Journal of Gastroenterology

, Volume 32, Issue 6, pp 830–835 | Cite as

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
Case Report


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.

Key words

acinar-islet cell carcinoma insulinoma α-fetoprotein trypsin liver metastases 


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Copyright information

© Springer-Verlag 1997

Authors and Affiliations

  • Tomoko Shimoike
    • 1
  • Masayoshi Goto
    • 1
  • Itsuro Nakano
    • 1
  • Takeaki Sato
    • 1
  • Yoshikatsu Migita
    • 1
  • Tetsuhide Ito
    • 1
  • Toshihiko Yanase
    • 1
  • Shu-Ichi Sezai
    • 2
  • Tsunemichi Suzuki
    • 2
  • Hajime Nawata
    • 1
  1. 1.Third Department of Internal Medicine, Faculty of MedicineKyushu UniversityFukuokaJapan
  2. 2.Department of Gastroenterology and PathologyTokyo Police HospitalTokyoJapan

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