A Case of Malignant Glucagonoma of Multicentric Occurrence

Kunihisa Shiozawa, Hirohisa Kitagawa, Keishi Nakamura, Genichi Nishimura, Takashi Fujimura, Masato Kayahara, Kouichi Shimizu, Tetuo Ota, Kouichi Miwa and Akitaka Nonomura^*

Department of Gastroenterological Surgery and Department of Pathology^*, Kanazawa University.

A 49-year-old, man diagnosed with hyperglycemia during a physical checkup in 1990 began losing weight in April 2000, dropping 5 kg in 6 months. He was diagnosed elsewhere with a pancreatic tumor and was referred to our department and admitted. On admission, we noted oxyhyperglycemia and hyperglucagonemia. Computed tomography (CT) showed multiple tumors in the pancreatic body and tail. Angiography showed hyperdense masses, suggesting tumors in the same lesion. Based on these findings, he was suspected of glucagonoma and underwent resection of the pancreatic body and tail. Three tumors detected in the pancreatic body and tail were removed tissue and vascular invasion was seen pathologically around the tumors, which were judged to be malignant. Tumor No. 1 tested positive in immunostaining for both glucagon and pancreatic polypeptide, Tumor No. 2 weakly positive for glucagon, Tumor No. 3 strongly positive for glucagon. All 3 tested negative for other pancreatic hormones. Although all were glucagon-producing, they differed in the production of other pancreatic hormones, and were thought as multicentric malignant glucagonoma. The postoperative course was uneventful, and blood glucagon normalized after surgery.

Key words
glucagonoma, multicentric onset

Reprint requests
Kunihisa Shiozawa Department of Gastroenterological Surgery, Kanazawa University 13-1 Takaramachi, Kanazawa, 920-8641 JAPAN

Accepted
September 25, 2002

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