Cases reported "insulinoma"

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1/305. Laparoscopic enucleation of a solitary pancreatic insulinoma.

    Insulinomas are usually small, benign tumors of the pancreas, often found in obese patients, which require an incision that is out of all proportion to the size of the lesion. A laparoscopic technique for enucleation of a pancreatic insulinoma is described. ( info)

2/305. insulinoma with hyperproinsulinemia during hypoglycemia and loss of expression of vacuolar-type H( )-ATPase (V-ATPase) in the tumor tissue.

    hypoglycemia with a low serum immunoreactive insulin (IRI) level and serum immunoreactive c-peptide (IRC) level was found in a 74-yr-old female. Although a fasting test induced hypoglycemia, the responses of IRI and IRC during the fasting test, and the results of a glucose tolerance test, glucagon test, and secretin test did not indicate the presence of an insulinoma. However, the serum proinsulin level before the fasting test was 130.5 pmol/L (N: 3.0-10.0 pmol/L), and this high level was maintained throughout the test. Soon after surgical enucleation of the tumor, the patient's blood glucose levels increased. Postoperatively, the hypoglycemic status resolved, and the serum proinsulin levels returned to normal (2.8 pmol/L). Histopathological studies revealed a typical insulinoma. Immunohistochemical studies by the recently developed method for vacuolar-type H (V-ATPase), which is responsible for acidification of the intracellular compartments in eukaryotic cells, showed that normal islets stained positive, but not the tumor. This finding indicates that the insulin-secretory granules in the insulinoma cells existed in a microenvironment in which V-ATPase activity had been lost. This suggests that the reduced activity of V-ATPase on the endomembrane of the insulin-secretory granules in insulinomas may result in loss of the acidic microenvironment and impaired conversion of proinsulin by converting enzymes. ( info)

3/305. Cytogenetic and CGH studies of four neuroendocrine tumors and tumor-derived cell lines of a patient with multiple endocrine neoplasia type 1.

    A malignant insulinoma (LOHG-I), a carcinoid of the lung (LOHG-L), a parathyroid adenoma (LOHG-NSA), and a fibroma (LOHG-F) were obtained from a patient with multiple endocrine neoplasia type 1 (MEN1). Long-term cultures were established. Essential neurobiological properties of the cell lines were proven immunocytochemically and by electron microscopy. Molecular analysis of the germline dna showed a 4 bp deletion in exon 3 of the MEN1 gene. Cytogenetic and CGH analyses of the tumors/tumor cell lines revealed diploidy and balanced and unbalanced structural aberrations different for each tumor. chromosomes 6q21, 11q and 17q were most frequently involved in clonal structural aberrations. ( info)

4/305. myotonic dystrophy associated with insulinoma.

    We describe a 51-year-old man with myotonic dystrophy (MyD) associated with insulinoma. In addition to the typical symptoms of MyD, he showed hypoglycemic attacks after meals. The radiological examination and selective blood sampling revealed an insulinoma in the head of the pancreas. The tumor was resected and histopathologically diagnosed as an insulinoma. In Southern blot analysis, CTG repeat of the myotonin protein kinase gene in the insulinoma showed the longest expansion, followed by normal tissue of the pancreas, muscle and white blood cells. Therefore, microsatellite instability was the most prominent in the tumor cells. ( info)

5/305. insulinoma diagnosed by endoscopic ultrasonography-guided biopsy.

    Endoscopic ultrasound-guided fine-needle aspiration biopsy (EUS-FNA) is a new technique that seems to expand the utility of EUS, making definitive diagnosis of pancreatic lesions possible. However, the exact indications for the method, as well as its limitations, are not fully defined. We report on a patient with an insulinoma in the tail of the pancreas undetected by other imaging modalities that was conclusively diagnosed by EUS-FNA. Endoscopic ultrasonography is a unique imaging modality for localization of small pancreatic lesions. In combination with FNA, it represents a significant improvement for the exact diagnosis of these tumors. ( info)

6/305. Elongation of (CTG)n repeats in myotonic dystrophy protein kinase gene in tumors associated with myotonic dystrophy patients.

    Length of (CTG)n triplet repeats in myotonic dystrophy protein kinase gene (DMPK) was estimated in tumors, normal tissues of the same organs, muscles, and leukocytes from three myotonic dystrophy (DM) patients and a non-DM patient. Using cDNA 25 as a probe, a Southern blot analysis of EcoRI- and BglI-digested dna from these tissues demonstrated the longest expansion of the repeats in the tumors of DM patients. In all tissues from a non-DM patient, the repeat length was confirmed to be stable by PCR analysis. Our data suggest that expanded (CTG)n repeat in tumor tissues may have increased the instability. This study emphasizes the importance of a long-term prospective study on the incidence of tumors in DM to clarify the pathological interrelation between the two entities. ( info)

7/305. Clearance of acanthosis nigricans associated with the hair-AN syndrome after partial pancreatectomy: an 11-year follow-up.

    We describe a woman with the syndrome characterised by hyperandrogenism, insulin resistance and acanthosis nigricans (the hair-AN syndrome), and an associated insulinoma (islet B-cell tumour), whose signs and symptoms cleared after partial pancreatectomy. ( info)

8/305. Giant insulinoma in a patient with multiple endocrine neoplasia-type I: a case report.

    We report a case of giant cystic insulinoma constituting part of multiple endocrine neoplasia (men) type I. A 29-year-old Japanese man presented with a history of recurrent hypoglycemic attacks. Endocrine examination showed hyperinsulinemia discordant with hypoglycemia, and a giant cystic insulinoma (11 x 10 cm) located in the pancreatic tail was detected radiologically. hyperprolactinemia due to pituitary adenoma and hyperparathyroidism due to parathyroid hyperplasia were also present. The insulinoma, prolactinoma and hyperplastic parathyroid gland were surgically removed. Fluorescent microsatellite analysis detected loss of heterozygosity (LOH) in chromosome 11q13 in dna samples from all resected tissues but not from white blood cells. This is a rare case of men type I because of the giant cystic insulinoma and the evidence of common LOH detected in all men type I tissues. ( info)

9/305. Laparoscopic resection of an insulinoma.

    Surgical excision of an insulinoma results in dramatic reversal of hypoglycemic symptoms. Laparoscopic resection, if feasible, could reduce postoperative discomfort. Successful laparoscopic resection of an insulinoma is described. Preoperative studies failed to visualize the tumor; however, it was visualized and then imaged successfully during surgery. The operative approach described allows access to the entire pancreas and, therefore, may be useful for islet cell tumors at most sites in the gland. Based on this case and others in the literature, further efforts at laparoscopic pancreatic surgery are warranted. ( info)

10/305. Laparoscopic management of neuroendocrine tumours of the pancreas.

    Neuroendocrine tumours of the pancreas are rare but can be fatal due to excessive secretion of regulatory peptides. The localization of these small tumours can be difficult while open surgical treatment is associated with a relatively high morbidity. Two cases are presented where endocrine tumours of the pancreas were successfully removed by laparoscopy. In the surgical treatment of endocrine pancreatic tumours, the use of laparoscopic techniques can provide a valuable means for localizing the tumour while improving the patient's comfort and decreasing operative morbidity. ( info)
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