Insulin‐like growth factor II‐producing colonic carcinoma presenting with non‐islet cell tumor hypoglycemia: An autopsy report revealing neuroendocrine differentiation in the metastatic foci and literature review
Insulin‐like growth factor II‐producing colonic carcinoma presenting with non‐islet cell tumor hypoglycemia: An autopsy report revealing neuroendocrine differentiation in the metastatic foci and literature review
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DOI：
10.1111/pin.13205
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发表时间：
2022-01
影响因子：
2.2
通讯作者：
Shiori Kondo;Hirotsugu Hashimoto;K. Nakajima;Sakiko Miura;Jun Sakuma;I. Fukuda;T. Noie;Teppei Morikawa
中科院分区：
文献类型：
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作者：
Shiori Kondo;Hirotsugu Hashimoto;K. Nakajima;Sakiko Miura;Jun Sakuma;I. Fukuda;T. Noie;Teppei Morikawa
非胰岛细胞肿瘤低血糖症（NICTH）是一种非常罕见的与胰腺外肿瘤相关的严重低血糖症状。它被认为是由胰岛素样生长因子（IGF）-II引起的。目前尚无经血清高分子量和肿瘤IGF-II证实的NICTH结直肠癌尸检病例。我们报告的情况下，46岁的妇女与先进的乙状结肠癌和肝转移。她接受了开放性乙状结肠切除术，组织学上，病变为分化型管状腺癌。开始术后化疗。然而，她在手术后10个月反复发生低血糖发作，同时肝转移增加。我们检查了低血糖的原因，并最终诊断她患有与高分子量IGF-II产生相关的NICTH，这是通过血清的Western免疫印迹证明的。她在手术后12个月死亡，并进行了尸检。肝转移瘤表现为腺癌向神经内分泌分化癌的转变。免疫组织化学显示，转移性肝癌和原发性结肠腺癌均为IGF-II阳性。尸检证实肝转移瘤的神经内分泌分化可能有助于肿瘤生长，这可能加剧了症状。
Non‐islet cell tumor hypoglycemia (NICTH) is a very rare symptom of severe hypoglycemia associated with extrapancreatic tumors. It is considered to be caused by insulin‐like growth factor (IGF)‐II. There have been no autopsy cases of colorectal carcinoma with NICTH confirmed with both serum high molecular weight and tumoral IGF‐II. We report the case of a 46‐year‐old woman with advanced sigmoid colon cancer and liver metastases. She underwent open sigmoidectomy, and histologically, the lesion was a differentiated‐type tubular adenocarcinoma. Postoperative chemotherapy was initiated. However, she experienced repeated hypoglycemia attacks 10 months after the operation, while the liver metastases increased. We examined the cause of hypoglycemia, and finally diagnosed her with NICTH associated with high molecular weight IGF‐II production, which was proven by Western immunoblot of the serum. She died 12 months after surgery and was examined by autopsy. Liver metastases showed a transition from adenocarcinoma to carcinoma with neuroendocrine differentiation. Immunohistochemistry showed that both metastatic carcinoma of the liver and primary colonic adenocarcinoma were positive for IGF‐II. Neuroendocrine differentiation in liver metastases proven by an autopsy may have contributed to tumor growth, which may have exacerbated the symptoms.