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Case Reports
. 2020 Jan 17;19(2):162-164.
doi: 10.4103/wjnm.WJNM_41_19. eCollection 2020 Apr-Jun.

Extrapancreatic insulinoma

Robin Garg  1 , Saba Memon  1 , Virendra Patil  1 , Tushar Bandgar  1
Affiliations
Case Reports

Extrapancreatic insulinoma

Robin Garg et al. World J Nucl Med. .

Abstract

A 38-year-old female presented with recurrent episodes of hypoglycemia for 5 years. On 72-h fast test, critical sample biochemistry was suggestive of endogenous hyperinsulinemic hypoglycemia. Both constrast-enhanced computed tomography and 68Ga-DOTATATE positron emission tomography/computerized tomography (PET/CT) revealed no pancreatic lesion but showed a jejunal lesion suggestive of neuroendocrine tumor (NET) but not confirmatory of insulinoma. 68Ga-Exendin-4 PET/CT showed intense uptake in the proximal jejunum, and this being a specific scan for insulinoma, confirmed it as an ectopic insulinoma. The patient attained normoglycemia after excision of this NET confirming it to be a case of ectopic insulinoma located in the jejunum. Although most insulinomas are located in the pancreas, rarely ectopic cases have been described in the spleen, perisplenic tissue, duodenohepatic ligament, adjacent to the ligament of Treitz, duodenum, and the jejunum. Functional scanning with 68Ga-Exendin-4 PET/CT scan aids the localization of ectopic insulinoma.

Keywords: 68Ga-DOTATATE positron emission tomography/computerized tomography; 68Ga-Exendin-4 positron emission tomography/computerized tomography; ectopic jejunal insulinoma.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Contrast-enhanced computed tomography of the abdomen showing pedunculated arterially enhancing lesion measuring 1.9 cm × 1.8 cm in the proximal jejunum (↑); with 47 Hounsfield units on unenhanced image (a) and 103 Hounsfield units on contrast-enhanced image (b)
Figure 2
Figure 2
68Ga-DOTATATE positron-emission tomography/computerized tomography scan showing diffuse tracer uptake (SUVmax 23) in the jejunal area (↑) in coronal (a and b) and axial (c and d) view. (b and d) Represent fusion images. SUVmax: Maximum standardized uptake value
Figure 3
Figure 3
68Ga-Exendin-4 positron emission tomography/computerized tomography scan showing intensely increased tracer uptake (SUVmax 37.8) in the lesion measuring 1.9 cm × 1.8 cm in proximal jejunum (↑) in coronal (a and b) and axial (c and d) view. (b and d) Represent fusion images. SUVmax: Maximum standardized uptake value
Figure 4
Figure 4
Hemotoxylin and eosin staining of tumor tissue under light microscopy showing jejunal mucosa (↑) with encapsulated tumor (star) in submucosa which is composed of sheets of monomorphic cells among blood vessels with stippled chromatin in nuclei and moderate eosinophilic cytoplasm with mitosis of <2/500 cells suggestive of neuroendocrine tumor Grade I (a and b) ([b] represents magnified view)
See this image and copyright information in PMC

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