Toyomasu Yoshitaka, Fukuchi Minoru, Yoshida Takatomo, Tajima Kohei, Osawa Hidenobu, Motegi Masahiko, Iijima Toshihide, Nagashima Kikuo, Ishizaki Masatoshi, Mochiki Erito, Kuwano Hiroyuki
Department of General Surgical Science (Surgery I), Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma 371-8511, Japan.
Am Surg. 2009 Apr;75(4):331-4.
An 82-year-old man was admitted to our hospital with a complaint of hypoglycemic syncope in the early morning. Insulinoma was suspected, but an abdominal CT showed no mass. Abdominal angiography showed a slight stain fed from the splenic artery. Arterial stimulation and venous sampling (ASVS) showed an abnormal insulin response only from the splenic artery. Under a provisional diagnosis of insulinoma, surgical treatment was undertaken. Although no pancreatic masses were palpable, we performed a distal pancreatectomy. Subsequently, a pathological examination revealed diffuse nesidioblastosis. Reported cases of diffuse nesidioblastosis have had common clinical features: postprandial hyperinsulinemic hypoglycemia, no abnormal findings in radiological examinations, and the presence of the ductulo-insular complex on histological examination. Surgical resection is recommended, but the extent of surgery is controversial. Our case had some clinical features of insulinoma but was diagnosed as diffuse nesidioblastosis according to histopathologic criteria. Because ASVS showed that the pancreatic body and tail had a lesion producing insulin abnormally, we performed a distal pancreatectomy to cure the hypoglycemia. Clinically, it is very difficult to distinguish diffuse nesidioblastosis from insulinoma. When we treat hyperinsulinemic hypoglycemia, ASVS can be an essential examination to decide the extent of pancreatectomy.
一名82岁男性因清晨低血糖晕厥入院。怀疑患有胰岛素瘤，但腹部CT未发现肿块。腹部血管造影显示脾动脉供血处有轻微染色。动脉刺激与静脉采血（ASVS）显示仅脾动脉有异常胰岛素反应。在胰岛素瘤的初步诊断下，进行了手术治疗。尽管未触及胰腺肿块，但我们还是进行了胰腺远端切除术。随后，病理检查显示为弥漫性胰岛母细胞增生症。已报道的弥漫性胰岛母细胞增生症病例具有共同的临床特征：餐后高胰岛素血症性低血糖、影像学检查无异常发现以及组织学检查发现存在导管-胰岛复合体。建议进行手术切除，但手术范围存在争议。我们的病例具有一些胰岛素瘤的临床特征，但根据组织病理学标准诊断为弥漫性胰岛母细胞增生症。由于ASVS显示胰体和胰尾有异常产生胰岛素的病变，我们进行了胰腺远端切除术以治愈低血糖。临床上，很难将弥漫性胰岛母细胞增生症与胰岛素瘤区分开来。当我们治疗高胰岛素血症性低血糖时，ASVS可能是决定胰腺切除范围的重要检查。
