A Case Report of a Malignant Insulinoma
Introduction: Despite rare (1-2% of pancreatic tumors/PT), insulinomas are the most common functional pNET. The diagnosis is established by demonstrating inappropriately high serum insulin levels during a spontaneous or induced episode of hypoglycemia.
Aim(s): To present the clinical case of a woman with malignant insulinoma(MI).
Materials and methods: A 73y old woman with persistent abdominal pain & recurrent spontaneous hypoglycemic episodes,PS:2,was diagnosed with a well differentiated G2 pancreatic NEN (Ki67:15%,Syn+:100%,Chr+:<10%,Isl-1+:100%,PDX-1+:100%,ATRX retained,Ins-,NESP55-,SSTR2a+:sc.+3) & multiple liver mets. Fasting C-peptide & insulin were elevated: 5.6ng/ml, 33μU/ml respectively. Octreoscan showed abnormal uptake in the aforementioned lesions. The diagnosis of MI was confirmed (1st case among 386 pts with PT, consecutively admitted in Our Dept between 1/1/2006-31/8/2017) and started on temozolomide+capecitabine+Somatulin autogel. After 3 cycles, liver PD was documented with serious hypoglycemic episodes. There was no improvement of her PS. She received 2nd line 5FU+Oxaliplatine+diazoxide & 6 cycles later she experienced radiological SD. Nevertheless,her clinical status was not improved, apart from the discontinuation of the hypoglycemic episodes. C-peptide & insulin:11ng/ml & 23μU/ml. Due to unsatisfactory results she started Everolimus(E) 10mg/d.
Conference: 15th Annual ENETSConcerence (2018)
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