Malignant Insulinoma and Gallbladder Agenesis: A Case Report

Abstract

Insulinoma and gallbladder agenesis are rare pathologies and co-existence of these two pathologies is not reported previously. A 74-year-old woman was admitted to our clinic with syncope brought on by fasting. After 4 hours of fasting, the patient’s blood glucose level was 14 mg/dL (normal range: 70-105 mg/dL) and her insulin level was 89.9 μU/mL (normal range: 5-25μU/mL). The symptoms resolved after intake of highsugar
foods. Abdominal ultrasonography and computerized tomography revealed an approximately 1 cm-diameter lesion consistent with an insulinoma in the distal pancreas. Additionally gallbladder was not seen on these radiological examinations. During surgery, gallbladder agenesis was confirmed, and distal pancreatectomy and splenectomy were performed to remove the tumor, which was adhered to vessels. After surgery, the patient’s blood glucose and insulin levels returned to normal, and her symptoms improved. Histopathological examination of the specimen revealed a 1.6×1.5×1-cm malignant neuroendocrine tumor and a peripancreatic lymph node metastasis. The article details this rare case of malignant insulinoma combined with gallbladder agenesis and reviews the literature.