Korean woman. A presumptive clinical diagnosis was made before surgery, based on the high plasma insulin-to-glucose ratio and a large solitary heterogeneous pancreatic mass by abdominal computed tomography and endosonography. The tumor measured 5.8×4.7×4.5 cm in dimension and showed capsular invasions and metastases in two of four peripancreatic lymph nodes. The tumor cells were strongly immunoreactive to insulin and had a high Ki-67 labeling index (13%) and atypical membranous electron-dense granules, ranging from 120 to 400 nm in diameter, in the cytoplasm on electron microscopy. The patient was treated by distal pancreatectomy with splenectomy and rapidly recovered without neurohypoglycemic symptoms. This case showed not only lymph node metastases, the most reliable parameter for malignancy in pancreatic endocrine tumors, but also other valid diagnostic clues, such as high Ki-67 labeling index, heterogeneous enodosonographic findings, capsular invasions with large tumor and pure atypical secretory granules. Korean Association of Internal Medicine 2003-03 /pmc/articles/PMC4531604/ /pubmed/12760268 http://dx.doi.org/10.3904/kjim.2003.18.1.45 Text en Copyright © 2003 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Lee, Chang Hwa
Lee, Goo
Kim, Dong Hoon
Kim, Nam
Kim, Sung Ja
Lee, Chang Woo
Song, Kuk Hyun
A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features
title A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features
title_full A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features
title_fullStr A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features
title_full_unstemmed A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features
title_short A Large Malignant Insulinoma: Case Report with Endosonographic, Immunohistochemical and Ultrastructural Features
title_sort large malignant insulinoma: case report with endosonographic, immunohistochemical and ultrastructural features
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4531604/
https://www.ncbi.nlm.nih.gov/pubmed/12760268
http://dx.doi.org/10.3904/kjim.2003.18.1.45
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