Ectopic insulinoma: case report.

Abstract

BACKGROUND:

Ectopic insulinoma is a rare entity that is difficult to diagnose before surgery. This article reports two cases of ectopic insulinoma.

CASE PRESENTATION:

Two patients manifested recurrent hypoglycemia with a typical Whipple triad. In terms of the qualitative diagnosis, the oral glucose tolerance test (OGTT) suggested a diagnosis of hyperinsulinemic hypoglycemia. However, preoperative imaging did not show a significant mass in the pancreas. In one patient, preoperative abdominal enhanced volume perfusion computed tomography (CT), somatostatin receptor imaging and 99mTc-HYNIC-TOC SPECT/CT revealed a mass with a rich blood supply anterior to the duodenum. In the other patient, preoperative enhanced CT, magnetic resonance imaging (MRI) and 68Ga-Exendin-4 PET/CT showed a mass above the spleen. After surgical removal of the tumor, both patients received a confirmed diagnosis of neuroendocrine tumors by postoperative pathology. The symptoms of hypoglycemia were relieved after surgery, and the blood glucose level was significantly increased.

CONCLUSION:

Ectopic insulinoma is difficult to locate before surgery. 68Ga-Exendin-4 PET/CT has a high diagnostic value. Surgical removal of the lesion is main treatment.

• Authors: Mengqing Sun, Yaping Luo, Yan You, Xianlin Han, Yupei Zhao, Xianlin Han, Yupei Zhao
• Journal: BMC surgery (BMC Surg) Vol. 19 Issue 1 Pg. 197 (Dec 18 2019) ISSN: 1471-2482 [Electronic] England
• PMID: 31852474 (Publication Type: Case Reports, Journal Article)

Topics

• Female
• Humans
• Hypoglycemia (etiology)
• Insulinoma (diagnosis, surgery)
• Middle Aged
• Neuroendocrine Tumors (diagnosis, surgery)
• Pancreatic Neoplasms (diagnosis, surgery)
• Positron Emission Tomography Computed Tomography
• Tomography, X-Ray Computed