Hagiwara Seiya, Taneda Shinji, Fukumoto Takaya, Hagiwara Kazuya, Kikuchi Minoru, Kimura Tetsunori, Nakayama Hidetaka, Manda Naoki
Manda Memorial Hospital Diabetes Center, Sapporo, Japan.
Fukumoto Dermatopathology Clinic, Nara, Japan.
Case Rep Endocrinol. 2017;2017:3985214. doi: 10.1155/2017/3985214. Epub 2017 Dec 18.
A 62-year-old man with type 2 diabetes mellitus, who had been on insulin therapy for the past 20 years, was found to have subcutaneous mass formation in the abdomen during a workup of worsened glycemic control. Because of suspected amyloid deposition, he was advised to avoid injections to the mass, which led to improvement of glycemic control. However, he strongly requested mass excision and was hospitalized. After evaluation using ultrasonography and computed tomography, a total mass excision was performed, and a diagnosis of insulin-derived amyloidosis was made. Comparison of the ultrasonographic and histopathological findings demonstrated that the location of the amyloid deposition nearly corresponded to the hypoechoic region. This case highlights that ultrasonography, which is a noninvasive imaging modality, can be useful for detection of insulin-derived amyloidosis.
一名62岁的2型糖尿病男性，过去20年来一直接受胰岛素治疗，在血糖控制恶化的检查过程中，发现腹部有皮下肿块形成。由于怀疑有淀粉样蛋白沉积，建议他避免在肿块处注射，这使得血糖控制得到改善。然而，他强烈要求切除肿块并住院治疗。在使用超声和计算机断层扫描进行评估后，进行了肿块全切术，并诊断为胰岛素源性淀粉样变。超声检查结果与组织病理学结果的比较表明，淀粉样蛋白沉积的位置几乎与低回声区域相对应。该病例突出表明，超声检查作为一种非侵入性成像方式，可用于检测胰岛素源性淀粉样变。
