title: Development of multifocal nodular lesions of a liver mimicking hepatic metastasis, following resection of an insulinoma in a child.
abstract: Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.
authors.affiliation: Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Sook Young
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Ben
authors.initials: B
authors.lastname: Kang
authors.affiliation: Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Yoon Mee
authors.initials: YM
authors.lastname: Choi
authors.affiliation: Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Jun Mee
authors.initials: JM
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Soon Ki
authors.initials: SK
authors.lastname: Kim
authors.affiliation: Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Young Se
authors.initials: YS
authors.lastname: Kwon
authors.affiliation: Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Lee
keywords: Focal nodular hyperplasia; Insulinoma; Neoplasm metastasis; Pediatrics