A Case of Pancreatic Insulinomas with Glucagon producting Tumors after Enucleation for Pancreatic Endocrine Tumor 4 yaers Before

Fumio Sakashita, Shinji Osada, Shuji Komori, Satoshi Matsui, Yasuharu Tokuyama, Naoki Okumura, Hidenori Tanaka, Yoshiki Hosono, Yasuyuki Sugiyama and Yosuke Adachi

Department of Oncologic Surgery, Gifu University, Graduate School of Medicine

A 24-year-old man undergoing enucleation of an asymptomatic pancreatic endocrine tumor 4 years earlier and brought to the hospital with very low blood glucose (31 mg/dl) was found in computed tomography to have six hypervascular tumors in the pancreatic tail, suggesting multiple insulinomas. Arterial stimulation venous sampling showed the dominant lesion for the endocrine tumors to be localized in the splenic artery. Under a diagnosis of multiple insulinomas of the pancreatic tail, we conducted spleen-preserving distal pancreatectomy. Immunohistochemical examination of pancreatic hormones indicated that almost all tumors were positive for insulin and negative for glucagons, but two other tumors were glucagons-positive and insulin-negative. He has remained well without recurrence or hypoglycemic attack for one year.

Key words
insulinoma, glucagonoma, arterial stimulation venous sampling (ASVS)

Reprint requests
Fumio Sakashita Department of Oncologic Surgery, Gifu University, Graduate School of Medicine
1-1 Yanagido, Gifu, 501-1194 JAPAN

Accepted
November 22, 2006

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