Megjelenés éve: Kivonat: Authors present the history of a year-old man who was evaluated for recurrent epigastrial pain.
Clinical investigation revealed a 4-cm tumor in the head of the pancreas and a solitary liver metastasis. Pathological examination of insulinoma surgically excised pancreatic tumor indicated a moderately differentiated neuroendocrine carcinoma and Ki labeling index revealed moderate proliferative activity.
Despite short-term chemotherapy combined with interferon and somatostatin analogue administration, the insulinoma disease rapidly progressed. Octreotide scintigraphy disclosed abundant expression of somatostatin receptors both on primary tumor and hepatic metastases.
Endocrine symptoms were not observed during the first 33 months of the disease. Serum insulin and C-peptide measurements confirmed insulin oversecretion.
Continuous administration of somatostatin analogue was supplemented with diazoxide, but the latter therapy was not tolerated because of severe water retention. The high dose oral carbohydrate intake was supplemented with continuous glucose infusion.
As a rescue procedure, repeated liver chemoembolisation was performed, which resulted only in a short-term effect.
The autopsy and the immunohistochemical investigations confirmed the diagnosis of insulin-producing, metastatic neuroendocrine carcinoma.