A histochemical technique (pinacyanole metachromasia), specific for insulin in vitro and in beta cells of pancreatic tissue sections, was used to study surgically resected pancreases of 12 patients with documented idiopathic hypoglycemia of infancy. Hematoxylin and eosin—stained sections from 3 patients revealed overt hypertrophy and hyperplasia of all insular units. In the pancreases of the other 9 patients, hematoxylin and eosin sections showed histologically unremarkable islets, whereas the histochemically stained sections revealed the presence of many additional beta cells scattered either singly or in small packets of 2 to 6 cells. These were separate from the islets and most often seen about the walls of small ducts or in the glandular acini proper. The term beta cell nesidioblastosis most appropriately describes this cellular variant. These results, including electron microscopic findings of membrane-bound insulin inclusions in many cells, provide histomorphologic correlation with other evidence in support of the concept that excess production of insulin is an important feature of idiopathic hypoglycemia of infancy. A histochemical technique (pinacyanole metachromasia), specific for insulin in vitro and in beta cells of pancreatic tissue sections, was used to study surgically resected pancreases of 12 patients with documented idiopathic hypoglycemia of infancy. Hematoxylin and eosin—stained sections from 3 patients revealed overt hypertrophy and hyperplasia of all insular units. In the pancreases of the other 9 patients, hematoxylin and eosin sections showed histologically unremarkable islets, whereas the histochemically stained sections revealed the presence of many additional beta cells scattered either singly or in small packets of 2 to 6 cells. These were separate from the islets and most often seen about the walls of small ducts or in the glandular acini proper. The term beta cell nesidioblastosis most appropriately describes this cellular variant. These results, including electron microscopic findings of membrane-bound insulin inclusions in many cells, provide histomorphologic correlation with other evidence in support of the concept that excess production of insulin is an important feature of idiopathic hypoglycemia of infancy.
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