Liu J, Zhang CW, Hong DF, Wu J, Yang HG, Chen Y, Zhao DJ, Zhang YH. Laparoscope resection of retroperitoneal ectopic insulinoma: A rare case. World J Gastroenterol 2015; 21(14): 4413-4418 [PMID: 25892896 DOI: 10.3748/wjg.v21.i14.4413]
Corresponding Author of This Article
Cheng-Wu Zhang, MD, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, China. zcw1989@sina.com
Research Domain of This Article
Surgery
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jie Liu, Cheng-Wu Zhang, De-Fei Hong, Jia Wu, Da-Jian Zhao, Yu-Hua Zhang, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
Hong-Guo Yang, Department of General Surgery, Haining Branch of Zhejiang Provincial People’s Hospital, Jiaxing 314408, Zhejiang Province, China
Yuan Chen, Department of Pathology, Zhejiang Provincial People’s Hospital, Hangzhou 310014, Zhejiang Province, China
Author contributions: Liu J and Zhang CW performed the surgery and perioperative treatment; Zhang YH provided figures and revised the manuscript; Yang HG and Wu J reviewed and analyzed the literature; Chen Y was responsible for pathology; Hong DF and Zhao DJ designed the surgical protocol.
Ethics approval: The study was reviewed and approved by the ZheJiang Provincial People’s Hospital Institutional Review Board.
Informed consent: The study participant provided informed written consent for this study.
Conflict-of-interest: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Cheng-Wu Zhang, MD, Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People’s Hospital, Shangtang Road 158, Hangzhou 310014, Zhejiang Province, China. zcw1989@sina.com
Telephone: +86-571-85893419 Fax: +86-571-85131448
Received: November 4, 2014 Peer-review started: November 5, 2014 First decision: December 11, 2014 Revised: December 25, 2014 Accepted: January 21, 2015 Article in press: January 21, 2015 Published online: April 14, 2015 Processing time: 161 Days and 23.2 Hours
Abstract
Ectopic insulinoma is a very rare and dormant tumor. Here we report the case of a 79-year-old female who presented with repeated episodes of hypoglycemia and was diagnosed with insulinoma based on laboratory and imaging examinations. Computed tomography and positron emission tomography revealed a tumor in the retroperitoneum under and left of the hepatoduodenal ligament, which was resected successfully using a laparoscopic approach. Pathologic results revealed an ectopic insulinoma, which was confirmed immunohistochemically. Ectopic insulinomas are accompanied by hypoglycemia that can be misdiagnosed as drug- or disease-induced. These tumors are difficult to diagnose and locate, particularly in atypical cases or for very small tumors. Synthetic or targeted examinations, including low blood glucose, elevated insulin, proinsulin, and C-peptide levels, 48-h fasting tests, and relevant imaging methods should be considered for suspected cases of insulinoma. Surgery is the treatment of choice for patients with insulinoma, and laparoscopic resection is a feasible and effective method for select ectopic insulinoma cases.
Core tip: Ectopic insulinoma is a very rare and dormant disease that is difficult to diagnose and locate. It should be considered in the differential diagnosis of cases of hypoglycemia thought to be caused by drugs and other diseases. Correlative laboratory and imaging examinations are necessary, and laparoscopic resection is a feasible and effective treatment approach.
