Values of intraoperative frozen pathology and pathological analysis for persistent hyperinsulinemic hypoglycemia in infants

Objective To explore the pathological types and clinical values of intraoperative frozen pathology for surgical children with persistent hyperinsulinemic hypoglycemia of infancy (PHHI). Methods A total of 25 PHHI infants were operated from April 2011 to October 2016. And retrospective analyses were performed for clinical data, surgical approaches and pathological characteristics. Results There were 17 boys and 8 girls with an age range from 16 days to 12 months. The fasting levels of blood glucose and insulin were (0.6-5.5) mmol/L and (3.1-50.1) mU/L respectively. Based upon the preoperative examinations and intraoperative frozen pathology, they underwent focal type and subtotal pancreatectomy respectively. During a postoperative follow-up period of (2-38) months, fasting blood glucose had a range of (3.0-12.6) mmol/L. Fifteen children recovered well without any complication. One case of hypoglycemia required glucagon. And a low fasting level of glucose normalized after ingesting (n=3) and postoperative hyperglycemia required medications for controlling blood glucose (n=6). One case with suspected focal pancreatic lesion underwent a focal resection of 50% and relapsed after 2 weeks. According to the pathological classification criteria, their clinical types were focal (n=6), diffuse (n=18) and atypical (n=1). Conclusions Clinically it is important to confirm the classification of pathological types. Preoperative examinations and intraoperative frozen pathology may help to find effective treatments and improve the outcomes. The most common pathological type is diffuse. Further studies are required for atypical type. Key words: Pathology; Persistent hyperinsulinemic hypoglycemia in infancy; Intraoperative frozen