Hypovascular insulinoma with reduced microvessel density on histopathology: a case report.

IF 1.3 Q4 ENDOCRINOLOGY & METABOLISM
Diabetology International Pub Date : 2024-09-20 eCollection Date: 2024-10-01 DOI:10.1007/s13340-024-00756-z
Risako Imai, Mayu Sakai, Takehiro Kato, Sayako Ozeki, Sodai Kubota, Yanyan Liu, Yoshihiro Takahashi, Ken Takao, Masami Mizuno, Takuo Hirota, Yukio Horikawa, Takaaki Murakami, Tomohiro Kanayama, Takahiro Kuroda, Tatsuhiko Miyazaki, Daisuke Yabe
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引用次数: 0

Abstract

Pancreatic neuroendocrine tumors (PanNETs) are generally hypervascular and readily detectable on imaging tests. However, hypovascular PanNETs are clinically problematic, requiring multiple imaging tests and tissue analyses to differentiate them from pancreatic ductal cancers. A 41 year-old man presented with Whipple's triad; 72 h fasting test followed by glucagon challenge test suggested insulinoma. However, contrast-enhanced computed tomography image showed a 17 mm tumor with poor enhancement and unclear borders in the tail of the pancreas. Abdominal magnetic resonance imaging and contrast-enhanced endoscopic ultrasonography (EUS) indicated cystic degeneration and necrosis at the same site; EUS-guided fine-needle aspiration cytology indicated a PanNET Grade 1 tumor. Although the imaging was inconclusive, diazoxide treatment ameliorated the hypoglycemia-related symptoms and insulinoma was deemed likely; following tail pancreatectomy and splenectomy, the symptoms disappeared. Pathological examination revealed a tumor positive for insulin and classed as PanNET Grade 1 according to the 2019 WHO classification. The microvessel density (MVD) of the tumor was found to be as low as 3.9%, which may partly account for the inconclusive images. The present case was difficult to diagnose preoperatively due to hypovascularity on imaging because of reduced MVD. It is clinically important to evaluate MVD in cases of hypovascular PanNETs by multiple preoperative imaging studies to differentiate them from pancreatic cancers and to validate the findings by postoperative pathological analysis.

组织病理学显示微血管密度降低的低血管性胰岛素瘤:病例报告。
胰腺神经内分泌肿瘤(PanNET)通常血管较多,容易在影像学检查中发现。然而,血管过少的 PanNET 在临床上很成问题,需要进行多种影像学检查和组织分析,才能将其与胰腺导管癌区分开来。一名 41 岁的男子出现 Whipple's 三联征;72 小时空腹试验和胰高血糖素挑战试验提示其为胰岛素瘤。然而,对比增强计算机断层扫描图像显示,胰腺尾部有一个 17 毫米的肿瘤,增强不佳,边界不清。腹部磁共振成像和造影剂增强内窥镜超声检查(EUS)显示同一部位有囊变性和坏死;EUS引导下细针穿刺细胞学检查显示为PanNET 1级肿瘤。虽然影像学检查未得出结论,但二氮卓治疗改善了低血糖相关症状,胰岛素瘤被认为是可能的;胰腺尾部切除术和脾切除术后,症状消失。病理检查显示肿瘤的胰岛素阳性,根据 2019 年世界卫生组织的分类,属于 PanNET 1 级。肿瘤的微血管密度(MVD)低至 3.9%,这可能是图像不确定的部分原因。本病例术前诊断困难,原因是 MVD 降低导致成像中血管过少。在临床上,通过术前多项影像学检查评估低血管PanNET的MVD,以将其与胰腺癌区分开来,并通过术后病理分析验证结果,具有重要意义。
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来源期刊
Diabetology International
Diabetology International ENDOCRINOLOGY & METABOLISM-
CiteScore
3.90
自引率
4.50%
发文量
42
期刊介绍: Diabetology International, the official journal of the Japan Diabetes Society, publishes original research articles about experimental research and clinical studies in diabetes and related areas. The journal also presents editorials, reviews, commentaries, reports of expert committees, and case reports on any aspect of diabetes. Diabetology International welcomes submissions from researchers, clinicians, and health professionals throughout the world who are interested in research, treatment, and care of patients with diabetes. All manuscripts are peer-reviewed to assure that high-quality information in the field of diabetes is made available to readers. Manuscripts are reviewed with due respect for the author''s confidentiality. At the same time, reviewers also have rights to confidentiality, which are respected by the editors. The journal follows a single-blind review procedure, where the reviewers are aware of the names and affiliations of the authors, but the reviewer reports provided to authors are anonymous. Single-blind peer review is the traditional model of peer review that many reviewers are comfortable with, and it facilitates a dispassionate critique of a manuscript.
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