Acinar cell carcinoma of the pancreas associated with hypoglycemia: involvement of "big" insulin-like growth factor-II.
Apart from insulinomas, pancreatic tumors are rarely complicated by hypoglycemia and some may produce insulin-like growth factor II (IGF-II). To our knowledge, IGF-II-producing pancreatic tumors associated with hypoglycemia have not been reported previously. We describe what we believe to be the first case of "big" IGF-II-producing pancreatic acinar cell carcinoma. A 68-year-old man presented with a history of recurrent hypoglycemia. Abdominal computed tomography scan and magnetic resonance imaging showed a mass, approximately 5 cm in diameter, in the tail of the pancreas and two low-density areas in the liver. Low serum glucose was associated with low insulin levels and high levels of hormones (i.e., glucagon and IGF-II) that are functionally opposite to insulin. Although serum IGF-II level was within the normal range, most IGF-II was of the high molecular weight form, as determined by Western immunoblot analysis. Based on these findings, a diagnosis of hypoglycemia induced by IGF-II-producing pancreatic tumor was made. Surgery was not possible because of the patient's poor general condition. The patient ultimately died as a result of malignant cachexia. At autopsy, a yellowish-white tumor was found in the tail of the pancreas, and a histopathologic diagnosis of acinar cell carcinoma was made. Immunohistologically, the tumor cells contained IGF-II in an irregular staining pattern, suggesting that the hypoglycemia was caused by a pancreatic tumor producing "big" IGF-II.
The Second Department of Internal Medicine, Nagasaki University School of Medicine, Sakamoto, Japan.
Y
Y
Mizuta
H
H
Isomoto
Y
Y
Futuki
N
N
Ehara
F
F
Takeshima
K
K
Omagari
K
K
Murase
Y
Y
Yakata
M
M
Senjyu
J
J
Masuda
N
N
Ikuno
M
M
Haraguchi
K
K
Iwasaki
I
I
Shimokawa
S
S
Kohno
D000368:Aged; D018267:Carcinoma, Acinar Cell / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology; D003937:Diagnosis, Differential; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007335:Insulin-Like Growth Factor II / Q000378:metabolism*; D008297:Male; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology
D007335:Insulin-Like Growth Factor II