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Rare disease
CASE REPORT
Ectopic insulinomas in the pelvis secondary to rectum neuroendocrine tumour
  1. Tian-NV Li1,
  2. Zijun Liu2,
  3. Yingdong Zhang3,
  4. Feng Wang4
  1. 1Nuclear Medicine, The First Affiliated Hospital of Nanjing Medical Univerity, Nanjing, Jiangsu, China
  2. 2Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
  3. 3Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
  4. 4Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
  1. Correspondence to Professor Feng Wang, fengwangcn{at}hotmail.com

Summary

We describe a middle-aged woman with recurrent hypoglycaemia, who confirmed with rectum G1 neuroendocrine tumour (NET) 6 years ago. Biochemical assay showed high concentration of serum insulin and C-peptide associated with hypoglycaemia. Because of recurrent hypoglycaemia in June 2015, she underwent a resection of the tail of the pancreas. However, hypoglycaemia attack happened more frequently and severely. 68Ga-DOTA-NOC positron emission tomography/CT revealed five foci in the pelvis with intense uptake. Immediately after excision of the pelvic lesions, insulin and C-peptide decreased to normal levels promptly, and therefore, serum glucose increased significantly. Hypoglycaemia was disappeared, and insulin and C-peptide were normal at 2 years follow-up after surgery. Immunohistochemistry validated the primary rectum NET and pelvic tumours expressed with higher insulin, somatostatin receptor and glucagon-like peptide-1. This is the first reported ectopic pelvic insulinomas secondary to rectum NET, which may originate both from neuroendocrine cells in the rectum and pelvic tissues.

  • radiology (diagnostics)
  • endocrine cancer
  • radiology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bcr-2018-224281

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    Footnotes

    • Contributors T-NVL was responsible for 68Ga-DOTA-NOC PET/CT and image interpretation. FW was responsible for radiolabelling and clinical management and manuscript preparation. LL was involved in the operation and tumour resection. YZ was involved in the mechanism exploration and clinical management including histopathology analysis.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.