title: Granulomatous Insulitis as a Cause of Acute-Onset Insulin-Dependent Diabetes Mellitus in a Patient With a Pancreatic Endocrine Carcinoma.
abstract: Autoimmune destruction of β cells is the cause of most cases of type 1 diabetes mellitus. Lymphocytic insulitis has been documented in the early phases of this disease as well as in recurrent diabetes after pancreas transplantation and in certain viral infections. We report a unique case of granulomatous insulitis in a patient with an endocrine tumor of the pancreas that clinically manifested as acute-onset insulin-dependent diabetes mellitus. Granulomata were present in islets with complete disappearance of β cells, as well as in the primary tumor, metastases, and lymph nodes. We postulate that these granulomata represent a sarcoid-like reaction to the tumor with secondary injury to nonneoplastic endocrine cells through a mechanism of molecular mimicry.
authors.affiliation: New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA.
authors.forename: Jad
authors.initials: J
authors.lastname: Saab
authors.affiliation: Long Island Jewish Medical Center, New Hyde Park, NY, USA.
authors.forename: Lihui
authors.initials: L
authors.lastname: Qin
authors.affiliation: New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA joj9034@med.cornell.edu.
authors.forename: Jose
authors.initials: J
authors.lastname: Jessurun
mesh_terms: D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D001943:Breast Neoplasms / Q000473:pathology; D018278:Carcinoma, Neuroendocrine / Q000150:complications* / Q000473:pathology; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000209:etiology*; D005260:Female; D006099:Granuloma / Q000209:etiology* / Q000473:pathology; D006111:Graves Disease / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007150:Immunohistochemistry; D016609:Neoplasms, Second Primary / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000473:pathology
chemical_list: D014408:Biomarkers, Tumor
keywords: diabetes mellitus; endocrine tumor; granulomatous insulitis; pancreas