| 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
|
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
|
| [1] | ZHANG Yuhang, WANG Han, DING Rongjing. Multiple System Atrophy with Neurogenic Orthostatic Hypotension: A Multidisciplinary Collaborative Rehabilitation Case Report[J]. Medical Journal of Peking Union Medical College Hospital, 2025, 16(2): 448-453. DOI: 10.12290/xhyxzz.2024-0490 |
| [2] | XU Kexin, LI Guozhuang, WU Zhihong, ZHANG Jianguo, DISCO(Deciphering Disorders Involving Scoliosis & Comorbidities) Study Group, WU Nan. Progress in Clinical Diagnosis and Management of Short Stature in Ehlers-Danlos Syndromes[J]. Medical Journal of Peking Union Medical College Hospital, 2025, 16(1): 163-170. DOI: 10.12290/xhyxzz.2024-0173 |
| [3] | ZHANG Shan, LIU Jie. Interpretation of NCCN Clinical Practice Guidelines for Primary Cutaneous Lymphomas (Version 1.2024) Based on the Current Diagnosis and Treatment Status of China[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(5): 1029-1037. DOI: 10.12290/xhyxzz.2024-0605 |
| [4] | CHEN Miao, YANG Chen, LIU Ziwei, CAO Wei, ZHANG Bo, LIU Xin, LI Jingnan, LIU Wei, PAN Jie, WANG Jian, ZHENG Yuehong, CHEN Yuexin, LI Fangda, DU Shunda, NING Cong, CHEN Limeng, YUE Cai, NI Jun, PENG Min, GUO Xiaoxiao, WANG Tao, LI Hongjun, LI Rongrong, WU Tong, HAN Bing, ZHANG Shuyang, Multidiscipline Collaboration Group on Rare Disease at Peking Union Medical College Hospital. Expert Consensus of Multidisciplinary Diagnosis and Treatment for Paroxysmal Nocturnal Hemoglobinuria(2024)[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(5): 1011-1028. DOI: 10.12290/xhyxzz.2024-0416 |
| [5] | YU Jiawen, WANG Jin, LIU Hongju, XU Li, NING Xiaohong, HUANG Yuguang. Treatment and Management of Chronic Cancer-related Pain in Adults[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(4): 764-770. DOI: 10.12290/xhyxzz.2024-0003 |
| [6] | CHEN Yuan, XU Qiang, WANG Weibin, ZHANG Taiping, GUO Junchao. Multidisciplinary Treatment of Pancreatic Cancer: Development and Experience of PUMCH[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(4): 758-763. DOI: 10.12290/xhyxzz.2024-0281 |
| [7] | SHI Yixin, WANG Yuekun, XING Hao, CHEN Wenlin, LIU Delin, ZHAO Binghao, YANG Tianrui, NIU Pei, WANG Yu, MA Wenbin. Diagnosis and Treatment Experience of Multidisciplinary Team for Brain Metastasis in Peking Union Medical College Hospital: A Summary of 159 Cases[J]. Medical Journal of Peking Union Medical College Hospital, 2023, 14(2): 306-314. DOI: 10.12290/xhyxzz.2022-0268 |
| [8] | Rare Diseases Society of Chinese Research Hospital Association, National Rare Diseases Committee, Beijing Rare Disease Diagnosis, Treatment and Protection Society, Gitelman Syndrome Consensus Working Group. Expert Consensus for the Diagnosis and Treatment of Gitelman Syndrome in China (2021)[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(6): 902-912. DOI: 10.12290/xhyxzz.2021-0555 |
| [9] | LU Xinyu, LIU Yuchen, LI Chen, YE Yuqian, CAO Yihan, LIU Wei, HUO Li, WU Huanwen, WANG Tao, WU Nan, LIU Xiaoqing, TIAN Xinlun, WANG Mu, ZHU Huijuan, ZHANG Wen, ZHANG Shuyang. Unveiling the Mystery of Long-term Repeated Multifocal-bone Swelling and Pain with Acne-like Rash[J]. Medical Journal of Peking Union Medical College Hospital, 2021, 12(3): 417-422. DOI: 10.12290/xhyxzz.20200046 |
| [10] | Xi BAI, Hui-juan ZHU, Hui PAN. The Multidisciplinary Pituitary Team of Peking Union Medical College Hospital: 40 Years of Hard Work[J]. Medical Journal of Peking Union Medical College Hospital, 2020, 11(3): 334-338. DOI: 10.3969/j.issn.1674-9081.20200060 |
Supported by: Beijing Renhe Information Technology Co., Ltd. 
Submit
Review
Office
Email Alert
RSS
DownLoad: