Focal hepatic steatosis surrounding a metastatic insulinoma
Department of Pathology, Osaka Medical College, Takatsuki, Osaka, Japan.Pathology International (Impact Factor: 1.69). 02/2008; 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.
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ABSTRACT: A 52-year-old man went to his family doctor because of nonspecific abdominal complaints. The physical findings were unremarkable. The abdominal ultrasound unexpectedly showed a nonhomogeneous focal fatty sparing around the gallbladder fossa, which was the reason why the patient was referred for contrast-enhanced ultrasonography (CEUS). The native ultrasound showed focal fatty sparing around the gallbladder fossa, while the CEUS demonstrated a high-flow hemangioma with subsequent peritumoral fatty sparing caused by arterioportal shunts. MRI of the liver confirmed the hemangioma. Focal fatty sparing which is nonspecific and not typical in its localization should be carefully investigated, because it could be a peritumoral fatty sparing. The same is true for nonhomogeneous fatty sparing at a typical position. Special attention should be given to signs of shunting. The CEUS in low-MI mode provides a dynamic real-time examination and is the method of choice in this situation.DMW - Deutsche Medizinische Wochenschrift 07/2011; 136(30):1523-5. DOI:10.1055/s-0031-1281548 · 0.54 Impact Factor
Article: Hyperechogenic liver lesion.[Show abstract] [Hide abstract]
ABSTRACT: Current paper focuses on an ultrasonography image representing a hyperechogenic liver lesion that appeared in less than a year time in a patient with clinical alarm signs. There are also described the steps for the final diagnosis, that proved to be geographical map steatosis and possible differential diagnoses together with brief literature correlations.07/2011; 6(3):213-4.
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