Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
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Development of multifocal nodular lesions of a liver mimicking hepatic metastasis, following resection of an insulinoma in a child

  • Jung, Sook Young (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine) ;
  • Kang, Ben (Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Yoon Mee (Department of Surgery, Inha University Hospital, Inha University School of Medicine) ;
  • Kim, Jun Mee (Department of Pathology, Inha University Hospital, Inha University School of Medicine) ;
  • Kim, Soon Ki (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine) ;
  • Kwon, Young Se (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine) ;
  • Lee, Ji Eun (Department of Pediatrics, Inha University Hospital, Inha University School of Medicine)
  • Received : 2013.09.06
  • Accepted : 2013.10.14
  • Published : 2015.02.10
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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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References

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