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KMID : 0870420060100040019
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
2006 Volume.10 No. 4 p.19 ~ p.23
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Insulin-releasing Neuroendocrine Carcinoma of the Gallbladder Presenting with Hypoglycemic Symptoms
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Namgung Jung-Man
Han Duck-Jong
Kim Kyu-Rae
Lee Young-Joo
Kim Song-Chael
Park Kwan-Tae
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Abstract
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A 52-year-old woman with a meningioma was transferred to our hospital due to abdominal mass and hypoglycemic symptoms. Abdominal computed tomography confirmed thickening of the gallbladder wall, with a 10 x 7 cm mass occupying the right inferior and medial segment of the liver. Her fasting glucose was low on hypoglycemic attack, with a serum insulin level of 173 mIU/ml (normal; 5~20 mIU/ml). Other radiologic tests, including portal venous sampling,did not localize the insulin producing lesion in the pancreas. The preoperative diagnosis was one of a malignant gallbladder tumor infiltrating the liver, with the possibility of nesidioblastosis; therefore, extended cholecystectomy and distal pancreatectomy were performed as the frozen biopsy of the pancreas confirmed an increase of cells in the islet of Langerhans. In permanent specimens, the pancreas showed normal histology and the gallbladder lesion showed a neuroendocrine carcinoma combined with an adenocarcinoma, with positive immunostaining for CD56, chromogranin A and synaptophysin. The special immunostaining for insulin was positive. The patient was in a glucose intolerant state with administration of small dose of oral hypoglycemic agents after operation. Metastases of the lesion to the skull and spine were observed two months after surgery. We report non-islet cell insulin releasing neuroendocrine carcinoma, combined with an adenocarcinoma of the gallbladder, presenting with hypoglycemic symptoms
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KEYWORD
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Neuroendocrine Carcinoma, Hypoglycemic, Insulin, Gallbladder
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