1
|
Garla V, Sonani H, Palabindala V, Gomez-Sanchez C, Subauste J, Lien LF. Non-islet Cell Hypoglycemia: Case Series and Review of the Literature. Front Endocrinol (Lausanne) 2019; 10:316. [PMID: 31156561 PMCID: PMC6529841 DOI: 10.3389/fendo.2019.00316] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/01/2019] [Indexed: 12/30/2022] Open
Abstract
Non-islet cell hypoglycemia (NICH) is hypoglycemia due to the overproduction of insulin-like growth factor-2 (IGF-2) and its precursors which can activate the insulin receptor. Typically, large mesenchymal and epithelial tumors can cause NICH. Diagnosis is confirmed by finding an elevated IGF-2/IGF-1 ratio. The mainstay of treatment is surgical excision. Glucocorticoids may be used in cases where surgery is not possible. We present two cases of NICH with different outcomes. A 33-year-old male patient admitted with altered mental. He was found walking naked outside his house. Laboratory assessment revealed severe hypoglycemia. Further evaluation showed low levels of insulin, C-peptide, and beta-hydroxybutyrate along with an elevated IGF-2/IGF-1 ratio confirming the diagnosis of NICH. Computed tomography (CT) of the abdomen showed a massive tumor of the liver consistent with hepatocellular carcinoma. Since the patient refused surgery, he was started on prednisone however the hypoglycemia persisted. A 54-year-old female patient with a history of type 2 diabetes mellitus (DM) admitted with recent onset hypoglycemia. Despite stopping her insulin, she continued to have hypoglycemia necessitating the administration of high concentrations of intravenous dextrose. Further evaluation showed low levels of insulin, C-peptide, and beta-hydroxybutyrate along with an elevated IGF-2/IGF-1 ratio consistent with the diagnosis of NICH. CT abdomen showed a 24 cm tumor near the uterus. The pathology was consistent with a gastrointestinal stromal tumor (GIST). After surgical excision of the tumor, the hypoglycemia resolved.
Collapse
Affiliation(s)
- Vishnu Garla
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
- *Correspondence: Vishnu Garla
| | - Hardik Sonani
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Venkatraman Palabindala
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Celso Gomez-Sanchez
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jose Subauste
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| | - Lillian Francis Lien
- Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, United States
| |
Collapse
|
2
|
Affiliation(s)
- V Marks
- Area Laboratory, West Park Hospital, Epsom
| | - E Samols
- Department of Medicine, Royal Free Hospital, London
| |
Collapse
|
3
|
Dynkevich Y, Rother KI, Whitford I, Qureshi S, Galiveeti S, Szulc AL, Danoff A, Breen TL, Kaviani N, Shanik MH, Leroith D, Vigneri R, Koch CA, Roth J. Tumors, IGF-2, and hypoglycemia: insights from the clinic, the laboratory, and the historical archive. Endocr Rev 2013; 34:798-826. [PMID: 23671155 DOI: 10.1210/er.2012-1033] [Citation(s) in RCA: 136] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Tumors of mesenchymal and epithelial origin produce IGF-2, which activates pathways in the tumors. In a minority of patients, the tumors (hepatomas, fibromas, and fibrosarcomas are the most common among many) release into the circulation enough IGF-2-related peptides to mimic the fasting hypoglycemia characteristic of patients with insulin-producing islet-cell tumors. Rarely, markedly elevated IGF-2 levels produce somatic changes suggestive of acromegaly. Typically, the elevated IGF-2 levels are associated with suppressed plasma levels of insulin, IGF-1, and GH. Complicating the pathophysiology are the IGF binding proteins (IGFBPs) that can bind IGF-2 and IGF-1, modifying hormone metabolism and action. IGFBP concentrations are often altered in the presence of these tumors. At the cellular level, the 3 hormone-related ligands, IGF-2, IGF-1, and insulin, all bind to 4 (or more) types of IGF-1 receptor (IGF-1R) and insulin receptor (IR). Each receptor has its own characteristic affinity for each ligand, a tyrosine kinase, and overlapping profiles of action in the target cells. The IGF-2R, in addition to binding mannose-6-phosphate-containing proteins, provides an IGF-2 degradation pathway. Recent evidence suggests IGF-2R involvement also in signal transduction. Surgery, the treatment of choice, can produce a cure. For patients not cured by surgery, multiple therapies exist, for the tumor and for hypoglycemia. Potential future therapeutic approaches are sketched. From 1910 to 1930, hypoglycemia, insulin, insulinomas, and non-islet-cell tumors were recognized. The latter third of the century witnessed the emergence of the immunoassay for insulin; the IGFs, their binding proteins, and assays to measure them; and receptors for the insulin-related peptides as well as the intracellular pathways beyond the receptor. In closing, we replace non-islet-cell tumor hypoglycemia, an outdated and misleading label, with IGF-2-oma, self-explanatory and consistent with names of other hormone-secreting tumors.
Collapse
Affiliation(s)
- Yevgeniya Dynkevich
- MD, FACP, Investigator, Feinstein Institute for Medical Research, Laboratory of Diabetes and Diabetes-Related Research, 350 Community Drive, Manhasset, NY 11030.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
4
|
Pandey M, Kothari KC, Patel DD. Haemangiopericytoma: current status, diagnosis and management. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 1997; 23:282-5. [PMID: 9315052 DOI: 10.1016/s0748-7983(97)90534-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Haemangiopericytoma (HPC) is a rare tumour, characterized by unidentifiable light microscopic features. Despite first being described over 50 years ago, nothing much was known about this tumour until the early 1980s, when ultrastructural studies and tumour markers made it possible to differentiate it from other mesenchymal tumours. Advancements in radiology and the emergence of MRI technology helped surgeons in better planning. Pre-operative vascular embolization helped to reduce the menace of operative haemorrhage. Improvements in localization and delivery of radiotherapy, coupled with early diagnosis, has tremendously improved the treatment outcome of haemangiopericytoma.
Collapse
Affiliation(s)
- M Pandey
- Department of Surgical Oncology, Gujarat Cancer and Research Institute, Ahmedabad, India
| | | | | |
Collapse
|
5
|
Höög A, Sandberg Nordqvist AC, Hulting AL, Falkmer UG. High-molecular weight IGF-2 expression in a haemangiopericytoma associated with hypoglycaemia. APMIS 1997; 105:469-82. [PMID: 9236865 DOI: 10.1111/j.1699-0463.1997.tb00596.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Spontaneous hypoglycaemia is usually caused by an insulin-producing islet-cell tumour of the pancreas. Rarely, it can be caused by non-islet cell tumours. Most of the tumours are of mesenchymal type, large, and slowly growing. One representative is haemangiopericytoma (HAP). The present report describes a case of a large recurrent retroperitoneal HAP associated with severe hypoglycaemia. Blood serum insulin and proinsulin concentrations were low. By means of acid-gel chromatography and dot-blot techniques, an increased amount of a high-molecular-weight IGF-2 peptide was found. By using antigen retrieval procedures, IGF-2-immunoreactive tumour cells were found in specimens of the recent tumour recurrence-but not in the original. When the in situ hybridization technique was used it could be shown that IGF-2 mRNA labelling had already occurred in the original tumour specimen, 11 years before the onset of hypoglycaemic symptoms. These observations confirm the hypothesized hypoglycaemic effects of high-molecular-weight (HMW) IGF-2, but also point to the presence of a prolonged compensation of this effect. A literature review, based on 17 similar cases of haemangiopericytoma with hypoglycaemia, is presented. Our observation and findings in the literature review support the idea that non-islet-cell tumour hypoglycaemia is caused by an overproduction of a HMW IGF-2 peptide. The insulin-like effect is mediated via non-specific binding to the insulin receptors. To anticipate patients at risk of developing this kind of hypoglycaemia, the histopathological investigation should include not only immunohistochemical analyses of the presence of IGF-2 peptide, but also in situ hybridization of the IGF-2 mRNA expression.
Collapse
Affiliation(s)
- A Höög
- Department of Oncology and Pathology, Karolinska Institute, Stockholm, Sweden
| | | | | | | |
Collapse
|
6
|
Noda N, Hasegawa H, Kanai M, Shimizu Y, Yoshida H, Matsumoto T, Akita M. Recurrent hemangiopericytoma of the liver: report of a case. Surg Today 1995; 25:72-5. [PMID: 7749294 DOI: 10.1007/bf00309391] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
We present herein the case of a 63-year-old man with a locally recurrent hemangiopericytoma in the hepatic hilum. The patient presented to our hospital for the investigation of elevated transaminases 6 years after undergoing resection of a hemangiopericytoma followed by chemotherapy at another hospital. Various imaging techniques demonstrated a well-circumscribed, hypervascular tumor with central necrosis in the hepatic hilum. Establishing a preoperative diagnosis would have been difficult without the information that he had previously had a hemangiopericytoma of the abdominal cavity. An extended right hepatic lobectomy was performed and histopathological examination confirmed the diagnosis of recurrent hemangiopericytoma. Although hemangiopericytoma is a rare tumor, the clinical presentation and radiologic features of this case were fairly typical.
Collapse
Affiliation(s)
- N Noda
- Department of Surgery, Nagoya Daini Red Cross Hospital, Aichi, Japan
| | | | | | | | | | | | | |
Collapse
|
7
|
Abstract
The first reported case of bilateral renal hemangiopericytoma is presented. The 19 previous renal hemangiopericytomas that have been reported in the world literature are reviewed. This lesion has afflicted patients ranging in age from sixteen to sixty-eight years (mean 41 years) with an equal sex distribution. Mortality from hemangiopericytoma of the kidney has been 50 percent, and the primary mode of therapy remains surgical.
Collapse
Affiliation(s)
- R K Heppe
- Department of Veterans Affairs Hospital, Denver, Colorado
| | | | | |
Collapse
|
8
|
Affiliation(s)
- H W Herr
- Department of Surgery and Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | | |
Collapse
|
9
|
Abstract
Three patients with extensive liver metastases from hormone-secreting tumors were treated with external beam radiation therapy to palliate signs and symptoms of tumor mass and/or hormone secretion. These patients experienced an objective response of 3, 14, and 24 months duration, respectively, as measured by plasma hormone levels and/or computed tomography (CT) scanning. Using conventional fractionation, a dose of 2400 to 3000 rad was delivered without significant acute or late toxicity. Although these tumors have a long natural history (many years), even after the development of liver metastases, radiation therapy can provide effective palliation and should be considered as a therapeutic option.
Collapse
|
10
|
Pasyk KA, Grabb WC, Cherry GW. Cellular haemangioma. Light and electron microscopic studies of two cases. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1982; 396:103-26. [PMID: 6289512 DOI: 10.1007/bf00428503] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Light and electron microscopic studies were conducted on the immature vascular tumors of two infants, containing various stages of differentiation of the blood vessels and both benign haemangioendotheliomas and haemangiopericytomas. We were able to confirm the existence of two kinds of hyperplastic, immature cells i.e. endothelial cells and pericytes in the same tumor. Presence of crystalloid inclusions in the endothelial cells and absence of the Weibel-Palade bodies, as well as a deficiency in factor VIII-related antigen and no tissue fibrinolytic activity, suggested that the endothelial cells in these lesions were immature. Electron microscopic studies appear more decisive in the diagnosis of heterogenous cellular vascular tumors than light microscopy and if available should be used to aid in the final diagnosis. The authors propose that the term cellular haemangioma would be more appropriate in describing this vascular entity.
Collapse
|
11
|
Asa SL, Bedard YC, Buckspan MB, Klotz PG, Bain J, Steinhardt MI. Spontaneous hypoglycemia associated with hemangiopericytoma of the kidney. J Urol 1981; 125:864-7. [PMID: 7241689 DOI: 10.1016/s0022-5347(17)55235-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
We report the third case of renal hemangiopericytoma associated with spontaneous hypoglycemia. The clinical and pathological features suggest that excessive glucose storage by the tumor is an important factor in the pathogenesis of the hypoglycemia. Other possible mechanisms producing hypoglycemia associated with mesenchymal tumors are reviewed.
Collapse
|
12
|
Yasuda Y, Kasahara K, Tenmoku S, Yabe C, Miyata M, Morioka Y, Sakamoto Y, Kuzuya T, Takeda K, Atsumi T, Shimizu H, Matsumoto S. Retroperitoneal hemangiopericytoma associated with hypoglycemia: report of a case. THE JAPANESE JOURNAL OF SURGERY 1979; 9:350-8. [PMID: 397364 DOI: 10.1007/bf02468636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A 34-year-old woman had episodes of hypoglycemic attack 8 years after a surgical resection of a retroperitoneal hemangiopericytoma. In spite of normal levels of serum IRI, insulin radioreceptor assay demonstrated high level of plasma ILA (insulin like activity). The patient underwent resection of a recurrent retroperitoneal tumor with metastatic lesions of the liver. Postoperatively, ILA level in plasma by insulin radioreceptor assay decreased, and hypoglycemic attacks disappeared. Therefore, this associated hypoglycemia was presumed to be not caused by excess glucose consumption by the tumor, not by excess secretion of IRI by the tumor, but caused by the presence of high level of ILA related to the tumor.
Collapse
|
13
|
Abstract
Hypoglycemia secondary to malignant tumors is rare. Mesenchymal tumors of nonpancreatic origin are the most common tumors associated with the hypoglycemia syndrome, and the clinical features of 115 reported cases are reviewed. The major anatomic distributions of the tumors are thoracic (30%) abdominal (65%), and uncommon locations (less than 5%). Approximately 50% of the tumors were resectable (59 patients), and in 60% the surgical procedure was curative. In the remaining 40% local recurrence predominated related to site of tumor and presence of contiguous organ invasion. The application of multimodality adjuvant therapy for hypoglycemia associated mesenchymal tumors should be based on an understanding of the natural history of the tumor.
Collapse
|
14
|
Abstract
All cases of hemangiopericytomas involving the male pelvis which have been reported in the English literature with clinical data have been reviewed. Their clinical features, roentgenographic findings, pathologic features, and treatment are presented with an illustrative case. The tumor is an aggressive neoplasm which characteristically produces late local recurrences or metastases. Since the clinical behavior cannot be reliably predicted from its histologic appearance, all must be regarded as malignant. Primary treatment should be en bloc excision since a high recurrence rate results when simple enucleation or excision is performed. Long-term follow-up is mandatory, and local recurrences or metastases should be resected whenever feasible. Radiation and chemotherapy may convert a nonresectable lesion into a resectable one and provide significant palliation.
Collapse
|
15
|
Saw HS, Prathap K. Haemangiopericytoma: problems in diagnosis and management. THE AUSTRALIAN AND NEW ZEALAND JOURNAL OF SURGERY 1979; 49:350-4. [PMID: 289377 DOI: 10.1111/j.1445-2197.1979.tb07678.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Three cases of haemangiopericytoma with diverse modes of presentation are reported. The difficulties with clinical diagnosis are emphasized. There is no consensus on the best mode of treatment, and we have chosen radical surgical excision in the first instance, but have not hesitated to employ radiotherapy or chemotherapy as adjunctive treatment if the need has arisen. The clinical behaviour of this tumour is unpredictable; therefore the prognosis for life must remain uncertain.
Collapse
|
16
|
Abstract
The concept of ectopic insulin production is challenged on the basis of a review of 120 cases from the literature on extrapancreatic tumours associated with hypoglycaemia in which insulin or insulin-like activity were measured. No case met two or more of five criteria of ectopic hormone production. The evidence indicates that hypoglycaemia of extrapancreatic tumours cannot be attributed to insulin. In those rare cases in which plasma insulin was reported as high, pancreatic beta-cells could not be excluded as the source of insulin. Interestingly, many of these dubious cases had carcinoid histology. The review also points out a close association between some spindle-cell tumours and carcinoid tumours which may be relevant to discussion on the disputed origin of some "mesothelial" tumours. Nonsuppressible insulin-like activity (NSILA) consists of a number of factors mimicking insulin activity which compete with insulin or proinsulin for membrane receptors and may crossreact in bioassays, immunoassays, and receptor assays. The question of whether one or several of these substances may be responsible for extrapancreatic hypoglycaemia remains to be elucidated.
Collapse
|
17
|
Abstract
This is a report of an exceptional case of haemangiopericytoma of the larynx, which occurred in a 50-year-old male patient. Histological examination of biopsy fragments allowed us to make the correct diagnosis, later confirmed at autopsy. From a comprehensive review of the world literature on haemangiopericytomas, it appears that cases of indisputable well-documented laryngeal occurrence of the neoplasm amount to two only, including the present case. The morphological pattern, histogenesis, biological behaviour and therapy of the tumour, as well as differential diagnosis from other lesions, are discussed.
Collapse
|
18
|
Abstract
Only 12 cases of nasal hemangiopericytoma have been reported in the literature. Ten additional cases are presented herein. Surgical excision is the recommended treatment; cryosurgery was used in one of our patients. Four of the tem patients had recurrences, one of which proved to be malignant (with distant metastases to the lung) and was ultimately fatal.
Collapse
|
19
|
Sooriyaarachchi GS, Ramirez G, Roley EL. Hemangiopericytoma of the uterus: report of a case with a comprehensive review of the literature. J Surg Oncol 1978; 10:399-406. [PMID: 732328 DOI: 10.1002/jso.2930100504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A case of locally recurrent and metastatic uterine hemangiopericytoma successfully treated with surgery, radiotherapy and chemotherapy is presented. The patient is alive without evidence of detectable tumor, 13 years after the initial diagnosis. Review of the literature revealed 64 reported cases of uterine hemangiopericytoma. The clinical features are not sufficiently characteristic to enable the diagnosis to be made preoperatively. However, with the help of histological and ultrastructural studies a definite diagnosis of hemangiopericytoma can be made. The primary treatment is radical surgery which usually involved total hysterectomy and bilateral salpingo-oophorectomy. The prognosis of uterine hemangiopericytoma is better than that of other sites. However, long follow-up of these patients is necessary because of the tendency to local and distant recurrence many years after the initial treatment. The recurrent tumor should be treated aggressively with surgery, radiotherapy, and chemotherapy as long-term survival is not unusual.
Collapse
|
20
|
L. Block N, Grabstald H, Melamed MR. Hemangiopericytomas of genitournary system. Urology 1977. [DOI: 10.1016/0090-4295(77)90077-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
21
|
|
22
|
Bommer G, Altenähr E, Kühnau J, Klöppel G. Ultrastructure of hemangiopericytoma associated with paraneoplastic hypoglycemia. ZEITSCHRIFT FUR KREBSFORSCHUNG UND KLINISCHE ONKOLOGIE. CANCER RESEARCH AND CLINICAL ONCOLOGY 1976; 85:231-41. [PMID: 131425 DOI: 10.1007/bf00284083] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A recurred and metastasized hemangiopericytoma of menigeal origin caused a terminal hypoglycemia syndrome in a 40 year old man. The disease had been observed over a period of 10 years. The total weight of the tumour metastases was 1800 g. Electron microscopical examination of the tumour cells revealed, in particular, a markedly developed ergastoplasm, prominent Golgi complexes surrounded by many microvesicles, round to ovoid electron dense bodies and fine fibrillar structures. Furthermore, large deposits of basement membrane-resembling material were found in the pericapillary and intercellular spaces. On the basis of the structural characteristics which indicate distinct synthesizing capacity of the cells, an excessive glucose consumption by the tumour is suggested to be an important factor in the pathogenesis of tumour hypoglycemia. The question whether the ultrastructure of the tumour also exhibits secretory processes, which may be related to the release of a presumed inhibitor of hepatic gluconeogenesis and/or glycogenolysis, remains open. Typical granules as in polypeptide hormon secreting cells were not observed. The possibility that the demonstrated electron dense membrane limited bodies represent atypical secretory granules is discussed.
Collapse
|
23
|
Abstract
A series of 106 cases of hemangiopericytoma was analyzed. The neoplasms occurred principally in adults (median age, 45 years), were deep seated, and were most common in the thigh (27 cases) and the pelvic retroperitoneum (26 cases). A painless mass was the first symptom in 96 of the patients. The median size of the excised tumors was 6.5 cm. Surgical removal of the tumor was often complicated by hemorrhage because of marked dilatation of the vascular bed in the vicinity of the neoplasm, probably as the result of rapid exchange of blood from the arterial to the venous circulation within the tumor. Microscopically, benign and malignant forms could be distinguished. The latter were characterized by increased cellularity, prominent mitotic activity, and foci of necrosis or hemorrhage. Follow-up information was obtained in 93 cases. Seventy-one of the 93 patients were living (two with recurrence and four with metastasis), and 22 had died (13 as the result of recurrence or metastasis in more than two-thirds of the related causes). Recurrence preceded metastasis in more than two-thirds of the patients with evidence of metastasis. The 10 year survival rate was 70 per cent. The morphologic differences from other mesenchymal tumors showing a hemangiopericytoma-like vascular pattern are discussed, and the close resemblance of hemangiopericytoma to richly vascular forms of fibrous histiocytomas and synovial sarcoma is emphasized. Congenital or infantile hemangiopericytoma is described as a separate entity having a distinctive microscopic pattern and behavior.
Collapse
|
24
|
Abstract
Foregut endocrine polypeptide-secreting APUD cells (Amine-Precursor-Uptake and Decarboxylation), in their embryologic migration from neural crest to foregut may become "arrested" in the mesoderm or in other ectopic locations. They may become hyperplastic, adenomatous or malignant. Eight illustrative patients are reported. One patient had "pancreatic hyperparathyroidism" with hypercalcemic crises, pancreatic apudocarcinoma, normal parathyroids, biologically active parathormone, but inert immunochemically to the usual parathyroid antisera. Two had gastrin-secreting malignancies in the mesoderm. Remission after excision, but eventual recurrence of the syndrome due to islet cell hyperplasia required total gastrectomy. One patient had a gastric corpus apudocarcinoma found prospectively with hypergastrinemia which required excision of the tumor. One patient had acromegaly with hypergastrinemia and antral gastrinosis treated by pituitary irradiation, One patient had the antral or intermediary type of the Zollinger-Ellison syndrome with moderate hypergastrinemia, duodenal ulcer and antral gastrinosis, treated by vagotomy and antrectomy. One patient had hyperparathyroidism with antral gastrinosis, treated by parathyroidectomy. One patient had malignant Zollinger-Ellison syndrome and developed associated thyroid parafollicular cell hyperplasia and parathyroid chief cell hyperplasia, treated by total gastrectomy and multiple endocrine excisions. These investigative observations demonstrate ectopic loci and associated hyperplasias which support the concept of migration and bizarre potentiality of polypeptide-secreting cells of the foregut.
Collapse
|
25
|
Abstract
Among the malignant tumors of nonendocrine origin that are capable of producing polypeptide hormones and of manifesting as different endocrine syndromes discussed here are ectopic ACTH syndrome, SIADH, and ectopic gonadotropin-producing tumors.
Collapse
|
26
|
Abstract
Seaton, D. (1974).Thorax,29, 595-598. Primary diaphragmatic haemangiopericytoma. Haemangiopericytomas are tumours consisting of vascular spaces surrounded by proliferating pericytes. Since this neoplasm was first described (Stout and Murray, 1942) over 300 cases have been reported. All tumours of the diaphragm are rare, and a primary diaphragmatic haemangiopericytoma has not been previously recorded in the English literature. Such a case is described and the features of haemangiopericytomas are discussed.
Collapse
|
27
|
|
28
|
Abstract
Meade, J. B., Whitwell, F., Bickford, B. J., and Waddington, J. K. B. (1974).Thorax,29, 1-15. Primary haemangiopericytoma of lung. Haemangiopericytoma is a rare neoplasm which may occur at any age and arise in almost any part of the body. At least 247 examples have been reported in the world literature, but only 24 appear to have arisen primarily in the lung. A summary of the features of these cases, collected from the literature, is presented, and four additional cases are described. The tumour may be innocent [ill] malignant, but there are no characteristic clinical or radiological features to distinguish it from other neoplasms of the lung. Because of uncertainty as to diagnosis and prognosis, surgical excision appears to be the treatment of choice. In the whole series of 28 cases, rather more than half (16) were female, and they tended to be older than the male patients. The mortality from recurrence was higher in males than in females (50% compared with 32%). The prognosis in general seems to be best with small, asymptomatic tumours, especially in female patients. A brief account is given of the nature and function of the pericyte. It was originally thought to be a cell of muscular type, but recent research suggests that it is a multipotent cell capable of development into other cell types and having phagocytic properties. It lies in the basement membrane of capillary blood vessels and may have some connection with antibody formation, but its exact function has not yet been elucidated.
Collapse
|
29
|
Bozzetti F, Doci R. Report of 11 Cases of Hemangiopericytoma and Review of the Most Recent Literature. TUMORI JOURNAL 1974; 60:25-32. [PMID: 4601883 DOI: 10.1177/030089167406000103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main features of the hemangiopericytoma: its ubiquity, the different grades of malignancy, the lack of correlation between clinical and histological features are discussed in the light of the literature and the experience gained at the National Cancer Institute of Milan. Surgical excision plays a very important role in the management of this tumor. The palliative results recently obtained with chemotherapy are set forth.
Collapse
|
30
|
|
31
|
|
32
|
|
33
|
|
34
|
|
35
|
Lucey C, Graham WJ. Hypoglycaemia due to retroperitoneal sarcoma with insulin-like activity. Ir J Med Sci 1968; 7:413-22. [PMID: 5722839 DOI: 10.1007/bf02958791] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
36
|
Paullada JJ, Lisci-Garmilla A, Gonzáles-Angulo A, Jurado-Mendoza J, Quijano-Narezo M, Gómez-Peralta L, Doria-Medina M. Hemangiopericytoma associated with hypoglycemia. Metabolic and electron microscopic studies of a case. Am J Med 1968; 44:990-9. [PMID: 5656203 DOI: 10.1016/0002-9343(68)90098-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
|
37
|
Steinke J, Soeldner JS. Metabolic effects of diazoxide in normal subjects, patients with diabetes mellitus, and patients with organic hypoglycemia. Ann N Y Acad Sci 1968; 150:326-36. [PMID: 4299223 DOI: 10.1111/j.1749-6632.1968.tb19058.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
38
|
|
39
|
Marks V, Samols E. Hypoglycaemia of non-endocrine origin (non-islet cell tumours). Proc R Soc Med 1966; 59:338-40. [PMID: 5937685 PMCID: PMC1900615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|