Case history of belated diagnosis of insulinoma

Abstract

A clinical case of an atypical course of neuroendocrine tumor (NET, insulinoma) of the tail of the pancreas is described. The histologic classification of WHO (2010) according to TNM and ENETS and AJCC is recognized worldwide. Of all pancreatic NET, insulinoma accounts for the highest number of cases, 1-2 people per million population per year. In the treatment of NET surgical methods dominate. We present the clinical observation of a 63-year-old patient with atypical clinic who was repeatedly examined in the city hospitals. At the final stage, in the Chita State Medical Academy of Chita, the tumor of the pancreatic tail (insulinoma?) was diagnosed. The patient was operated. The tumor conglomerate including pancreatic tail, spleen and fragment of the left dome of the diaphragm with regional lymph nodes and fiber was intraoperatively detected and removed. The revision operation did not reveal any distant metastases. The macro preparation was a dense tumor of gray-white color, emanating from the tail of the pancreas with sprouting into the spleen and the left dome of the diaphragm. The postoperative period was severe, it was difficult to adjust carbohydrate metabolism. Histological conclusion: the tumor consists of adenoid-like trabecular, lobular, solid structures from relatively monomorphic mean sized cells with rounded nuclei and well expressed eosinophilic cytoplasm. Disseminated vascular invasion was noted. A belated diagnosis caused by an atypical variant of NET led to the involvement of the spleen and the left dome of the diaphragm, accompanied by metastases to the regional lymph nodes. Timely diagnosis of NET and subsequent treatment remains a difficult and complex task; it is necessary to consolidate the efforts of endocrinologists, oncologists, surgeons, radiologists and pathomorphologists.

Keywords

• neuroendocrine tumor
• diagnosis
• surgical treatment