Korean J Pediatr.  2015 Feb;58(2):69-72. 10.3345/kjp.2015.58.2.69.

Development of multifocal nodular lesions of a liver mimicking hepatic metastasis, following resection of an insulinoma in a child

• Jung SY
• Kang B
• Choi YM
• Kim JM
• Kim SK
• Kwon YS
• Lee JE

• KMID: 2140676
• DOI: http://doi.org/10.3345/kjp.2015.58.2.69

Abstract

Insulinoma, which arises from insulin-producing pancreatic beta cells, is a rare tumor in children. Only 5%-10% of insulinomas are malignant and undergo metastasis. We report a case of an 11-year-old girl who experienced hypoglycemia-related seizures induced by an insulinoma; after resection of the primary tumor, she developed hepatic focal nodular hyperplasia (FNH). Laboratory test results indicated marked hypoglycemia with hyperinsulinemia. Abdominal ultrasonography (US) and computed tomography results were normal; however, magnetic resonance imaging (MRI) showed a solid mass in the pancreatic tail. Therefore, laparoscopic distal pancreatectomy was performed. Two months after the surgery, an abdominal MRI revealed multiple nodular lesions in the liver. An US-guided liver biopsy was then performed, and histological examination revealed FNH without necrosis or mitotic activity. The patient has been free of hypoglycemia for 2 years, and recent MRI studies showed a decrease in the size of FNH lesions, without any evidence of metastasis. Even though no metastatic lesions are noted on imaging, close observation and follow-up imaging studies are required in a child with insulinoma that has malignant potential on histopathologic findings.

Keyword

Insulinoma; Focal nodular hyperplasia; Neoplasm metastasis; Pediatrics

MeSH Terms

Biopsy
Child*
Female
Focal Nodular Hyperplasia
Humans
Hyperinsulinism
Hypoglycemia
Insulin-Secreting Cells
Insulinoma*
Liver*
Magnetic Resonance Imaging
Necrosis
Neoplasm Metastasis*
Pancreatectomy
Pediatrics
Seizures
Ultrasonography