A Case of Insulinoma with Lymph Node Metastases

Katsutoshi Murase, Tsuyoshi Shimamoto, Tetsuya Kondo, Takuya Sugimoto and Yutaka Ozeki

Department of Surgery, Tosei National Hospital

A 57-year-old man reporting cold sweats and general fatigue since about 1998 was found a November 2002 checkup to have hypoglycemia. His fasting blood sugar was 35 mg/dl and the blood insulin level (IRI) and C peptide slightly elevated. Enhanced CT showed a low-density mass, 15 mm mass in the tail of the pancreas and swollen lymph nodes at the splenic hilum. A selective arterial calcium injection test suggested that the tumor was fed by the splenic artery. Based on a tentative diagnosis of insulinoma of the tail of the pancreas, we conducted surgery. The tumor in the tail of the pancreas necessitated partial resection of the pancreas. At the operation, lymph nodes at the splenic hilum were swollen, and intraoperative pathological examination indicated lymph node metastasis. Lymph node dissection and splenectomy were then done. IRI was monitoring intraoperatively. The IRI was normalized after primary lesion resection, but no change was seen before and after lymph node dissection. Histological examination of the tumor suggested an endocrine cell tumor. Immunohistochemically, tumor cells were positive for insulin. The pathological diagnosis was insulinoma with lymph node metastasis. After surgery, blood insulin normalized and the patient remains symptom-free.

Key words
insulinoma, lymph node metastasis, intraoperative IRI monitoring

Reprint requests
Katsutoshi Murase Department of Surgery, Tosei National Hospital
762-1 Nagasawa, Shimizu-cho, Sunto-gun, Shizuoka, 411-8611 JAPAN

Accepted
February 25, 2004

To read the PDF file you will need Abobe Reader installed on your computer.