Acinar-islet cell carcinoma presenting as insulinoma

Tomoko Shimoike, Masayoshi Goto, Itsuro Nakano, Takeaki Sato, Yoshikatsu Migita, Tetsuhide Ito, Toshihiko Yanase, Shu Ichi Sezai, Tsunemichi Suzuki, Hajime Nawata

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20 Citations (Scopus)


A case of acinar-islet cell carcinoma presenting as insulinoma is reported. The patient was a 28-year-old man who presented with two convulsive episodes. Fajans' index [immunoreactive insulin (IRI; μU/ml / glucose mg/dl)l and Turner's [IRI (μU/ml) x 100 / glucose (mg/dl) - 30] index were high (2.8 and 308, respectively), as were serum proinsulin levels (550 pg/ml). Abdominal computed tomography and angiography revealed a highly vascular tumor in the pancreatic tail and several similar tumors in the liver. Histologic features of a biopsy specimen from a hepatic tumor were those of a malignant pancreatic endocrine tumor. Insulin secretion by the liver metastases was confirmed by venous sampling after arterial stimulation with calcium. These findings led us to diagnose malignant insulinoma with liver metastases. Serum levels of α-fetoprotein and trypsin were markedly elevated, to 2234 ng/ml (normal < 10) and 22,000 ng/ml (normal < 460) respectively, and these levels continued to rise with further growth of the liver metastases. Immunohistochemically, the metastatic liver tumor specimen was positive for α-fetoprotein, α1-antichymotrypsin, chromogranin A, and neuron-specific enolase. These findings of amphicrine features in the tumor were indicative of acinar-islet cell carcinoma that produced α-fetoprotein and trypsin in addition to insulin.

Original languageEnglish
Pages (from-to)830-835
Number of pages6
JournalJournal of gastroenterology
Issue number6
Publication statusPublished - Dec 1997
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Gastroenterology


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