Skip to main content
SpringerLink
Log in

Acinar-islet cell carcinoma presenting as insulinoma

  • Case Report
  • Published:
Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

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)] and Turner's [IRI (μU/ml) × 100/glucose (mg/dl)—30] index were high (2.8 and 308, respectively), as were serum proinsulin levels (550pg/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 2234ng/ml (normal <10) and 22000ng/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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Ulich T, Cheng L, Lewin KJ. Acinar-endocrine cell tumor of the pancreas. Report of a pancreatic tumor containing both zymogen and neuroendocrine granules. Cancer 1982;50:2099–2105.

    Article  PubMed  CAS  Google Scholar 

  2. Ichijima K, Akaishi K, Toyoda N, et al. Carcinoma of the pancreas with endocrine component in childhood. A case report. Am J Clin Pathol 1985;83:95–100.

    PubMed  CAS  Google Scholar 

  3. Machida H, Nakaya Y, Kojima K, et al. A case of acinar-islet cell tumor of the pancreas body (in Japanese with English abstract). Nippon Geka Gakkai Zasshi (J Jpn Surg Soc) 1991;92:603–606.

    CAS  Google Scholar 

  4. Klimstra DS, Rosai J, Heffess CS. Mixed acinar-endocrine carcinomas of the pancreas. Am J Surg Pathol 1994;18:765–778.

    Article  PubMed  CAS  Google Scholar 

  5. Sommers SC, Meissner WA. Unusual carcinomas of the pancreas. AMA Arch Pathol 1954;58:101–111.

    PubMed  CAS  Google Scholar 

  6. Glenner GG, Mallory GK. The cystadenoma and related nonfunctional tumors of the pancreas. Pathogenesis, classification, and significance. Cancer 1956;9:980–996.

    Article  PubMed  CAS  Google Scholar 

  7. Schron DS, Mendelsohn G. Pancreatic carcinoma with duct, endocrine, and acinar differentiation. A histologic, immunocytochemical, and ultrastructural study. Cancer 1984;54:1766–1770.

    Article  PubMed  CAS  Google Scholar 

  8. Nonomura A, Kono N, Mizukami Y, et al. Duct-acinar-islet cell tumor of the pancreas. Ultrastruct Pathol 1992;16:317–329.

    Article  PubMed  CAS  Google Scholar 

  9. Hassan MO, Gogate PA. Malignant mixed exocrine-endocrine tumor of the pancreas with unusual intracytoplasmic inclusions Ultrastruct Pathol 1993;17:483–493.

    Article  PubMed  CAS  Google Scholar 

  10. Okada Y, Mori H, Tsutsumi A. Duct-acinar-islet cell tumor of the pancreas. Pathol Int 1995;45:669–676.

    Article  PubMed  CAS  Google Scholar 

  11. Fajans SS, Floyd JC. Fasting hypoglycemia in adults. N Engl J Med 1976;294:766–772.

    PubMed  CAS  Google Scholar 

  12. Turner RC, Oakley NW, Nabarro JDN. Control of basal insulin secretion, with special reference to the diagnosis of insulinomas. BMJ 1971;2:132–135.

    PubMed  CAS  Google Scholar 

  13. Doppman JL, Miller DL, Change R, et al. Insulimomas: Localization with selective intraarterial injection of calcium. Radiology 1991;178:237–241.

    PubMed  CAS  Google Scholar 

  14. Lee PC, Lebenthal E. Prenatal and postnatal development of the human exocrine pancreas. In: Go VLW, Dimagno EP, Gardner JD, Lebenthal E, Reber HA, Sheele GA (eds). The pancreas. New York: Raven, 1993:57–73.

    Google Scholar 

  15. Githens S. Differentiation and development of the pancreas in animals. In: Go VLW, Dimagno, EP, Gardner JD, Lebenthal E, Reber HA, Sheele GA (eds). The pancreas. New York: Raven, 1993:21–55.

    Google Scholar 

  16. Kodama T, Mori W. Morphological behavior of carcinoma of the pancreas. 2. Argyrophil cells and Langerhans' islets in the carcinomatous tissues. Acta Pathol Jpn 1983;33:483–493.

    PubMed  CAS  Google Scholar 

  17. Kay D, Delellis RA, Dayal Y, et al. Ductal adenocarcinoma of the pancreas with neuroendocrine cells: An immunohistochemical study. Lab Invest 1985;52:33–34A.

    Google Scholar 

  18. Klimstra DS, Heffess CS, Oertel, JE. Acinar cell carcinoma of the pancreas. A clinicopathologic study of 28 cases. Am J Surg Pathol 1992;16:815–837.

    Article  PubMed  CAS  Google Scholar 

  19. Inaba N, Kasahara K, Kashii A, et al., Mixed ductal and acinar cell cancer of the pancreas head; report of a case (in Japanese with English abstract). Nippon Geka Gakkai Zasshi (J Jpn Surg Soc) 1987;88:773–777.

    CAS  Google Scholar 

  20. Tomita T, Bhatia P, Gourley W. Mucin producing islet cell adenoma. Hum Pathol 1981;12:850–853.

    Article  PubMed  CAS  Google Scholar 

  21. Reid JD, Yuh SL, Petrelli M, et al. Ductuloinsular tumors of the pancreas: A light, electron microscopic and immunohistochemical study. Cancer 1982;49:908–915.

    Article  PubMed  CAS  Google Scholar 

  22. Arihori K, Inai K. Malignant islet cell tumor of the pancreas with multiple hormone production and expression of CEA and CA19-9. Report of an autopsy case. Acta Pathol Jpn 1991;41:150–157.

    Google Scholar 

  23. Kashiwabara K, Nakajima T, Shinkai H, et al. A case of malignant duct-islet cell tumor of the pancreas: Immunohistochemical and cytofluorometric study. Acta Pathol Jpn 1991;41:636–641.

    PubMed  CAS  Google Scholar 

  24. Gitlin D, Perricelli A, Gitlin GM. Synthesis of alpha-fetoprotein by liver, yolk sac and gastrointestinal tract of the human conceptus. Cancers Res 1972;32:979–982.

    CAS  Google Scholar 

  25. Kawamoto S, Hiraoka T, Kanemitsu K, et al. Alpha-fetoprotein-producing pancreatic cancer—a case report and review of 28 cases. Hepatogastroenterology 1992;39:282–286.

    PubMed  CAS  Google Scholar 

  26. Kato K, Akai S, Tobita Y, et al. α-Fetoprotein-positive cases in cancer exept for hepatoma and malignant teratoma—review of data in Japan. Jpn J Cancer Clin 1974;20:376–382.

    Google Scholar 

  27. Hoorens A, Lemonie NR, McLellan E, et al., Pancreatic acinar cell carcinoma. An analysis of cell lineage markers, p53 expression, and ki-ras mutation. Am J Pathol 1993;143:685–698.

    PubMed  CAS  Google Scholar 

  28. Kawai S, Watanabe, K, Hirama S, et al. An alpha-fetoprotein-producing pancreatic carcinoma (in Japanese with English abstract). Jpn J Cancer Clin 1992;38:1013–1018.

    Google Scholar 

  29. Nojima T, Kojima T, Kato H, et al. Alpha-fetoprotein-producing acinar cell carcinoma of the pancreas. Hum Pathol 1992;23:828–830.

    Article  PubMed  CAS  Google Scholar 

  30. Shinagawa T, Tadokoro T, Maeyama S, et al. Alpha fetoprotein-producing acinar cell carcinoma of the pancreas showing multiple lines of differentiation. Virchows Arch 1995; 426:419–423.

    Article  PubMed  CAS  Google Scholar 

  31. Shimizu E, Kikuyama M, Hashimoto M, et al. A case of α-fetoprotein-producing pancreatic carcinoma. Review of 41 cases reported in Japan (in Japanese). Jpn J Gastroenterol 1996;93:921–926.

    CAS  Google Scholar 

  32. Yasuo E. Carcino-fetal antigens (in Japanese with English abstract). Nippon Rinsho 1996;54:1499–1504.

    Google Scholar 

  33. Ishiguro T, Yoshida Y. Molecular heterogenecity of alphafetoprotein in ovarian or extragonadal yolk sac tumor (in Japanese with English abstract). Acta Obstet Gynaecol Jpn 1991;43:391–398.

    CAS  Google Scholar 

  34. Fukuda H, Yano M, Houchi N, et al. A, case of nonseminomatous germ cell tumor: Usefulness of alphafetoprotein subfracton (in Japanese with English abstract). Hinyokika-Kiyo (Acta Urol Jpn) 1994;40:357–360.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Third Department of Internal Medicine, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, 812, Fukuoka, Japan

    Tomoko Shimoike, Masayoshi Goto, Itsuro Nakano, Takeaki Sato, Yoshikatsu Migita, Tetsuhide Ito, Toshihiko Yanase & Hajime Nawata

  2. Department of Gastroenterology and Pathology, Tokyo Police Hospital, Tokyo, Japan

    Shu-Ichi Sezai & Tsunemichi Suzuki

Authors
  1. Tomoko Shimoike
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Masayoshi Goto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Itsuro Nakano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takeaki Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Yoshikatsu Migita
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tetsuhide Ito
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Toshihiko Yanase
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Shu-Ichi Sezai
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tsunemichi Suzuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Hajime Nawata
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shimoike, T., Goto, M., Nakano, I. et al. Acinar-islet cell carcinoma presenting as insulinoma. J Gastroenterol 32, 830–835 (1997). https://doi.org/10.1007/BF02936964

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02936964

Key words

Search

Navigation