肝脏远期转移性恶性胰岛素瘤一例病例报道及文献复习  

Hepatic long-term metastatic malignant insulinoma:one case report and literature review

作　　者：秦瑶[1] 付真真[1] 周卫忠[2] 刘希胜[3] 李相成[4] 刘晓云[1] 张梅[1] Qin Yao;Fu Zhenzhen;Zhou Weizhong;Liu Xisheng;Li Xiangcheng;Liu Xiaoyun;Zhang Mei(Department of Endocrinology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Interventional Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Center of Liver Transplant,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院内分泌科,210029 [2]南京医科大学第一附属医院介入放射科,210029 [3]南京医科大学第一附属医院放射科,210029 [4]南京医科大学第一附属医院肝脏移植中心,210029

出　　处：《中华内分泌代谢杂志》2020年第11期970-974,共5页Chinese Journal of Endocrinology and Metabolism

摘　　要：本文报道1例胰腺胰岛素瘤术后12年肝转移的恶性胰岛素瘤病例。该患者48岁,女性,于2006年首次诊断胰腺胰岛素瘤,手术完整切除1.9 cm×1.3 cm肿瘤。术前影像学检查及术中探查无侵袭或转移性病灶,结合组织病理结果诊断为良性胰岛素瘤。在随后12年患者无低血糖发作,每年监测空腹血糖均正常。2018年患者体检空腹血糖2.8 mmol/L,逐渐出现心慌出冷汗症状,进食后缓解。2018年5月住院,血糖1.73 mmol/L,胰岛素1128 pmol/L。CT和MRI检查提示胰腺术后,肝脏异常信号。通过改良的选择性动脉钙刺激静脉采血(selective intra-arterial calcium stimulated venous sampling,ASVS)最终明确肝脏肿瘤分泌胰岛素。行肝部分切除术,组织病理结果为神经内分泌肿瘤,最终诊断为肝脏转移性恶性胰岛素瘤。This article reported a case of malignant insulinoma which recurred as liver metastasis 12 years after the initial pancreatic insulinoma resection.The patient was a 48-year-old woman who was firstly diagnosed as pancreatic insulinoma in 2006 and underwent the surgery involved complete resection of a 1.9 cm×1.3 cm tumor located in pancreas.No signs of either invasion or metastasis was detected according to preoperative imaging examination and intraoperative exploration.The tumor was diagnosed as a benign insulinoma according to histopathological results.The patient had no hypoglycemia and the fasting blood glucose was normal during the subsequent 12 years.The patient underwent a fasting blood glucose of 2.8 mmol/L in 2018,and gradually experienced palpitation and cold sweats,which was relieved by eating.She was hospitalized in May 2018 with blood glucose of 1.73 mmol/L and insulin of 1128 pmol/L.CT and MRI revealed morphologic changes of postoperative pancreas and abnormal liver signal,the liver tumor was finally identified as insulinoma by modified selective intra-arterial calcium stimulated venous sampling(ASVS).Partial liver resection was performed and the histopathological result was neuroendocrine tumor.Therefore,the disease was diagnosed as liver metastatic malignant insulinoma.

关 键 词：恶性胰岛素瘤 肝转移 选择性动脉钙刺激静脉采血 

分 类 号：R735.9[医药卫生—肿瘤]