Pancreatic Insulinoma with a Rare Association of Gray Matter Heterotopia: A Case Report

Abstract

Abstract Background: Insulinoma is a functioning pancreatic neoplasm reported with some rare associations, but gray matter heterotopia has never been reported as its association in literature yet. Case Presentation: We report the case of a nineteen-year-old man, a diagnosed case of epilepsy, who presented with typical Whipple’s triad. Computerized tomography of abdomen revealed nodule in the head of pancreas raising suspicion of insulinoma. As a part of workup to rule out multiple endocrine neoplasia type 1, magnetic resonance imaging of brain was performed which showed incidental finding of two foci of gray matter heterotopia in left lateral ventricle: one nodular growth in frontal horn causing corrugated outline and the other nipple-like outpouching in sub-ependymal location near centrum semi-ovale. After localization of pancreatic lesion, organ preserving open enucleation of tumour was performed. Histopathology confirmed 1.6 x 1.4 x 1 cmgrade II well differentiated neuroendocrine tumour. Post-operative complication of pancreatico-cutaneous fistula arose for which pancreatic duct stent placement was done through endoscopic retrograde cholangio-pancreaticography. Leakage from wound persisted for which the wound was surgically re-explored to perform pancreatico-gastrostomy. Leakage resolved and patient was discharged within a week. Epilepsy correlating with his incidental finding of gray matter heterotopia responded well to anti-epileptic medication hence requiring no surgical intervention. Conclusion: We report gray matter heterotopia as a rare association of insulinoma which has never been reported in literature yet.