Abstract
BackgroundEctopic insulinoma is a rare entity that is difficult to diagnose before surgery. This article reports two cases of ectopic insulinoma.Case presentationTwo patients manifested recurrent hypoglycemia with a typical Whipple triad. In terms of the qualitative diagnosis, the oral glucose tolerance test (OGTT) suggested a diagnosis of hyperinsulinemic hypoglycemia. However, preoperative imaging did not show a significant mass in the pancreas. In one patient, preoperative abdominal enhanced volume perfusion computed tomography (CT), somatostatin receptor imaging and 99mTc-HYNIC-TOC SPECT/CT revealed a mass with a rich blood supply anterior to the duodenum. In the other patient, preoperative enhanced CT, magnetic resonance imaging (MRI) and 68Ga-Exendin-4 PET/CT showed a mass above the spleen. After surgical removal of the tumor, both patients received a confirmed diagnosis of neuroendocrine tumors by postoperative pathology. The symptoms of hypoglycemia were relieved after surgery, and the blood glucose level was significantly increased.ConclusionEctopic insulinoma is difficult to locate before surgery. 68Ga-Exendin-4 PET/CT has a high diagnostic value. Surgical removal of the lesion is main treatment.
Highlights
Ectopic insulinoma is a rare entity that is difficult to diagnose before surgery
Insulinoma is the most common functional pancreatic neuroendocrine tumor derived from islet β-cells
The literature summarizes its characteristics according to 90% statements: 90% of insulinomas are single adenomas, 90% are benign, 90% are < 2 cm in diameter, and 90% are located in the pancreas [2]
Summary
Ectopic insulinoma is a rare entity that is difficult to diagnose before surgery. This article reports two cases of ectopic insulinoma.Case presentation: Two patients manifested recurrent hypoglycemia with a typical Whipple triad. We report two patients with ectopic insulinoma who were admitted to Peking Union Medical College Hospital. After completion of the preoperative qualitative and localization diagnoses, the patient underwent robotassisted ectopic islet cell tumor resection under general anesthesia. In terms of the localization diagnosis, somatostatin receptor imaging did not show high somatostatin receptor expression levels, i.e., no signs of a neuroendocrine tumor.
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