Aberrant insulinoma of the duodenal bulb

Pathology International
W WatanabeY Tsutsumi

Abstract

A rare insulin-immunoreactive neuroendocrine tumor of the duodenum in a 54 year old male is reported. The incidentally identified tumor was located on the anterior free wall of the duodenal bulb and measured approximately 6 mm in diameter. Uncomplicated endoscopic resection of the tumor was carried out. The lesion exhibited classic histologic features of insulinoma of the beta-islet cell type with stromal amyloid deposition. In addition to positive reactivities of chromogranin A, neuron-specific enolase, synaptophysin, Leu 7 (CD57), cystatin C, CA15-3 and cytokeratin, the non-argyrophilic tumor cells were strongly immunoreactive for insulin and C-peptide. The stromal amyloid was clearly labeled for amylin. A few cells were stained for somatostatin, whereas other hormones were negative. Interestingly, a few isolated insulin-positive cells were identified in the non-neoplastic duodenal mucosa in the proximity of the tumor. Immunoelectron microscopy using paraffin sections disclosed insulin-immunoreactive secretory granules in the cytoplasm. The patient exhibited no signs or symptoms of hypoglycemia. Serum insulin levels were not measured prior to resection. No tumors were demonstrated in the pancreas. Magnetic resonance imaging r...Continue Reading

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Citations

Oct 29, 2005·Best Practice & Research. Clinical Gastroenterology·K Martin HoffmannRobert T Jensen
Sep 1, 1999·Pathology International·M Murakami, Y Tsutsumi
Apr 22, 2015·World Journal of Gastroenterology : WJG·Jie LiuYu-Hua Zhang
Dec 20, 2019·BMC Surgery·Mengqing SunYupei Zhao

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