RESUMO
Glucagonoma syndrome is an extremely rare paraneoplastic disorder. The key presenting feature is a rash (necrolytic migratory erythema) which can easily be misdiagnosed as a primary skin disorder. Moreover, 50 to 80 % of patients already have metastatic disease at diagnosis. We report a case of a 38-year female presenting with epigastric pain and a skin rash all over the body. Workup revealed a neuroendocrine tumor (NET) of the pancreas, for which she underwent resection, resulting in a complete cure. A follow-up MRI after 8 months showed a hyperintense and arterially enhancing nodular liver lesion which did not show any uptake on the octreotide scan. However, a subsequent biopsy revealed a recurrence of the tumor. This was a unique finding in our case where a highly sensitive octreotide scan failed to identify metastasis, emphasising the importance of biopsy in such cases. Key Words: Glucagonoma, Necrolytic migratory erythema, Alpha-cell adenom.
Assuntos
Glucagonoma , Eritema Migratório Necrolítico , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Feminino , Glucagonoma/complicações , Glucagonoma/diagnóstico , Glucagonoma/cirurgia , Humanos , Eritema Migratório Necrolítico/diagnóstico , Eritema Migratório Necrolítico/etiologia , Eritema Migratório Necrolítico/patologia , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Octreotida/uso terapêutico , Pâncreas/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Doenças RarasAssuntos
Eritema Migratório Necrolítico , Tumores Neuroendócrinos , Neoplasias Pancreáticas , Humanos , Eritema Migratório Necrolítico/etiologia , Eritema Migratório Necrolítico/patologia , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , NecroseRESUMO
Glucagonoma is an extremely rare neuroendocrine tumor that arises from pancreatic islet alpha cells. Although glucagonoma is usually accompanied by a variety of characteristic clinical symptoms, early diagnosis is still difficult due to the scarcity of the disease. In this study, we present the cumulative experiences, clinical characteristics and treatments of seven patients diagnosed with glucagonoma during the past 10 years at the First Affiliated Hospital of Xi'an Jiaotong University. The seven patients in our cohort consisted of six females and one male with an average diagnosis age of 40.1 years (range 23-51). The average time from onset of symptoms to diagnosis of glucagonoma was 14 months (range 2-36 months). All the patients visited dermatology first for necrolytic migratory erythema (NME) 7/7 (100%), and other presenting symptoms included diabetes mellitus (DM) 4/7 (57%), stomatitis 2/7 (28%), weight loss 4/7 (57%), anemia 4/7 (57%), diarrhea 1/7 (14%), and DVT1/7 (14%). Plasma glucagon levels were increased in all patients (range 216.92-3155 pg/mL) and declined after surgery. Imaging studies revealed that four of seven patients had liver metastasis. Six of seven patients received surgical resection, and all of them received somatostatin analog therapy. Symptoms improved significantly in 6 out of 7 patients. Three of seven patients died of this disease by the time of follow-up. Our data suggest that if persistent NME is associated with DM and high glucagon levels, timely abdominal imaging should be performed to confirm glucagonoma. Once diagnosed, surgery and somatostatin analogs are effective for symptom relief and tumor control.
Assuntos
Diabetes Mellitus , Glucagonoma , Eritema Migratório Necrolítico , Neoplasias Pancreáticas , Adulto , Feminino , Glucagon , Glucagonoma/complicações , Glucagonoma/diagnóstico , Glucagonoma/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/diagnóstico , Eritema Migratório Necrolítico/etiologia , Eritema Migratório Necrolítico/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patologia , Somatostatina , Adulto JovemRESUMO
This case concerns an 81-year-old man with weight loss and erythematosquamous plaques, with central clearing and atrophy. Due to a CT scan and blood test the diagnosis necrolytic migratory erythema as a paraneoplastic manifestation of glucagonoma was made. The pathogenesis is not completely elucidated. Early recognition of symptoms is important.
Assuntos
Glucagonoma , Eritema Migratório Necrolítico , Neoplasias Pancreáticas , Idoso de 80 Anos ou mais , Eritema/diagnóstico , Eritema/etiologia , Glucagonoma/complicações , Glucagonoma/diagnóstico , Humanos , Masculino , Eritema Migratório Necrolítico/diagnóstico , Eritema Migratório Necrolítico/etiologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Tomografia Computadorizada por Raios X , Redução de PesoAssuntos
Glucagonoma , Eritema Migratório Necrolítico , Neoplasias Pancreáticas , Glucagonoma/complicações , Glucagonoma/diagnóstico , Glucagonoma/cirurgia , Humanos , Eritema Migratório Necrolítico/diagnóstico , Eritema Migratório Necrolítico/etiologia , Necrose , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgiaRESUMO
Necrolytic migratory erythema is most commonly associated with glucagonoma syndrome. We report a rare case of glucagonoma syndrome with necrolytic migratory erythema presenting as pruritic papules and follicular pustules in a 57-year-old woman; showing eosinophilic infiltration on histology. However, the final diagnosis was confirmed by demonstrating neuroendocrine tumour on histopathological examination of the liver metastases. Nutrition therapy was administered as a palliative treatment. This case also highlights the atypical clinical features and nonspecific histology of necrolytic migratory erythema which makes the diagnosis difficult.
Assuntos
Glucagonoma/patologia , Eritema Migratório Necrolítico/patologia , Síndromes Paraneoplásicas/diagnóstico , Feminino , Glucagonoma/etiologia , Humanos , Neoplasias Hepáticas/secundário , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/etiologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/secundário , Neoplasias Pancreáticas/patologiaRESUMO
No disponible
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/etiologia , Glucagonoma/complicações , Síndromes Endócrinas Paraneoplásicas/etiologia , Eritema Migratório Necrolítico/patologia , Eritema Migratório Necrolítico/tratamento farmacológico , Síndromes Endócrinas Paraneoplásicas/patologiaAssuntos
Glucagonoma/complicações , Eritema Migratório Necrolítico/etiologia , Neoplasias Pancreáticas/complicações , Complicações do Diabetes , Glucagonoma/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/patologia , Pâncreas/diagnóstico por imagem , Neoplasias Pancreáticas/diagnóstico por imagem , Radiografia Abdominal , Tomografia Computadorizada por Raios XAssuntos
Glucagonoma/cirurgia , Eritema Migratório Necrolítico/etiologia , Pancreatectomia/métodos , Neoplasias Pancreáticas/cirurgia , Glucagon/sangue , Glucagonoma/complicações , Glucagonoma/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/patologia , Eritema Migratório Necrolítico/terapia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Doenças Raras , Recuperação de Função Fisiológica , Medição de Risco , Síndrome , Resultado do Tratamento , Redução de PesoAssuntos
Glucagonoma , Eritema Migratório Necrolítico , Neoplasias Pancreáticas , Eritema/etiologia , Glucagonoma/complicações , Glucagonoma/diagnóstico , Humanos , Eritema Migratório Necrolítico/diagnóstico , Eritema Migratório Necrolítico/etiologia , Necrose , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnósticoRESUMO
RATIONALE: Glucagonoma is a rare type of functional pancreatic neuroendocrine tumor that is characterized by distinctive clinical manifestations; among these, necrolytic migratory erythema represents the hallmark clinical sign of glucagonoma syndrome and is usually presented as the initial complaint of patients. PATIENT CONCERNS: A 30-year-old male patient was admitted to our hospital with a complaint of diffuse erythematous ulcerating skin rash for more than 10 months. He also complained of hyperglycemia and a weight loss of 15âkg in those months. DIAGNOSIS: This patient underwent a contrast-enhanced computed tomography scan which showed a pancreatic body mass measuring approximately 6âcm with low density accompanied by partial calcification in plain scanning images and uneven enhancement in strengthening periods. In addition, laboratory tests indicated elevated fasting blood glucagon (1109âpg/mL, normal range: 50-150âpg/mL) levels. Glucagonoma syndrome was ultimately diagnosed in clinical. INTERVENTION: Spleen-preserving distal pancreatectomy was conducted and postoperative pathology revealed the presence of glucagonoma. OUTCOMES: The patient recovered uneventfully with the glucagonoma syndrome disappeared soon after surgery, and the postoperative plasma glucagon decreased to a normal level. Follow-up showed no recurrence for 5 years since the surgery. LESSONS: The treatment of glucagonoma should be directed according to the stage at which the disease is diagnosed. Surgery is currently the only method available to cure the tumor, although medications are given to patients who present with advanced glucagonoma and who are not candidates for operation. Multidisciplinary therapy and multimodality treatment are advised, although these have been systematically evaluated to a lesser degree.
Assuntos
Glucagonoma/diagnóstico , Eritema Migratório Necrolítico/etiologia , Neoplasias Pancreáticas/diagnóstico , Adulto , Diagnóstico Diferencial , Glucagonoma/complicações , Glucagonoma/diagnóstico por imagem , Glucagonoma/cirurgia , Humanos , Excisão de Linfonodo , Masculino , Pancreatectomia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Baço , Síndrome , Tomografia Computadorizada por Raios XRESUMO
A 70-year-old man reported progressive weight loss, fatigue and a generalised rash. The rash was consistent with necrolytic migratory erythema, further investigations were performed and the patient was diagnosed with a mass in the tail of the pancreas, in keeping with a localised glucagonoma. Somatostatin analogue therapy was started for symptom control, leading to complete resolution of the skin rash and an improvement in constitutional symptoms. Subsequently, the pancreatic lesion was excised, and pathology assessment confirmed the diagnosis of well-differentiated neuroendocrine tumour with high expression of glucagon compatible with glucagonoma.
Assuntos
Glucagonoma/diagnóstico , Eritema Migratório Necrolítico/tratamento farmacológico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Somatostatina/análogos & derivados , Idoso , Glucagonoma/complicações , Glucagonoma/cirurgia , Humanos , Injeções , Masculino , Eritema Migratório Necrolítico/etiologia , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/cirurgia , Somatostatina/administração & dosagemAssuntos
Glucagon/sangue , Glucagonoma/etiologia , Eritema Migratório Necrolítico/etiologia , Idoso , Glucagonoma/sangue , Glucagonoma/diagnóstico por imagem , Glucagonoma/terapia , Humanos , Masculino , Eritema Migratório Necrolítico/sangue , Eritema Migratório Necrolítico/terapia , Neoplasias Pancreáticas/sangue , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia Computadorizada por Raios XAssuntos
Glucagonoma/complicações , Eritema Migratório Necrolítico/etiologia , Neoplasias Pancreáticas/complicações , Síndromes Endócrinas Paraneoplásicas/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/patologia , Síndromes Endócrinas Paraneoplásicas/patologia , FotografaçãoAssuntos
Glucagonoma/diagnóstico , Eritema Migratório Necrolítico/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Pele/patologia , Biópsia , Glucagonoma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Eritema Migratório Necrolítico/etiologia , Eritema Migratório Necrolítico/patologia , Neoplasias Pancreáticas/complicaçõesRESUMO
Necrolytic migratory erythema (NEM) is associated with glucagonoma, an endocrine malignancy of the pancreas. It is a rare and a likely underrecognized paraneoplastic dermatitis. A 38-year-old woman presented to our clinic with a 3-year history of reocurring pruritic skin rashes with increasing intensity. The skin lesions presented with active annular borders, central scaling, and postinflammatory hyperpigmentation, but also with erosions, pustules, and crusted lesions. Multiple skin biopsies were taken. The workup of the patient revealed a tumor localized in the head of the pancreas, and glucagon serum levels were elevated. Clues to the diagnosis of NEM were the waxing and waning of serpiginous erythemas with active borders localized on extremities, intertriginous areas, and face. On histopathology, dyskeratosis in all layers of the epidermis were an early feature of NEM, and long-standing lesions typically showed psoriasiform hyperplasia with pallor and necrosis of upper epidermal layers. Clinicians and histopathologists need to be aware of the wide spectrum of skin manifestations in glucagonoma. Early diagnosis of the tumor is crucial for patients.
Assuntos
Glucagonoma/complicações , Eritema Migratório Necrolítico/patologia , Neoplasias Pancreáticas/complicações , Síndromes Paraneoplásicas/patologia , Pele/patologia , Adulto , Biópsia , Evolução Fatal , Feminino , Glucagonoma/diagnóstico por imagem , Glucagonoma/cirurgia , Humanos , Excisão de Linfonodo , Eritema Migratório Necrolítico/etiologia , Pancreatectomia , Neoplasias Pancreáticas/diagnóstico por imagem , Neoplasias Pancreáticas/cirurgia , Síndromes Paraneoplásicas/etiologia , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Carcinoma Neuroendócrino/diagnóstico por imagem , Linfoma de Células B/diagnóstico por imagem , Eritema Migratório Necrolítico/etiologia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Compostos Organometálicos/administração & dosagem , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos/administração & dosagem , Idoso , Biópsia , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/patologia , Humanos , Imuno-Histoquímica , Linfoma de Células B/complicações , Linfoma de Células B/patologia , Imageamento por Ressonância Magnética , Masculino , Eritema Migratório Necrolítico/diagnóstico , Gradação de Tumores , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/patologia , Neoplasias Pancreáticas/complicações , Neoplasias Pancreáticas/patologia , Valor Preditivo dos TestesAssuntos
Glucagonoma/complicações , Eritema Migratório Necrolítico/etiologia , Neoplasias Pancreáticas/complicações , Adulto , Glicemia/metabolismo , Glucagon/sangue , Glucagonoma/sangue , Hemoglobinas Glicadas/metabolismo , Humanos , Masculino , Eritema Migratório Necrolítico/patologia , Neoplasias Pancreáticas/sangueRESUMO
Necrolytic migratory erythema (NME) is a rare skin disorder that is a cutaneous manifestation of the glucagonoma syndrome. It presents with annular eruptions of migrating erythematous papules and plaques with superficial epidermal necrosis, central flaccid bullae, and crusted erosions located primarily in the intertriginous areas. Treatment with the long-acting somatostatin analog Octreotide is a potential therapy to help ameliorate skin symptoms. We present a case of a patient with a 1-year history of a pancreatic glucagonoma that developed an ulcerated, plaque-like, weeping rash over multiple areas of their body despite current treatment with Octreotide and stable pancreatic tumor staging. The patient had a similar rash when initially diagnosed with a glucagonoma, and it quickly improved after Octreotide treatment. Clinical examination and biopsy were consistent with necrolytic migratory erythema due to an underlying glucagonoma. This rare case adds to our understanding of the clinical presentation of NME, as well as highlights the relapsing and remitting course, even if the underlying pancreatic tumor is stable and the patient is undergoing treatment.