title: Laparoscope resection of retroperitoneal ectopic insulinoma: a rare case.
abstract: Ectopic insulinoma is a very rare and dormant tumor. Here we report the case of a 79-year-old female who presented with repeated episodes of hypoglycemia and was diagnosed with insulinoma based on laboratory and imaging examinations. Computed tomography and positron emission tomography revealed a tumor in the retroperitoneum under and left of the hepatoduodenal ligament, which was resected successfully using a laparoscopic approach. Pathologic results revealed an ectopic insulinoma, which was confirmed immunohistochemically. Ectopic insulinomas are accompanied by hypoglycemia that can be misdiagnosed as drug- or disease-induced. These tumors are difficult to diagnose and locate, particularly in atypical cases or for very small tumors. Synthetic or targeted examinations, including low blood glucose, elevated insulin, proinsulin, and C-peptide levels, 48-h fasting tests, and relevant imaging methods should be considered for suspected cases of insulinoma. Surgery is the treatment of choice for patients with insulinoma, and laparoscopic resection is a feasible and effective method for select ectopic insulinoma cases.
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Liu
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Cheng-Wu
authors.initials: CW
authors.lastname: Zhang
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: De-Fei
authors.initials: DF
authors.lastname: Hong
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Wu
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Hong-Guo
authors.initials: HG
authors.lastname: Yang
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Da-Jian
authors.initials: DJ
authors.lastname: Zhao
authors.affiliation: Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Hangzhou 310014, Zhejiang Province, China.
authors.forename: Yu-Hua
authors.initials: YH
authors.lastname: Zhang
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001706:Biopsy; D002828:Choristoma / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007340:Insulinoma / Q000737:chemistry / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D064847:Multimodal Imaging; D010190:Pancreatic Neoplasms; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012186:Retroperitoneal Neoplasms / Q000737:chemistry / Q000175:diagnosis / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D014408:Biomarkers, Tumor
keywords: Diagnosis; Ectopic insulinoma; Hypoglycemia; Laparoscopic resection; Localization