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Case Reports
. 2018 Dec 27;18(1):98.
doi: 10.1186/s12902-018-0325-4.

A case of malignant insulinoma responsive to somatostatin analogs treatment

Mariasmeralda Caliri  1 , Valentina Verdiani  1 , Edoardo Mannucci  2 , Vittorio Briganti  3 , Luca Landoni  4 , Alessandro Esposito  4 , Giulia Burato  5 , Carlo Maria Rotella  2 , Massimo Mannelli  1 , Alessandro Peri  6
Affiliations
Case Reports

A case of malignant insulinoma responsive to somatostatin analogs treatment

Mariasmeralda Caliri et al. BMC Endocr Disord. .

Abstract

Background: Insulinoma is a rare tumour representing 1-2% of all pancreatic neoplasms and it is malignant in only 10% of cases. Locoregional invasion or metastases define malignancy, whereas the dimension (> 2 cm), CK19 status, the tumor staging and grading (Ki67 > 2%), and the age of onset (> 50 years) can be considered elements of suspect.

Case presentation: We describe the case of a 68-year-old man presenting symptoms compatible with hypoglycemia. The symptoms regressed with food intake. These episodes initially occurred during physical activity, later also during fasting. The fasting test was performed and the laboratory results showed endogenous hyperinsulinemia compatible with insulinoma. The patient appeared responsive to somatostatin analogs and so he was treated with short acting octreotide, obtaining a good control of glycemia. Imaging investigations showed the presence of a lesion of the uncinate pancreatic process of about 4 cm with a high sst2 receptor density. The patient underwent exploratory laparotomy and duodenocephalopancreasectomy after one month. The definitive histological examination revealed an insulinoma (T3N1MO, AGCC VII G1) with a low replicative index (Ki67: 2%).

Conclusions: This report describes a case of malignant insulinoma responsive to octreotide analogs administered pre-operatively in order to try to prevent hypoglycemia. The response to octreotide analogs is not predictable and should be initially assessed under strict clinical surveillance.

Keywords: Hypoglycemia; Insulinoma; Octreotide; Somatostatin analogs.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval N/A and informed consent to participate to the study was obtained from the patient.

Consent for publication

It was obtained from the patient in written form.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Abdominal MRI showing a solid tumor with definite margins of the uncinate pancreatic process of 4x3x3.5 cm
Fig. 2
Fig. 2
Octreoscan showing a lesion localized in the pancreatic site, with high sstR density
Fig. 3
Fig. 3
a Macrosection of the neoplasia showing vascular (thin arrow) and adipose tissue (thick arrows) infiltration by the tumor. b-c Immunohistochemical staining for insulin and synaptophysin, respectively
See this image and copyright information in PMC

References

    1. Oberg K, Eriksson B. Endocrine tumours of the pancreas. Best Pract Res Clin Gastroenterol. 2005;19:753–781. doi: 10.1016/j.bpg.2005.06.002. - DOI - PubMed
    1. Hirshberg B, Cochran C, Skarulis MC, Libutti SK, Alexander HR, Wood BJ, et al. Malignant insulinoma: spectrum of unusual clinical features. Cancer. 2005;104:264–272. doi: 10.1002/cncr.21179. - DOI - PMC - PubMed
    1. Grant CS. Insulinoma. Best Pract Res Clin Gastroenterol. 2005;19:783–798. doi: 10.1016/j.bpg.2005.05.008. - DOI - PubMed
    1. Jonkers YM, Claessen SM, Veltman JA, Geurts van Kessel A, Din-jens WN, Skogseid B, et al. Molecular parameters associated with insulinoma progression: chromosomal instability versus p53 and CK19 status. Cytogenet Genome Res. 2006;115:289–297. doi: 10.1159/000095926. - DOI - PubMed
    1. Pape UF, Berndt U, Müller-Nordhorn J, Böhmig M, Roll S, Koch M, et al. Prognostic factors of long-term outcome in gastroenteropancreatic neuroendocrine tumours. Endocr Relat Cancer. 2008;15:1083–1097. doi: 10.1677/ERC-08-0017. - DOI - PubMed

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