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Korean J Pediatr. 2015 Feb;58(2):69-72. English. Case Report. https://doi.org/10.3345/kjp.2015.58.2.69
Jung SY , Kang B , Choi YM , Kim JM , Kim SK , Kwon YS , Lee JE .
Department of Pediatrics, Inha University Hospital, Inha University School of Medicine, Incheon, Korea. anicca@inha.ac.kr
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Department of Surgery, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
Department of Pathology, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
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.

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