Concurrent insulinoma and pancreatic adenocarcinoma: report of a rare case and review of the literature

Abstract

Pancreatic adenocarcinoma is the 5th leading cause of cancer-related death in Western countries and insulinomas are rare endocrine neoplasms of the pancreas. The concurrent appearance of pancreatic adenocarcinoma and insulinoma is very rare and to the best of our knowledge has never been reported again. Herein, we present such an occurrence in a 74-year-old man. Resection of a mass in the uncinate process of the pancreas revealed pancreatic adenocarcinoma with severe desmoplastic reaction. Two years later, due to symptomatology persistence the patient was re-examined and a new 2 cm mass in the uncinate process was found leading to surgery, which demonstrated a 2 cm endocrine islet-cell tumor. Establishing a diagnosis in patients with insulinoma is difficult and the imaging studies still have low sensitivity and specificity except for intra-operative ultrasonography, which is the most accurate method detecting 90% of these lesions.

Figure 1

Contrast enhanced CT scan depicting the 1.5 cm solid mass in the uncinate process of the pancreas (arrow).

Figure 2

Microscopic focus of pancreatic adenocarcinoma with desmoplastic reaction (Hematoxylin-Eosin × 400).

Figure 3

Contrast enhanced CT scan, after the first operation, demonstrating a 2 cm mass in the uncinate pancreatic process, with characteristics of an endocrine neoplasm (arrow).

Figure 4

Pancreatic endocrine tumour ("insulinoma") adjacent to the pancreatic parenchyma (Hematoxylin-Eosin × 100).

Figure 5

Pancreatic endocrine tumour, intensely immunostained for insulin (x 100).