Abstract
IntroductionThis case report demonstrates that the differential immunohistochemical reactivities of Siemens' Double Antibody Glucagon compared to DakoCytomation's Polyclonal Rabbit Anti-Human Glucagon allow for pathologic distinction of enteral versus pancreatic glucagonoma.Case presentationA 64-year-old Caucasian man was diagnosed with a duodenal enteroglucagonoma following presentation with obstructive jaundice. He had a low serum glucagon level using Siemens' Double Antibody Glucagon, a clinical syndrome consistent with glucagon hypersecretion. A periampullary mass biopsy proved to be a neuroendocrine tumor, with positive immunohistochemical reactivity to DakoCytomation's Polyclonal Rabbit Anti-Human Glucagon.ConclusionsDifferential comparison of the immunohistochemical reactivities of Siemens' Double Antibody Glucagon and DakoCytomation's Polyclonal Rabbit Anti-Human Glucagon discerns enteroglucagon from pancreatic glucagon.
Highlights
This case report demonstrates that the differential immunohistochemical reactivities of Siemens' Double Antibody Glucagon compared to DakoCytomation's Polyclonal Rabbit Anti-Human Glucagon allow for pathologic distinction of enteral versus pancreatic glucagonoma.Case presentation: A 64-year-old Caucasian man was diagnosed with a duodenal enteroglucagonoma following presentation with obstructive jaundice
Differential comparison of the immunohistochemical reactivities of Siemens' Double Antibody Glucagon and DakoCytomation's Polyclonal Rabbit Anti-Human Glucagon discerns enteroglucagon from pancreatic glucagon
Necrotizing migratory erythema (NME), glucose intolerance, weight loss and anemia form a presenting constellation known as the glucagonoma syndrome
Summary
Pancreatic glucagonomas are rare neuroendocrine tumors with an estimated incidence of approximately 1 in 20 million [1]. Stevens et al reported assay positivity for an N-terminal reactive antibody measuring both pancreatic and gut glucagon-like immunoreactivity with negative Cterminal reactive antibody more specific for pancreatic glucagon and demonstrating only a 2% cross-reactivity with gut extracts [9]. These tumors were clinically diagnosed and treated as glucagonomas [2,9,10]. New onset diabetes mellitus was diagnosed 3 weeks before developing jaundice His medical history was significant for gout, hypertension, hyperlipidemia, osteoarthritis, degenerative disk disease, erectile dysfunction, and two episodes of idiopathic pancreatitis 15 years earlier. Results of the multidisciplinary gastrointestinal tumor board recommended close monitoring with long-acting octreotide
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