title: Pancreatic insulinoma combined with glucagon positive cell: A case report.
abstract: We present a 70-year-old man who was referred for surgery with uncontrollable hypoglycemia. Ultrasonography and abdominal contrast computed tomography revealed a hypervascular tumor of 1 cm in diameter in the pancreatic tail. With a diagnosis of insulinoma, we performed a distal pancreatectomy. The patient showed a good postoperative course without any complications. The patient's early morning fasting hypoglycemia disappeared. The respective levels of C-peptide and insulin dropped from 14.9 ng/mL and 4860 μIU/mL preoperatively to 5.3 ng/mL and 553 μIU/mL after surgery. A histopathological examination demonstrated that the tumor was a pancreatic neuroendocrine tumor, grade 1. Immunostaining was negative for insulin and positive for CD56, chromogranin A, synaptophysin and glucagon. These findings suggested that the tumor was clinically an insulinoma but histopathologically a glucagonoma. Among all insulinoma cases reported between 1985 and 2010, only 5 cases were associated with independent glucagonoma. In this report, we characterize and discuss this rare type of insulinoma by describing the case we experienced in detail.
authors.affiliation: Suguru Yamashita, Nobutaka Tanaka, Michiro Takahashi, Motoki Nagai, Takatoshi Furuya, Yukihiro Nomura, Department of Surgery, Asahi General Hospital, Chiba 289-2511, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Yamashita
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Tanaka
authors.forename: Michiro
authors.initials: M
authors.lastname: Takahashi
authors.forename: Motoki
authors.initials: M
authors.lastname: Nagai
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Furuya
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Nomura
keywords: Glucagon; Hypoglycemia; Insulinoma; Neuroendocrine tumor; Pancreas
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