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Case Reports
. 2019 Nov 1;9(5):425-429.
doi: 10.1080/20009666.2019.1671574. eCollection 2019.

Unremitting chronic skin lesions: a case of delayed diagnosis of glucagonoma

Hameem I Kawsar  1 , Alma Habib  1 , Azhar Saeed  1 , Anwaar Saeed  1
Affiliations
Case Reports

Unremitting chronic skin lesions: a case of delayed diagnosis of glucagonoma

Hameem I Kawsar et al. J Community Hosp Intern Med Perspect. .

Abstract

A 54-year-old Caucasian male with history of hypertension, hyperlipidemia, insulin-dependent diabetes mellitus, and chronic skin rash of 4 years presented to the emergency department with worsening rash and weight loss. Physical examination revealed diffuse erythematous rash, skin ulceration, bullae with associated paresthesia in the lower extremities, trunk, bilateral upper extremities, and palms and soles. A computed tomography (CT) scan with contrast showed a large, heterogenously enhancing pancreatic mass measuring 9.4 × 3.8 cm with surrounding low-attenuation soft tissue thickening. Blood tests showed hemoglobin A1C of 10.0%. Glucagon level was elevated to 2,178 (normal < 80 pg/dl). Endoscopic ultrasound (EUS)-guided fine needle aspiration (FNA) from the pancreatic mass was suggestive of pancreatic endocrine tumor. The tumor cells were positive for synaptophysin, chromogranin, CD56, and pan-cytokeratin with focal positivity for glucagon, suggestive of glucagonoma. The patient underwent distal pancreatectomy along with splenectomy and cholecystectomy. The glucagon level normalized to 25 pg/dl within a week of tumor resection, and during his 6-week outpatient follow up, skin rash had completely resolved.

Keywords: Glucagonoma; MEN-1; Necrolytic Migratory Erythema (NME); alpha cell tumor; neuroendocrine tumor.

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Figures

Figure 1.
Figure 1.
Affected area of the skin showed desquamation, erythema, and ulceration in lower extremities and sole.
Figure 2.
Figure 2.
A CT scan with contrast of abdomen showed a large, heterogenously enhancing mid to distal pancreatic mass measuring 9.4 × 3.8 cm with surrounding low-attenuation soft tissue thickening (white arrows).
Figure 3.
Figure 3.
A biopsy of skin lesion showing psoriasiform inflammatory reaction and confluent parakeratosis.
See this image and copyright information in PMC

References

    1. Becker SW, Kahn D, Rothman S.. Cutaneous manifestations of internal malignant tumors. JAMA Dermatol. 1942;45(6):1069–1080.
    1. Lobo I, Carvalho A, Amaral C, et al. Glucagonoma syndrome and necrolytic migratory erythema. Int J Dermatol. 2010;49(1):24–29. - PubMed
    1. Halvorson SA, Gilbert E, Hopkins RS, et al. Putting the pieces together: necrolytic migratory erythema and the glucagonoma syndrome. J Gen Intern Med. 2013;28(11):1525–1529. - PMC - PubMed
    1. McGavran MH, Unger RH, Recant L, et al. A glucagon-secreting alpha-cell carcinoma of the pancreas. N Engl J Med. 1966;274(25):1408–1413. - PubMed
    1. Mallinson CN, Bloom SR, Warin AP, et al. A glucagonoma syndrome. Lancet. 1974;2(7871):1–5. - PubMed

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