Report of a Novel Molecular Profile in Malignant Insulinoma

Author:

Burns Laura1ORCID,Naimi Bita2ORCID,Ronan Matthew34,Xu Huihong3ORCID,Weber Horst Christian13ORCID

Affiliation:

1. Department of Medicine, Boston University School of Medicine and Boston Medical Center, Boston, MA 02118, USA

2. Boston University School of Medicine, Boston, MA 02118, USA

3. VA Boston Healthcare System, Boston, MA 02130, USA

4. Department of Medicine, Harvard Medical School, Boston, MA 02115, USA

Abstract

Pancreatic neuroendocrine tumors, or pNETs, represent a rare and clinically heterogenous subset of pancreatic neoplasms. One such pNET, the insulinoma, is found to be malignant in just 4% of all insulinomas. Due to the exceedingly uncommon occurrence of these tumors, there is controversy regarding the optimal evidence-based management for these patients. We therefore report on a 70-year-old male patient admitted with 3 months of episodic confusion with concurrent hypoglycemia. The patient was found to have inappropriately elevated endogenous insulin levels during these episodes, and somatostatin-receptor subtype 2 selective imaging revealed a pancreatic mass metastatic to local lymph nodes, spleen, and the liver. Fine needle aspiration of pancreatic and liver lesions confirmed the diagnosis of a low grade pancreatic neuroendocrine tumor. Molecular analysis of tumor tissue revealed a novel mutational profile consistent with pNET. The patient was initiated on octreotide therapy. However, treatment with octreotide alone demonstrated limited efficacy in controlling the patient’s symptoms, prompting consideration of other therapies.

Publisher

MDPI AG

Subject

General Medicine

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