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Pancreatic insulinoma co-existing with gastric GIST in the absence of neurofibromatosis-1.

Alabraba E, Bramhall S, O'Sullivan B, Mahon B, Taniere P - World J Surg Oncol (2009)

Bottom Line: A 76 year old woman presented with a 12 month history of hypoglycaemia symptoms.Abdominal CT scan demonstrated a 13 mm insulinoma localized in the tail of her pancreas.In addition, we make the first report of rapidly growing cystic GIST recurrence following resection of a primary GIST tumour.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Birmingham and UHB Foundation NHS Trust, Birmingham, UK. e.b.alabraba@bham.ac.uk

ABSTRACT

Background: Gastrointestinal stromal tumours (GIST) frequently occur in patients with neurofibromatosis type 1 (NF-1). It has been reported that GIST may co-exist with pancreatic endocrine tumors but this has only been in association with NF-1.

Case presentation: A 76 year old woman presented with a 12 month history of hypoglycaemia symptoms. Abdominal CT scan demonstrated a 13 mm insulinoma localized in the tail of her pancreas. She was commenced on diazoxide and later underwent surgery for enucleation of insulinoma when a small (< 1 cm) incidental tumour was discovered on her stomach wall which was identified as GIST.

Conclusion: This is the first case report of a pancreatic insulinoma co-existing with a GIST in a patient without NF-1. In addition, we make the first report of rapidly growing cystic GIST recurrence following resection of a primary GIST tumour.

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EUS-guided aspiration biopsy cytology of recurrent GIST showing clusters of atypical epithelioid and spindle cells (PAP ×400).
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Figure 4: EUS-guided aspiration biopsy cytology of recurrent GIST showing clusters of atypical epithelioid and spindle cells (PAP ×400).

Mentions: She subsequently underwent oesophagogastroduodenoscopy-guided endoscopic ultrasound confirming an ill-defined mass extending into the stomach wall. Cytology revealed groups of spindly and epithelioid cells highly suggestive of recurrent/metastatic GIST but not indicative of a neuroendocrine tumour (figure 4). She was managed symptomatically, discharged and had another abdominal CT scan 7 months later that showed that the lesion had not significantly grown in size, but did appear to have formed 2 well defined cystic components measuring 29 × 28 mm, and 21 × 24 mm. Owing to the small size of the primary GIST and the frail state of the patient, she was not treated with Imatinib (Glivec) or offered further surgery but has subsequently been regularly reviewed by CT scan surveillance of the lesion and has fortunately had no evidence of tumour size increase or metastases.


Pancreatic insulinoma co-existing with gastric GIST in the absence of neurofibromatosis-1.

Alabraba E, Bramhall S, O'Sullivan B, Mahon B, Taniere P - World J Surg Oncol (2009)

EUS-guided aspiration biopsy cytology of recurrent GIST showing clusters of atypical epithelioid and spindle cells (PAP ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2651171&req=5

Figure 4: EUS-guided aspiration biopsy cytology of recurrent GIST showing clusters of atypical epithelioid and spindle cells (PAP ×400).
Mentions: She subsequently underwent oesophagogastroduodenoscopy-guided endoscopic ultrasound confirming an ill-defined mass extending into the stomach wall. Cytology revealed groups of spindly and epithelioid cells highly suggestive of recurrent/metastatic GIST but not indicative of a neuroendocrine tumour (figure 4). She was managed symptomatically, discharged and had another abdominal CT scan 7 months later that showed that the lesion had not significantly grown in size, but did appear to have formed 2 well defined cystic components measuring 29 × 28 mm, and 21 × 24 mm. Owing to the small size of the primary GIST and the frail state of the patient, she was not treated with Imatinib (Glivec) or offered further surgery but has subsequently been regularly reviewed by CT scan surveillance of the lesion and has fortunately had no evidence of tumour size increase or metastases.

Bottom Line: A 76 year old woman presented with a 12 month history of hypoglycaemia symptoms.Abdominal CT scan demonstrated a 13 mm insulinoma localized in the tail of her pancreas.In addition, we make the first report of rapidly growing cystic GIST recurrence following resection of a primary GIST tumour.

View Article: PubMed Central - HTML - PubMed

Affiliation: University of Birmingham and UHB Foundation NHS Trust, Birmingham, UK. e.b.alabraba@bham.ac.uk

ABSTRACT

Background: Gastrointestinal stromal tumours (GIST) frequently occur in patients with neurofibromatosis type 1 (NF-1). It has been reported that GIST may co-exist with pancreatic endocrine tumors but this has only been in association with NF-1.

Case presentation: A 76 year old woman presented with a 12 month history of hypoglycaemia symptoms. Abdominal CT scan demonstrated a 13 mm insulinoma localized in the tail of her pancreas. She was commenced on diazoxide and later underwent surgery for enucleation of insulinoma when a small (< 1 cm) incidental tumour was discovered on her stomach wall which was identified as GIST.

Conclusion: This is the first case report of a pancreatic insulinoma co-existing with a GIST in a patient without NF-1. In addition, we make the first report of rapidly growing cystic GIST recurrence following resection of a primary GIST tumour.

Show MeSH
Related in: MedlinePlus