Case report of a recurrent resected glucagonoma

INTRODUCTION AND IMPORTANCE: Glucagonoma is a rare neuroendocrine tumor (NET). Most glucagonomas are in the tail or body of the pancreas and are diagnosed at a metastatic stage. We report a case of an early recurrence after surgical resection of a glucagonoma and its management. CASE REPORT: We present a case of a 44-year-old female patient with no medical and surgical history, operated on in May 2018 for pancreatic glucagonoma revealed by skin necrolytic migratory erythema. The patient was regularly monitored by clinical exams and CT scans. In December 2020 (31 months postoperatively), we noticed the recurrence of the cutaneous lesions. Admission laboratory measurements demonstrated hyperglycemia as well as elevated blood Glucagon levels. Explorations showed 3 retro-pancreatic lesions. Based on these findings, we concluded that it was a recurrence of her glucagonoma. The patient was operated on by median laparotomy We performed a warshow's procedure. Pathology confirmed the endocrine nature of the 3 nodules. We are currently 6 months behind the surgery. The examination is strictly normal with no recurrence of the skin lesions so far. CLINICAL DISCUSSION: Surgical resection on a recurrent glucagonoma is what is unique in our case as we haven't found any case in the literature to our knowledge. What is also unique about our case is both the local aspect of the recurrence and the multiplicity of the tumors observed as multiple nodules around the tail of the pancreas. These lesions were not metastatic lymph nodes as confirmed by pathology. Probably it was an effraction of the big tumor at enucleation. CONCLUSION: Due to its rareness, there is no clear consensus on the management of glucagonomas therefore we chose to write our case in order to further enrich the literature to achieve one-day guidelines for glucagonomas treatment.