title: Non-islet cell tumor hypoglycemia caused by intrathoracic solitary fibrous tumor: a case report.
abstract: BACKGROUND
  Non-islet cell tumor hypoglycemia (NICTH) is defined as a form of hypoglycemia caused by an extrapancreatic tumor. Solitary fibrous tumor (SFT) associated with hypoglycemia is rare.
  
  
  METHODS
  A 76-year-old woman, who had frequently experienced hypoglycemic symptoms such as presyncope for the prior 6 months, visited our hospital to undergo detailed examinations. Her fasting glucose level was low at 49 mg/dl. The blood levels of IRI and C-peptide were also low at 0.2 μU/ml and 0.21 ng/ml, respectively. Chest computed tomography revealed a mass measuring 15 cm in the left thoracic cavity. Percutaneous needle biopsy yielded a diagnosis of intrathoracic SFT associated with NICTH. The tumor was removed by video-assisted thoracoscopic surgery. Histological examination showed a tumor composed of simple spindle-shaped cells with an irregular arrangement. Immunohistochemical staining was positive for CD34, bcl-2, and vimentin and negative for alpha SMA and mesothelin. These results confirmed the diagnosis of SFT. Her hypoglycemic symptoms resolved rapidly after surgery. The clinical course has since remained favorable with no signs of recurrence.
  
  
  CONCLUSIONS
  We report a case of non-islet cell tumor hypoglycemia caused by intrathoracic SFT. The high-molecular-weight IGF-II produced by the tumor has been regarded as the cause of NICTH.
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan. k1111@asahikawa-med.ac.jp.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kitada
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yasuda
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Nana
authors.initials: N
authors.lastname: Takahashi
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Ishibashi
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hayashi
authors.affiliation: Department of Respiratory Center, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, 078-8510, Japan.
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Ohsaki
authors.affiliation: Department of Clinical Pathology, Asahikawa Medical University, Midorigaoka-Higashi 2-1-1-1, Asahikawa, Hokkaido, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Miyokawa
mesh_terms: D000368:Aged; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000209:etiology*; D007335:Insulin-Like Growth Factor II / Q000378:metabolism; D008970:Molecular Weight; D054364:Solitary Fibrous Tumors / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D013899:Thoracic Neoplasms / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D020775:Thoracic Surgery, Video-Assisted
chemical_list: C035170:IGF2 protein, human; D007335:Insulin-Like Growth Factor II; D002097:C-Reactive Protein
keywords: Hypoglycemia; Non-islet cell tumor hypoglycemia; Solitary fibrous tumor