Ectopic Malignant Insulinoma with Multiple Liver Metastases: A Case Report

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Introduction: Malignant insulinoma arising from ectopic pancreas is very rare.

Aim(s): To report the diagnosis and treatment of a case with ectopic malignant insulinoma.

Materials and methods: A 31-year-old woman was detected a lesion(size 1.7cm) in the liver by ultrasound in 2008(misdiagnosed as hemangioma). Since 2012 she complained of confusion, hand trembling, palpitation and sweating, and these symptoms occurred more frequently over the time. On May 2014 she was found to be hypoglycemic, elevated serum insulin and C-P, Abdomen CT with contrast showed multiple lesions in liver(largest 4.3cm), enlarged lymph nodes around the pancreas, a lesion(3.5cm) at proximal jejunum. Liver biopsy showed NET G1, Ki-67(+2%). Octreoscan showed high expression of SSR in jejunum area, multiple liver masses and mesenteric lymph nodes. 68Ga-exendin-4 PET/CT confirmed the lesion located at jejunum section, below the body of pancreas, where expressed GLP-1R was most hypercaptant(SUV 21.7), supposed to jejunum origin. The diagnosis of ectopic malignant insulinoma was made.

Conference: 13th Annual ENETSConcerence (2016)

Presenting Author: Liu Q

Authors: Liu Q, Luo J, Li C, Zhu Z, Tan H,

Keywords: ectopic malignant insulinoma, octreotide, everolimus, 68Ga-exendin-4 PET/CT,