Malignant insulinoma in ectopic pancreatic tissue.
BACKGROUND
Both ectopic pancreatic tissue and malignant insulinoma are rare. We encountered the combination of these rare entities in a patient demonstrating hypoglycemic symptoms.


METHODS
A patient with episodic hypoglycemia, non-suppressed serum insulin levels, positive fasting test and a positive localization on both ultrasound and somatostatin receptor scintigraphy by (111)I-labelled octreotide, was operated and investigated.


RESULTS
(111)I-labelled octreotide-guided surgery was performed and a tumor adjacent to the ligament of Treitz was extirpated. Follow-up was uneventful. Histopathology revealed a malignant insulinoma. The patient is currently under close surveillance.


CONCLUSIONS
The rare combination of an insulinoma in ectopic pancreatic tissue, where the usual diagnostic endoscopic ultrasound revealed an extrapancreatic mass, is described. This was followed by a positive somatostatin receptor scintigraphy, enabling both radio-guided surgery and future treatment of developing recurrent disease or metastases.
Hennings
Joakim
J
Department of Surgery, Uppsala University Hospital, Uppsala, Sweden. joakim.hennings@surgsci.uu.se
Garske
Ultike
U
Botling
Johan
J
Hellman
Per
P
D000368:Aged; D002828:Choristoma / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000150:complications*; D007340:Insulinoma / Q000000981:diagnostic imaging / Q000601:surgery*; D015282:Octreotide / Q000031:analogs & derivatives; D010179:Pancreas; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; C094279:indium-111-octreotide; D015282:Octreotide