Takeshita Atsushi, Yamamoto Kazuhiro, Fujita Atsushi, Hanafusa Toshiaki, Yasuda Emi, Shibayama Yuro
Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan.
Pathol Int. 2008 Jan;58(1):59-63. doi: 10.1111/j.1440-1827.2007.02190.x.
Reported herein is a case of focal hepatic steatosis surrounding a metastatic insulinoma in the liver of a 69-year-old woman. The patient complained of losing consciousness after meals, and hypoglycemia and hyperinsulinemia were confirmed. On CT and abdominal angiography a mass, 1 cm in diameter, was seen in the tail of the pancreas. In the early phase of dynamic CT a mass, 5 mm in diameter, was seen in the liver. In the late phase this mass appeared to be 3 cm in diameter. An arterial calcium stimulation/venous sampling test showed insulin levels after calcium injections in the hepatic artery to be extremely high. Thus, the liver tumor was diagnosed as a metastatic insulinoma, and distal pancreatectomy and partial resection of the liver were performed. The pancreatic tumor cells were immunohistochemically positive for insulin. The liver tumor was pale yellow. A white area surrounded the tumor. Histologically, the liver tumor was an insulinoma and the white area was focal fatty change of the liver. High insulin levels are said to inhibit oxidation of free fatty acids into triglycerides, causing free fatty acids to accumulate in hepatocytes. Focal hepatic steatosis caused by the local effects of insulin can present as a focal rim surrounding a metastatic insulinoma.
本文报道了一例69岁女性肝脏中转移性胰岛素瘤周围局灶性肝脂肪变性的病例。患者餐后出现意识丧失，经确认存在低血糖和高胰岛素血症。在CT和腹部血管造影检查中，胰腺尾部可见一个直径1厘米的肿块。动态CT早期，肝脏可见一个直径5毫米的肿块。晚期该肿块直径似乎为3厘米。动脉钙刺激/静脉采血试验显示，肝动脉注射钙后胰岛素水平极高。因此，肝脏肿瘤被诊断为转移性胰岛素瘤，并进行了远端胰腺切除术和肝脏部分切除术。胰腺肿瘤细胞胰岛素免疫组化呈阳性。肝脏肿瘤呈淡黄色，肿瘤周围有白色区域。组织学检查显示，肝脏肿瘤为胰岛素瘤，白色区域为肝脏局灶性脂肪变性。据说高胰岛素水平会抑制游离脂肪酸氧化为甘油三酯，导致游离脂肪酸在肝细胞中积聚。由胰岛素局部作用引起的局灶性肝脂肪变性可表现为转移性胰岛素瘤周围的局灶性边缘。
