| Citation: |
LIAO Jinhao, GAO Yuting, WANG Xiang, WANG Zhiwei, XU Qiang, ZHAO Yuxing, CHI Yue, MAO Jiangfeng, YANG Hongbo. Multiple Liver Metastases in Malignant Insulinoma: A Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(4): 968-972. DOI: 10.12290/xhyxzz.2024-0208
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Malignant insulinoma is a kind of rare and challenging neuroendocrine tumor. It is often accompanied by distant metastasis, among which liver metastasis is most common, and the prognosis is often non-promising. In this paper, we report a case of multiple liver metastases from malignant insulinoma. The patient, a 70-year-old male, was admitted to the hospital due to "episodic consciousness disorder for more than four months." Blood glucose monitoring revealed recurrent hypoglycemia in the early morning, after meals, and at night. Pancreatic perfusion CT and dynamic enhanced MRI of the liver revealed a mass in the uncinate process of the pancreatic head and multiple liver metastases. Percutaneous liver biopsy confirmed the diagnosis of insulinoma. After multidisciplinary discussions, hepatic artery embolization and radiofrequency ablation were performed in stages, in combination with everolimus treatment. Thereafter, the enhanced CT demonstrated that some liver metastases shrank. The patient had regular meals, and the blood sugar gradually increased and remained normal thereafter. This article discusses this case's clinical characteristics and multidisciplinary collaborative diagnosis and treatment, aiming to provide experience for the comprehensive clinical diagnosis and treatment of malignant insulinoma patients.
| [1] |
Kittah N E, Vella A. Management of endocrine disease: pathogenesis and management of hypoglycemia[J]. Eur J Endocrinol, 2017, 177(1): R37-R47. DOI: 10.1530/EJE-16-1062
|
| [2] |
Zhu L, Xue H D, Sun H, et al. Insulinoma detection with MDCT: is there a role for whole-pancreas perfusion?[J]. AJR Am J Roentgenol, 2017, 208(2): 306-314. DOI: 10.2214/AJR.16.16351
|
| [3] |
Zhu L, Xue H D, Sun Z Y, et al. Prospective comparison of biphasic contrast-enhanced CT, volume perfusion CT, and 3 Tesla MRI with diffusion-weighted imaging for insulinoma detection[J]. J Magn Reson Imaging, 2017, 46(6): 1648-1655. DOI: 10.1002/jmri.25709
|
| [4] |
Brandi M L, Agarwal S K, Perrier N D, et al. Multiple endocrine neoplasia type 1: latest insights[J]. Endocr Rev, 2021, 42(2): 133-170. DOI: 10.1210/endrev/bnaa031
|
| [5] |
吴文铭, 陈洁, 白春梅, 等. 中国胰腺神经内分泌肿瘤诊疗指南(2020)[J]. 中华消化外科杂志, 2021, 20(6): 579-599. DOI: 10.3760/cma.j.cn115610-20210520-00224
Wu W M, Chen J, Bai C M, et al. The Chinese guidelines for the diagnosis and treatment of pancreatic neuroendocrine neoplasms (2020)[J]. Chin J Dig Surg, 2021, 20(6): 579-599. DOI: 10.3760/cma.j.cn115610-20210520-00224
|
| [6] |
Baudin E, Caron P, Lombard-Bohas C, et al. Malignant insulinoma: recommendations for characterisation and treatment[J]. Ann Endocrinol (Paris), 2013, 74(5/6): 523-533.
|
| [7] |
Yu R, Nissen N N, Hendifar A, et al. A clinicopathological study of malignant insulinoma in a contemporary series[J]. Pancreas, 2017, 46(1): 48-56. DOI: 10.1097/MPA.0000000000000718
|
| [8] |
Sada A, Glasgow A E, Vella A, et al. Malignant insulinoma: a rare form of neuroendocrine tumor[J]. World J Surg, 2020, 44(7): 2288-2294. DOI: 10.1007/s00268-020-05445-x
|
| [9] |
Kurakawa K I, Okada A, Manaka K, et al. Clinical characteristics and incidences of benign and malignant insulinoma using a national inpatient database in Japan[J]. J Clin Endocrinol Metab, 2021, 106(12): 3477-3486.
|
| [10] |
Frilling A, Li J, Malamutmann E, et al. Treatment of liver metastases from neuroendocrine tumours in relation to the extent of hepatic disease[J]. Br J Surg, 2009, 96(2): 175-184. DOI: 10.1002/bjs.6468
|
| [11] |
Caplin M E, Pavel M, Phan A T, et al. Lanreotide autogel/depot in advanced enteropancreatic neuroendocrine tumours: final results of the CLARINET open-label extension study[J]. Endocrine, 2021, 71(2): 502-513. DOI: 10.1007/s12020-020-02475-2
|
| [12] |
Vogl T J, Naguib N N N, Zangos S, et al. Liver metastases of neuroendocrine carcinomas: interventional treatment via transarterial embolization, chemoembolization and thermal ablation[J]. Eur J Radiol, 2009, 72(3): 517-528. DOI: 10.1016/j.ejrad.2008.08.008
|
| [13] |
Mohan H, Nicholson P, Winter D C, et al. Radiofrequency ablation for neuroendocrine liver metastases: a systematic review[J]. J Vasc Interv Radiol, 2015, 26(7): 935-942. e1. DOI: 10.1016/j.jvir.2014.12.009
|
| [14] |
Engelman E S, Leon-Ferre R, Naraev B G, et al. Comparison of transarterial liver-directed therapies for low-grade metastatic neuroendocrine tumors in a single institution[J]. Pancreas, 2014, 43(2): 219-225. DOI: 10.1097/MPA.0000000000000030
|
| [15] |
Rinke A, Krug S. Neuroendocrine tumours-medical therapy: biological[J]. Best Pract Res Clin Endocrinol Metab, 2016, 30(1): 79-91. DOI: 10.1016/j.beem.2015.09.004
|
| [16] |
Brighi N, Lamberti G, Maggio I, et al. Biliary stone disease in patients receiving somatostatin analogs for neuroendocrine neoplasms. a retrospective observational study[J]. Dig Liver Dis, 2019, 51(5): 689-694. DOI: 10.1016/j.dld.2018.09.013
|
| [17] |
Pavel M, Öberg K, Falconi M, et al. Gastroenteropancreatic neuroendocrine neoplasms: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up[J]. Ann Oncol, 2020, 31(7): 844-860. DOI: 10.1016/j.annonc.2020.03.304
|
| [18] |
Jin K Z, Xu J, Chen J, et al. Surgical management for non-functional pancreatic neuroendocrine neoplasms with synchronous liver metastasis: a consensus from the Chinese Study Group for Neuroendocrine Tumors (CSNET)[J]. Int J Oncol, 2016, 49(5): 1991-2000. DOI: 10.3892/ijo.2016.3711
|
| [19] |
Burns L, Naimi B, Ronan M, et al. Report of a novel molecular profile in malignant insulinoma[J]. J Clin Med, 2023, 12(4): 1280. DOI: 10.3390/jcm12041280
|
| [20] |
Bösch F, Brüwer K, Altendorf-Hofmann A, et al. Immune checkpoint markers in gastroenteropancreatic neuroendocrine neoplasia[J]. Endocr Relat Cancer, 2019, 26(3): 293-301. DOI: 10.1530/ERC-18-0494
|
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