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Estrada-Maya J, Montejo JS, Báez López KD, Garzón JC. Doege-Potter syndrome due to a solitary fibrous tumor of the pleura: a case report. J Med Case Rep 2024; 18:383. [PMID: 39138498 PMCID: PMC11323447 DOI: 10.1186/s13256-024-04658-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/02/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Doege-Potter syndrome is a rare paraneoplastic phenomenon associated with solitary fibrous tumors of the pleura (SFTPs). It is characterized by the presence of severe, sustained, and treatment-refractory hypoglycemia. Hypoglycaemia, which may be the sole symptom at disease onset, is mediated by the secretion of high-molecular-weight insulin-like growth factor (IGF-2). Most tumors exhibit benign behavior, with a 100% survival rate at 5 years. However, 10% of these tumors may display aggressive behavior with local or metastatic recurrence. We present a clinical case of a patient with a benign solitary fibrous tumor of the pleura who presented with symptomatic hypoglycemia and required pulmonary and pleural surgical resection to control the paraneoplastic phenomenon. CASE PRESENTATION A Hispanic 46-year-old man presented with a 15-day history of transient alterations in consciousness worsened by fasting. The relevant medical history included obstructive sleep apnea treated with continuous positive air pressure (CPAP) and previous smoking. In-hospital studies revealed noninsulinemic hypoglycemia and a benign SFTP. Complete surgical resection was performed while the patient received dextrose fluids and corticosteroids perioperatively for hypoglycemia. Subsequently, the hypoglycemia resolved, and the patient was followed-up without disease recurrence. CONCLUSION Doege-Potter syndrome is challenging to recognize. However, effective treatment can be achieved with a high survival rate. Raising awareness among healthcare professionals about the recognition of this paraneoplasic syndrome patients will improve diagnostic suspicion, biochemical confirmation, the development of diagnostic and therapeutic guidelines, and the creation of predictive indices for aggressive presentations requiring closer monitoring.
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Affiliation(s)
- Juan Estrada-Maya
- Internal Medicine, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163ª#13B-60, Bogotá, Colombia.
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia.
| | - Juan Sebastián Montejo
- Internal Medicine, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163ª#13B-60, Bogotá, Colombia
- School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | | | - Juan Carlos Garzón
- Thoracic Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
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2
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Dullaart RPF. Central role of pro-IGFII(68-88) (big IGFII) in the pathogenesis nonislet cell tumour-induced hypoglycaemia. Eur J Clin Invest 2024:e14268. [PMID: 38898707 DOI: 10.1111/eci.14268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/03/2024] [Accepted: 06/07/2024] [Indexed: 06/21/2024]
Affiliation(s)
- Robin P F Dullaart
- Division of Endocrinology, Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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3
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Lippincott MD, McDonald JD, Bui MM, Gonzalez RJ, Voss RK. Non-Islet Cell Tumor Hypoglycemia Secondary to a 20 cm Intra-Abdominal Leiomyoma in a Male Patient: A Case Report and Literature Review. Case Rep Surg 2024; 2024:6651107. [PMID: 38911593 PMCID: PMC11192599 DOI: 10.1155/2024/6651107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/25/2024] Open
Abstract
Non-islet cell tumor hypoglycemia (NICTH) is a rare clinical entity associated with large mesenchymal tumors. Its pathogenesis is most commonly mediated by tumor overproduction of "big" insulin-like growth factor-2. Here, we present a 54-year-old male who presented with noninsulin-mediated hypoglycemia and a 20 cm intra-abdominal leiomyoma. His hypoglycemic episodes resolved after the resection of his tumor. To our knowledge, this is the only documented case in the English literature of NICTH associated with leiomyoma in a male patient. NICTH due to a benign leiomyoma should be in the differential diagnosis for any patient with hypoglycemia and an abdominal mass.
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Affiliation(s)
| | - James D. McDonald
- Department of Sarcoma OncologyH. Lee Moffitt Cancer Center and Research Institute Tampa, Tampa, FL, USA
| | - Marilyn M. Bui
- Department of PathologyH. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Ricardo J. Gonzalez
- Department of Sarcoma OncologyH. Lee Moffitt Cancer Center and Research Institute Tampa, Tampa, FL, USA
| | - Rachel K. Voss
- Department of Sarcoma OncologyH. Lee Moffitt Cancer Center and Research Institute Tampa, Tampa, FL, USA
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4
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Mohammed SR, Mack N, Ramoutar V, Rampersad J. Recurrent Hypoglycemia in a Non-diabetic Female: A Case Study on Doege-Potter Syndrome. Cureus 2024; 16:e63329. [PMID: 39077286 PMCID: PMC11283929 DOI: 10.7759/cureus.63329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
Solitary fibrous tumors (SFT) are mesenchymal cell tumors that may arise from any site throughout the body. A small percentage of patients with SFT develop non-islet cell tumor-induced hypoglycemia (NICTH), eponymously termed Doege-Potter Syndrome (DPS). DPS is characterized by severe, refractory hypoinsulinemic hypoglycemia. Diagnosis of SFT is dependent on histologic findings and immunohistochemistry (IHC). NAB2-STAT6 gene fusions are pathognomonic for SFT but may be difficult to identify in routine cytogenetic studies. STAT6 IHC is a highly sensitive and specific surrogate for the NAB2-STAT6 gene fusion. Total resection of the tumor remains the gold-standard definitive treatment of SFT of the pleura. Palliative tumor debulking is recommended if total resection is not feasible. We here report a case of DPS in a 73-year-old female, managed with palliative care.
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Affiliation(s)
- Saeed R Mohammed
- Department of Clinical Medical Sciences, The University of the West Indies, St. Augustine Campus, Champs Fleurs, TTO
| | - Narine Mack
- Department of Medicine, San Fernando General Hospital, San Fernando, TTO
| | - Valmikie Ramoutar
- Department of Medicine, San Fernando General Hospital, San Fernando, TTO
| | - Jessica Rampersad
- Department of Medicine, San Fernando General Hospital, San Fernando, TTO
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5
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Guijt MC, Heineman DJ, Jonker JT. Recurrent Falls Due to Hypoglycemia: Case of an IGF-2-producing Fibrous Tumor of the Pleura. JCEM CASE REPORTS 2024; 2:luae061. [PMID: 38666048 PMCID: PMC11045011 DOI: 10.1210/jcemcr/luae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Indexed: 04/28/2024]
Abstract
This case report delineates the clinical presentation of a 77-year-old male who experienced falls and sustained a humerus fracture attributed to hypoglycemia. Despite the absence of insulin use and normal laboratory results for cortisol, TSH, blood count, and liver and kidney function, a fasting test revealed diminished C-peptide and insulin levels, ruling out insulinoma, exogenous insulin use, or β-cell hyperplasia. Subsequent laboratory investigations demonstrated lowered IGF-1 and elevated IGF-2 levels, indicative of an IGF-2-producing tumor as the etiology of the hypoglycemia. A positron emission tomography computed tomography scan identified a right-sided thoracic cavity tumor, prompting an open resection. Postoperatively, hypoglycemic episodes abated within 2 days, and pathology confirmed a 14.9-cm solitary fibrous tumor. Nonislet cell tumor hypoglycemia (NICTH), also known as Doege Potter syndrome, arises from aberrant production of IGF-2 or its precursors. Elevated IGF-2 levels induce hypoglycemia through heightened glucose uptake on binding to insulin receptors. The literature supports the efficacy of both surgical intervention and corticosteroids in managing NICTH. This case underscores the importance of considering NICTH as a rare etiology in unexplained hypoglycemia cases, advocating for the utility of fasting tests in diagnosis, and suggesting surgical resection as a viable treatment option when radical excision is feasible.
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Affiliation(s)
- Mathijs Cornelis Guijt
- Department of Internal Medicine, Haga Ziekenhuis Den Haag, Els Borst-Eilersplein 275, 2545 AA, Den Haag, The Netherlands
| | - David J Heineman
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC location Vrije Universiteit Amsterdam—Cancer Center Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jacqueline Thérèse Jonker
- Department of Internal Medicine, Alrijne Ziekenhuis Leiderdorp, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
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6
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Schöler F, Storz MA, Khavaran A, Hümmler N, Russe MF, Wielenberg C, Laubner K, Seufert J. Effective management of recurrent Doege-Potter syndrome with somatostatin-analogues: A case report. Cancer Rep (Hoboken) 2024; 7:e1992. [PMID: 38441351 PMCID: PMC10913086 DOI: 10.1002/cnr2.1992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 12/10/2023] [Accepted: 01/15/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Doege-Potter syndrome is defined as paraneoplastic hypoinsulinemic hypoglycemia associated with a benign or malignant solitary fibrous tumor frequently located in pleural, but also extrapleural sites. Hypoglycemia can be attributed to paraneoplastic secretion of "Big-IGF-II," a precursor of Insulin-like growth factor-II. This prohormone aberrantly binds to and activates insulin receptors, with consecutive initiation of common insulin actions such as inhibition of gluconeogenesis, activation of glycolysis and stimulation of cellular glucose uptake culminating in recurrent tumor-induced hypoglycemic episodes. Complete tumor resection or debulking surgery is considered the most promising treatment for DPS. CASE Here, we report a rare case of a recurrent Doege-Poter Syndrome with atypical gelatinous tumor lesions of the lung, pleura and pericardial fat tissue in an 87-year-old woman. Although previously described as ineffective, we propose that adjuvant treatment with Octreotide in conjunction with intravenous glucose helped to maintain tolerable blood glucose levels before tumor resection. The somatostatin-analogue Lanreotide was successfully used after tumor debulking surgery (R2-resection) to maintain adequate blood glucose control. CONCLUSION We conclude that somatostatin-analogues bear the potential of being effective in conjunction with limited surgical approaches for the treatment of hypoglycemia in recurrent or non-totally resectable SFT entities underlying DPS.
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Affiliation(s)
- Felix Schöler
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Maximilian Andreas Storz
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
- Department of Internal Medicine II, Center for Complementary Medicine, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Ashkan Khavaran
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Nicolas Hümmler
- Department of Thoracic Surgery, Medical CenterUniversity Hospital of FreiburgFreiburgGermany
| | - Maximilian Frederik Russe
- Department of Radiology, Clinic for Diagnostic and Interventional Radiology, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Jochen Seufert
- Division of Endocrinology and Diabetology, Department of Internal Medicine II, University Hospital of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburgGermany
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Pulikkal I, Meena M, Goel G, Goyal A, Sharma T. Cytological Perspective in a Case of Doege-Potter Syndrome With Hypoinsulinemic Hypoglycemia. Cureus 2024; 16:e56041. [PMID: 38606238 PMCID: PMC11007478 DOI: 10.7759/cureus.56041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 04/13/2024] Open
Abstract
Solitary fibrous tumor (SFT) of the lung is a rare mesenchymal neoplasm of uncertain histogenesis, unknown molecular features, and unpredictable clinical behavior, characterized by NAB2-STAT6 fusion. Hypoglycemia accompanying SFT (Doege-Potter syndrome) is an uncommon presentation. We present the cytomorphological features on biopsy imprint smears of a histopathologically confirmed case of SFT of the lung with an uncommon presentation. A 76-year-old non-smoker, non-alcoholic, and non-diabetic man presented with complaints of intermittent episodes of confusion with syncopal attacks (>10 episodes) for six months. The patient had no respiratory complaints and no history of weight loss. Laboratory investigations revealed fasting blood sugar of 38 mg/dl with low serum insulin and C-peptide levels. Physical examination revealed reduced air entry on the left side of the chest. Chest X-ray showed left-sided homogenous opacity. High-resolution computed tomography (HRCT) of the chest showed a large left-sided lung mass. A biopsy was performed. Biopsy imprint smears were cellular and showed tumor cells arranged in clusters and fragments with traversing capillaries displaying monomorphic pump to oval nuclei, fine granular evenly dispersed chromatin, regular nuclear membrane, inconspicuous nucleoli, and a moderate amount of wispy cytoplasm. Foci of intercellular hyaline stromal material were noted. A cytodiagnosis of low-grade mesenchymal neoplasm was made. Histopathology revealed a cellular tumor comprising tightly packed round to fusiform cells arranged around blood vessels with intervening thick collagen, positive for CD99, vimentin, BCL2, CD34, and STAT6 and negative for EMA, CK AE1/AE3, S100, TLE1, and SMA. Familiarity with cytomorphology plays a pivotal role in clinching an early diagnosis of this rare neoplasm of the lung, particularly in the setting of presentation with hypoglycemia.
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Affiliation(s)
- Ingitha Pulikkal
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Mahadev Meena
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Garima Goel
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Abhishek Goyal
- Pulmonary Medicine and Tuberculosis, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
- Respiratory Medicine, Graphic Era Institute of Medical Sciences, Dehradun, Dehradun, IND
| | - Tanya Sharma
- Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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8
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Leivaditis V, Ehle B, Papatriantafyllou A, Mulita F, Koletsis E, Verras GI, Tasios K, Antzoulas A, Charokopos N, Dahm M, Katsakiori PF, Grapatsas K. Addressing recurrent hypoglycaemia through thoracic surgical intervention: understanding Doege-Potter syndrome, a rarity in syndromes. Arch Med Sci Atheroscler Dis 2024; 9:e33-e40. [PMID: 38846055 PMCID: PMC11155461 DOI: 10.5114/amsad/183433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 01/29/2024] [Indexed: 06/09/2024] Open
Abstract
Doege-Potter syndrome (DPS), a rare paraneoplastic phenomenon characterised by non-islet cell tumour hypoglycaemia (NICTH), presents clinicians with intricate diagnostic and therapeutic challenges. This comprehensive review consolidates current understanding, clinical presentations, diagnostic modalities, therapeutic interventions, and emerging trends in managing DPS. The pathophysiology of DPS revolves around dysregulated insulin-like growth factors (IGF), particularly IGF-2, produced by mesenchymal tumours, notably solitary fibrous tumours (SFT). Clinical manifestations encompass recurrent hypoglycaemic episodes, often distinct from typical hypoglycaemia, with implications for insulin and counterregulatory hormone levels. Diagnosis necessitates a multidisciplinary approach integrating biochemical assays, imaging studies, and histopathological confirmation of the underlying neoplasm. Surgical resection remains the cornerstone of treatment, complemented by adjunctive therapies to manage persistent hypoglycaemia. Prognosis is influenced by successful tumour resection and long-term surveillance for recurrence. A patient-centred approach, incorporating supportive services and multidisciplinary care, is essential for optimal outcomes in individuals affected by DPS.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
| | | | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, Greece
| | | | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Andreas Antzoulas
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, Greece
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | | | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, Ruhrlandklinik, West German Lung Centre, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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9
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Vu A, Chik C, Kwong S. IGF-2-mediated hypoglycemia: a case series and review of the medical therapies for refractory hypoglycemia. Endocrinol Diabetes Metab Case Rep 2024; 2024:23-0089. [PMID: 38432069 PMCID: PMC10959053 DOI: 10.1530/edm-23-0089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 01/30/2024] [Indexed: 03/05/2024] Open
Abstract
Summary Non-islet cell tumour hypoglycemia (NICTH), typically mediated by insulin-like growth factor 2 (IGF-2), is a rare but highly morbid paraneoplastic syndrome associated with tumours of mesenchymal or epithelial origin. Outside of dextrose administration and dietary modification which provide transient relief of hypoglycemia, resection of the underlying tumour is the only known cure for NICTH. Available medical therapies to manage hypoglycemia include glucocorticoids, recombinant growth hormone, and pasireotide. We report two cases of IGF-2 mediated hypoglycemia. The first was managed surgically to good effect, highlighting the importance of a timely diagnosis to maximise the likelihood of a surgical cure. The second patient had unresectable disease and was managed medically, adding to a growing number of cases supporting the efficacy of glucocorticoids and recombinant growth hormone in NICTH. Learning points Recurrent fasting hypoglycemia in the setting of a malignancy should raise suspicion of non-islet cell tumour hypoglycemia (NICTH), which is typically mediated by IGF-2. The initial workup for NICTH should include a serum glucose, C-peptide, insulin, insulin antibodies, beta-hydroxybutyrate, IGF-2, IGF-1, and sulphonylurea screen during a spontaneous or induced hypoglycemic episode. An IGF-2/IGF-1 ratio above 10 is highly suggestive of IGF-2-mediated hypoglycemia if the IGF-2 level is normal or elevated. False positives may be seen with sepsis and cachexia as both IGF-2 and IGF-1 are subnormal in these cases. A low IGF binding protein 3 (IGFBP3), such as in renal failure, may also result in a falsely normal or low IGF-2/IGF-1 ratio. Surgical resection of the associated tumour is curative in most NICTH cases. When the tumour is unresectable, moderate-dose glucocorticoids, low-dose glucocorticoids in combination with recombinant growth hormone, and pasireotide are medical therapies with promising results in controlling NICTH.
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Affiliation(s)
- Albert Vu
- Division of Endocrinology & Metabolism, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Constance Chik
- Division of Endocrinology & Metabolism, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sarah Kwong
- Division of Endocrinology & Metabolism, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Torres Gómez A, García Alabarce AM, García Castro JM, Navas Bueno B, Rueda Villafranca B, Fernández JL. Doege-Potter syndrome. ENDOCRINOL DIAB NUTR 2023; 70:556-557. [PMID: 37858413 DOI: 10.1016/j.endien.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 10/21/2023]
Affiliation(s)
- Antonio Torres Gómez
- Departamento de Medicina Interna, Hospital Universitario San Agustín, Linares, Jaén, Spain.
| | | | | | - Belén Navas Bueno
- Departamento de Neumología, Hospital Santa Ana de Motril, Motril, Granada, Spain
| | | | - José Luis Fernández
- Departamento de Medicina Interna, Hospital Santa Ana de Motril, Motril, Granada, Spain
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11
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Gohir Q, Ghosh S, Bosher O, Crawford E, Srinivasan K, Moudgil H. Pleural-based giant solitary fibrous tumour with associated hypoglycaemia: unusual presentation with pulmonary hypertension in a patient with Doege-Potter syndrome. Clin Med (Lond) 2023; 23:518-520. [PMID: 37775170 PMCID: PMC10541276 DOI: 10.7861/clinmed.2023-0274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2023]
Abstract
Refractory hypoglycaemia in a patient with a solitary fibrous tumour (SFT) is very rare and was first reported in 1930 independently by Doege and Potter, leading to it being named 'Doege-Potter syndrome'. Here, we report the unusual case of a 77-year-old woman with a giant solitary fibrous pleural tumour who presented with complicating pulmonary hypertension and associated heart failure with hypoglycaemia, and subsequently underwent curative resection of the pleural mass with clinical improvement.
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Affiliation(s)
- Qasim Gohir
- Princess Royal Hospital, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK
| | - Shilajit Ghosh
- Royal Stoke University Hospital, University Hospitals North Midlands, Stoke-on-Trent, UK
| | - Olivia Bosher
- Princess Royal Hospital, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK
| | - Emma Crawford
- Princess Royal Hospital, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK, and honorary lecturer, University of Keele Medical School, Stoke-on-Trent, UK
| | - Koottalai Srinivasan
- Princess Royal Hospital, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK, and honorary senior lecturer, University of Keele Medical School, Stoke-on-Trent, UK
| | - Harmesh Moudgil
- Princess Royal Hospital, Shrewsbury and Telford Hospitals NHS Trust, Telford, UK and University of Keele Medical School, Stoke-on-Trent, UK, and honorary senior lecturer, University of Keele Medical School, Stoke-on-Trent, UK
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12
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Paz-Ibarra J, Lu-Antara J, Uscamayta BE, Martinez-Auris J, Valencia-Rivera M, Sáenz-Bustamante S, Delgado-Rojas M, Salcedo-Vasquez J, Concepción-Zavaleta M. Imatinib use in the management of a patient with Doege-Potter syndrome. Endocrinol Diabetes Metab Case Rep 2023; 2023:22-0360. [PMID: 37931416 PMCID: PMC10241232 DOI: 10.1530/edm-22-0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/16/2023] [Indexed: 10/16/2023] Open
Abstract
Summary Doege-Potter syndromeis a paraneoplastic syndrome characterized by nonislet cell tumor hypoglycemia due to a solitary fibrous tumor, which produces insulin-like growth factor II. In this report, we present the case of a 67-year-old male with recurrent and refractory hypoglycemia due to DPS successfully treated with imatinib. He initially presented with neuroglycopenic symptoms and dyspnea secondary to a giant tumor in the left hemithorax, which was totally resected. During follow-up, 7 years later, he presented with thoracoabdominal tumor recurrence associated with severe hypoglycemia and underwent subtotal tumor resection, with a subsequent improvement of symptoms. The following year, he had a recurrence of his intra-abdominal tumor, which was unresectable, associated with severe hypoglycemia refractory to dextrose infusion and corticosteroids, thus receiving imatinib with a favorable response. The clinical presentation, diagnostic approach, progression of the disease, and response to treatment with imatinib in the management of a patient with large, recurrent, and unresectable mesenchymal tumors with insulin-like growth factor-2 secretion causing hypoglycemiahighlight the importance of this case report. Learning points Doege-Potter syndrome (DPS) is a rare cause of tumoral hypoglycemia of non-pancreatic origin. Some malignant or benignant neoplasms have ectopic secretion of insulin-like growth factor-2. Total surgical removal is the principal treatment in patients with DPS. Tyrosine kinase inhibitors management in DPS may contribute to improved tumor control in patients with unresectable tumors and severe hypoglycemia.
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Affiliation(s)
- Jose Paz-Ibarra
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- National Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - Jose Lu-Antara
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- Scientific Society of San Fernando, Lima, Peru
| | - Brenda-Erendida Uscamayta
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- Scientific Society of San Fernando, Lima, Peru
| | - Jhancy Martinez-Auris
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- Scientific Society of San Fernando, Lima, Peru
| | - Miriam Valencia-Rivera
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- Scientific Society of San Fernando, Lima, Peru
| | - Sofía Sáenz-Bustamante
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- National Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - Marialejandra Delgado-Rojas
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- National Hospital Edgardo Rebagliati Martins, Lima, Peru
| | - Julia Salcedo-Vasquez
- Faculty of Medicine, National University of San Marcos, Lima, Peru
- National Hospital Edgardo Rebagliati Martins, Lima, Peru
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Castaldo V, Domenici D, Biscosi MV, Ubiali P, Miranda C, Zanette G, Mazzon C, Tonizzo M. Doege-Potter Syndrome; A Case of Solitary Fibrous Pleura Tumor Associated with Severe Hypoglycemia: A Case Report in Internal Medicine. Endocr Metab Immune Disord Drug Targets 2023; 23:1562-1569. [PMID: 37357513 PMCID: PMC10548549 DOI: 10.2174/1871530323666230623112047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/12/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND Doege-Potter syndrome is a rare paraneoplastic entity that is often diagnosed incidentally during the work-up of hypoglycemia of unclear etiology. It is characterized by a non-islet cell tumor hypoglycemia mostly associated with solitary fibrous tumors. These uncommon tumors have been reported in <5% of solitary fibrous tumors. Although not unique in its kind, this case is extremely important as this syndrome often conceals unrecognized tumors that can be surgically resolved. CASE PRESENTATION We present the case of a 59-year-old non-diabetic man with a 2-month history of severe and recurrent fasting hypoglycaemia presenting with severe dyspnea and sweating. Further workup revealed low insulin, C-peptide, and IGF-1 levels and a large right in-trathoracic solitary fibrous tumor. Unfortunately, bioassays for IGF-2 were unavailable at our hos-pital. Nevertheless, as hypoglycemia completely resolved after resection of the mass, Doege-Potter syndrome was highly suspected. CONCLUSION Doege-Potter syndrome is a complication of rare tumors. If hy-poglycemia is unexplained, this syndrome should always be suspected, and the presence of un-known masses should be investigated.
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Affiliation(s)
- Viviana Castaldo
- Department of Internal Medicine, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | - Daniela Domenici
- Department of Endocrinology and Metabolic Diseases, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | | | - Paolo Ubiali
- Department of General Surgery, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | - Cesare Miranda
- Department of Endocrinology and Metabolic Diseases, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | - Giorgio Zanette
- Department of Endocrinology and Metabolic Diseases, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | - Cinzia Mazzon
- Department of Endocrinology and Metabolic Diseases, Hospital Santa Maria degli Angeli, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, Hospital Santa Maria degli Angeli, Pordenone, Italy
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14
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Perinkulam Sathyanarayanan S, Añel-Tiangco RML, Tiangco NDL. Doege-Potter syndrome in a patient with solitary fibrous tumor of the lung: A rare cause of recurrent hypoglycemia. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2022. [DOI: 10.1016/j.jecr.2022.100112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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15
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Lopez‐Hinostroza M, Moya‐Salazar J, Dávila J, Absencio AY, Contreras‐Pulache H. Doege-Potter syndrome due to endothoracic solitary hypoglycemic fibrous tumor. Clin Case Rep 2022; 10:e05611. [PMID: 35414906 PMCID: PMC8979144 DOI: 10.1002/ccr3.5611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 01/16/2022] [Accepted: 03/07/2022] [Indexed: 11/26/2022] Open
Abstract
Doege-Potter syndrome leads to severe and sustained symptomatic hypoglycemia and is associated with the solitary fibrous tumor. It is a rare cause, and its diagnosis requires a clinical suspicion and other markers such as insulin-like growth factor II. Here, we describe a case of a patient with intrathoracic tumor and hypoglycemia.
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Affiliation(s)
| | - Jeel Moya‐Salazar
- Hospital Nacional Docente Madre Niño San BartoloméLimaPeru
- Cancerology and Pathology UnitNESH HubbsLimaPerú
- Digital Transformation CenterNorbert Wiener UniversityLimaPerú
| | - Juan Dávila
- Department of Respiratory DiseaseHospital Nacional Guillermo Almenara IrigoyenLimaPeru
| | | | - Hans Contreras‐Pulache
- South America Center for Education and Research in Public HealthUniversidad Norbert WienerLimaPeru
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16
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Novel Therapeutic Options for Solitary Fibrous Tumor: Antiangiogenic Therapy and Beyond. Cancers (Basel) 2022; 14:cancers14041064. [PMID: 35205812 PMCID: PMC8870479 DOI: 10.3390/cancers14041064] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/15/2022] [Accepted: 02/16/2022] [Indexed: 01/10/2023] Open
Abstract
SFT is an ultrarare mesenchymal ubiquitous tumor, with an incidence rate <1 case/million people/year. The fifth WHO classification published in April 2020 subdivided SFT into three categories: benign (locally aggressive), NOS (rarely metastasizing), and malignant. Recurrence can occur in up to 10-40% of localized SFTs, and several risk stratification models have been proposed to predict the individual risk of metastatic relapse. The Demicco model is the most widely used and is based on age at presentation, tumor size, and mitotic count. Total en bloc resection is the standard treatment of patients with a localized SFT; in case of advanced disease, the clinical efficacy of conventional chemotherapy remains poor. In this review, we discuss new insights into the biology and the treatment of patients with SFT. NAB2-STAT6 oncogenic fusion, which is the pathognomonic hallmark of SFT, is supposedly involved in the overexpression of vascular endothelial growth factor (VEGF). These specific biological features encouraged the successful assessment of antiangiogenic drugs. Overall, antiangiogenic therapies showed a significant activity toward SFT in the advanced/metastatic setting. Nevertheless, these promising results warrant additional investigation to be validated, including randomized phase III trials and biological translational analysis, to understand and predict mechanisms of efficacy and resistance. While the therapeutic potential of immunotherapy remains elusive, the use of antiangiogenics as first-line treatment should be considered.
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17
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Donato BB, Sewell MA, Sen A, Beamer SE. OUP accepted manuscript. Interact Cardiovasc Thorac Surg 2022; 35:6563852. [PMID: 35381086 PMCID: PMC9631964 DOI: 10.1093/icvts/ivac089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/21/2022] [Accepted: 03/23/2022] [Indexed: 11/14/2022] Open
Abstract
Doege Potter syndrome is a rare condition causing non-islet cell paraneoplastic hypoglycaemia associated with fibrous tumours, which can be both benign and malignant. The vast majority are solitary and located within the chest. Non-islet cell tumour-induced hypoglycaemia, as in Doege Potter syndrome, is quite rare and occurs around 4 times less often than islet cell-associated paraneoplastic hypoglycaemia. We present a case of Doege Potter syndrome with severe hypoglycaemia in conjunction with multiple recurrent fibrous tumours of the lung and pleura.
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Affiliation(s)
- Britton B Donato
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
- Corresponding author. Department of Surgery, Mayo Clinic Hospital, 5777 E Mayo Blvd., Phoenix, AZ 85054, USA. Tel: 480-342-2849; e-mail: (B.B. Donato)
| | - Marisa A Sewell
- Department of Surgery, Oregon Health & Science University, Portland, OR, USA
| | - Ayan Sen
- Department of Critical Care Medicine, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Staci E Beamer
- Department of Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
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18
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Guo W, Ji Y, Guo L, Che S, Huai Q, Yang K, Tan F, Xue Q, Gao S, He J. Severe hypoglycemia and finger clubbing in a patient with a BRCA1 mutation in a solitary fibrous tumor: a case report. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1093. [PMID: 34423005 PMCID: PMC8339833 DOI: 10.21037/atm-21-914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/31/2021] [Indexed: 12/17/2022]
Abstract
Solitary fibrous tumors (SFTs) are rare tumors that stem from mesenchymal cells of submesothelial tissues belonging to the pleura. They can occur in many places such as the spinal canal, intracranial, neck, kidney, liver, pelvis, limbs and other places, most commonly in the chest and abdomen. Pleural SFTs are one of the most common types, and are common in middle-aged people. Pleural SFTs can have an insidious expression, such that the illness can progress for years before diagnosis. SFTs can induce paraneoplastic syndromes, such as reactive hypoglycemia [Doege-Potter syndrome (DPS)] or hypertrophic osteoarthropathy [Pierre-Marie-Bamberger syndrome (PMBS)]. In this article, we report a case study of a 51-year-old man with pleural SFTs. Preoperative imaging examinations, including chest X-ray, computed tomography (CT), and magnetic resonance imaging (MRI), showed a huge mass in the right thoracic cavity, compressing surrounding tissues and organs and may invade other tissues. In addition, he suffers from severe hypoglycemia and finger clubbing, and has successfully undergone a complete resection, and now attends regular follow-up appointments. The paraneoplastic syndromes have resolved, and no recurrence has been found. Importantly, we used next-generation sequencing (NGS) to explore the molecular characteristics of the patient’s pathological tissue at the DNA level and mRNA level, and found that breast cancer gene 1 (BRAC1) mutations may be an important pathogenic factor.
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Affiliation(s)
- Wei Guo
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Ji
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lei Guo
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shunan Che
- Department of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qilin Huai
- Department of Graduate School, Zunyi Medical University, Zunyi, China
| | - Kun Yang
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fengwei Tan
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shugeng Gao
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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19
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Kiely NP, Sinha R, Tang K, Wan KM. Doege-Potter syndrome: a systematic review of the literature and case presentation of a rare pelvic malignant solitary fibrous tumour. BMJ Case Rep 2021; 14:e242447. [PMID: 34413033 PMCID: PMC8378376 DOI: 10.1136/bcr-2021-242447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2021] [Indexed: 11/04/2022] Open
Abstract
Solitary fibrous tumours (SFTs) are a rare mesenchymal neoplasm with an incidence of 2.8 per 100 000 of which only 1% occur in the female genital tract. Doege-Potter syndrome is a paraneoplastic phenomenon associated with approximately 5%-10% of SFTs and is characterised by non-islet cell hypoglycaemia due to tumour production of low molecular weight insulin-like growth factor-II. We present the fourth confirmed case of female pelvic SFT with Doege-Potter syndrome and a literature review.
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Affiliation(s)
- Neill Paul Kiely
- School of Women and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Obstetrics and Gynaecology, The Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Rinkita Sinha
- School of Women and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Royal Hospital for Women, Randwick, New South Wales, Australia
| | - Katrina Tang
- Department of Pathology, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - King Man Wan
- School of Women and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Department of Gynaecological Oncology, Royal Hospital for Women, Randwick, New South Wales, Australia
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20
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Doege-Potter Syndrome: A Presumptive Case of Metastatic Hemangiopericytoma with Persistent Hypoglycemia in a 27-Year-Old Male. J ASEAN Fed Endocr Soc 2021; 36:90-94. [PMID: 34177094 PMCID: PMC8214353 DOI: 10.15605/jafes.036.01.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 02/28/2021] [Indexed: 11/17/2022] Open
Abstract
Doege-Potter syndrome (DPS) is a rare paraneoplastic condition characterized by hypoinsulinemic hypoglycemia from a solitary fibrous tumor. The underlying mechanism is the secretion of a prohormone form of insulin-like growth factor II (IGF-II) by the tumor, which causes decreased release of glucose into the circulation. We report the case of a 27-year-old Filipino male with presumptive DPS from a recurrent right temporo-zygomatic hemangiopericytoma (HPC). The complexity of DPS requires a multidisciplinary approach. Early screening for metastases from HPC may prevent the undesirable sequelae of the disease process.
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21
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Reizun CE, Sorrells WS, Grossman RA. Recurrent Hypoglycemia Due to a Massive Abdominal Tumor in a Nonagenarian: A Case Report and Review of the Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e930727. [PMID: 34088888 PMCID: PMC8196397 DOI: 10.12659/ajcr.930727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patient: Male, 94-year-old Final Diagnosis: Doege Potter syndrome • solitary fibrous tumor Symptoms: Falls • hypoglycemia Medication: — Clinical Procedure: — Specialty: Geriatrics • Medicine, General and Internal
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Affiliation(s)
- Catherine E Reizun
- Department of Internal Medicine, Naples Community Hospital, Naples, FL, USA
| | - W Sheaffer Sorrells
- Department of General Surgery, Mayo Clinic of Jacksonville, Jacksonville, FL, USA
| | - Robert A Grossman
- Department of General Surgery, Naples Community Hospital, Naples, FL, USA
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22
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Outside the Thorax: Doege-Potter Syndrome Presenting as a Retroperitoneal Abdominal Mass. Case Rep Endocrinol 2021; 2021:9919321. [PMID: 34104499 PMCID: PMC8159632 DOI: 10.1155/2021/9919321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/02/2021] [Accepted: 05/08/2021] [Indexed: 11/17/2022] Open
Abstract
Objective We present a case of refractory hypoglycemia, weight loss, and retroperitoneal solitary fibrous tumor. Case report. A 68-year-old female presented with symptomatic hypoglycemia, weight loss, and abdominal mass identified on CT scan of the abdomen. Blood work during symptomatic hypoglycemia was consistent with an IGF-2-producing tumor. The abdominal mass pathology was consistent with solitary fibrous tumor surrounding the adrenal gland, and resection resulted in complete resolution of hypoglycemia. Discussion. Understanding the biochemical mechanisms behind glucose regulation is necessary to diagnose and adequately treat Doege–Potter syndrome, a paraneoplastic syndrome observed in patients with solitary fibrous tumors. Solitary fibrous tumors can be characterized by specific histologic and immunohistochemical studies. Conclusion This report describes the clinical workup of a patient presenting with hypoglycemia and a retroperitoneal tumor. This case is unique because of its presentation with severe, refractory hypoglycemia and the tumor's location in the retroperitoneum, given the majority of solitary fibrous tumors are found in the lungs originating from the pleura.
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23
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Tong J, Athayde J, MacKenzie S, Ho M. Successful multidisciplinary treatment of Doege-Potter syndrome: hypoglycaemia caused by paraneoplastic IGF-2 production by a metastatic haemangiopericytoma. BMJ Case Rep 2021; 14:14/4/e241724. [PMID: 33858901 PMCID: PMC8055102 DOI: 10.1136/bcr-2021-241724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Hypoglycaemia due to insulin-like growth factor (IGF)-2 secretion is a paraneoplastic complication of malignancy with significant morbidity that can often go unrecognised due to its uncommon presentation. We report on a case of a 51-year-old man with metastatic haemangiopericytoma presenting with refractory hypoglycaemia, requiring continuous dextrose 10% infusion while in hospital. IGF-2 levels were significantly elevated, in keeping with a rare entity associated with solitary fibrous tumours, known as Doege-Potter syndrome. The patient was managed using uncooked cornstarch in conjunction with debulking of the hepatic tumour burden with bland IR-guided transarterial embolisation, and eventual surgical resection to treat his non-islet cell tumour hypoglycaemia (NICTH). The case highlights this rare paraneoplastic phenomenon that should be included in the differential for hypoglycaemia, especially if a history of a solitary fibrous tumour is elicited. Our case is the first to document a successful approach to treating the hypoglycaemia using preoperative transarterial bland embolisation.
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Affiliation(s)
- Jeffery Tong
- Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Jonathan Athayde
- Department of Medicine, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
| | - Shawn MacKenzie
- Department of Surgery, The University of British Columbia Faculty of Medicine, New Westminster, British Columbia, Canada
| | - Meghan Ho
- Department of Medicine, The University of British Columbia Faculty of Medicine, New Westminster, British Columbia, Canada
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24
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Mohammed T, Ozcan G, Siddique AS, Araneta Iii RN, Slater DE, Khan A. Doege-Potter Syndrome with a Benign Solitary Fibrous Tumor: A Case Report and Literature Review. Case Rep Oncol 2021; 14:470-476. [PMID: 33976622 PMCID: PMC8077665 DOI: 10.1159/000512823] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/27/2022] Open
Abstract
Doege-Potter syndrome is a rare paraneoplastic syndrome that is often diagnosed incidentally during the workup of hypoglycemia of unclear etiology. It is characterized by a non-islet cell tumor hypoglycemia secondary to excessive production of partially processed IGF-II hormone from a solitary fibrous tumor (SFT). Often these tumors are intrathoracic, benign, and asymptomatic. Occasionally they present as a paraneoplastic event; hypertrophic osteoarthropathy in Pierre-Marie-Bamberger syndrome and hypoglycemia in Doege-Potter syndrome. The NAB2-STAT6 gene fusion is the hallmark of the SFT. Complete surgical resection of the tumor often results in resolution of symptoms and cure in most cases. Here we present the case of an 83-year-old non-diabetic female with recurrent syncopal events who was diagnosed with the Doege-Potter syndrome secondary to a SFT of pleura. Her tumor was positive for NAB2-STAT6 gene fusion on RT-PCR. Following the resection of the giant tumor mass, she became symptom-free within 24 h, and has remained asymptomatic at 4 months follow-up.
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Affiliation(s)
- Turab Mohammed
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Gonca Ozcan
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
| | - Ayesha S Siddique
- Department of Pathology, Hartford Hospital, Hartford, Connecticut, USA
| | | | - Dennis E Slater
- Department of Hematology-Oncology, Hartford Hospital, Hartford, Connecticut, USA
| | - Aziz Khan
- Department of Internal Medicine, University of Connecticut, Farmington, Connecticut, USA
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25
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Doege-Potter syndrome: a case report. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-021-00938-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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26
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Pinho Dos Santos D, Correia R, Carragoso A, Casimiro C, Lemos A. Non-Islet Cell Tumor Hypoglycemia Caused by Recurrent Pelvic Solitary Fibrous Tumor. Cureus 2021; 13:e12878. [PMID: 33633907 PMCID: PMC7899187 DOI: 10.7759/cureus.12878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Non-islet cell tumor hypoglycemia is a rare paraneoplastic condition caused by an extra-pancreatic tumor. We report a rare case of hypoglycemia caused by a relapsing pelvic solitary fibrous tumor associated with Big-IGF-2 production. A 72-year-old woman was admitted to our hospital because of loss of consciousness and hypoglycemia. She had a history of ovarian solitary fibrous tumor, which has relapsed. From investigation, serum levels of insulin and C-peptide were suppressed; IGF-1 was slightly reduced and IGF-2 was within the normal range, but the IGF-2: IGF-1 ratio was elevated, indicating the presence of Big-IGF-2 secreting non-islet cell tumor. Contrast-enhanced computed tomography (CT) showed a large pelvic mass. She was then submitted to surgical resection of the mass, which histologically proved to be a solitary fibrous tumor. Three months later, she remains asymptomatic. Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and recurrent hypoglycemia.
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Affiliation(s)
| | - Rui Correia
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
| | - Adelino Carragoso
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
| | - Carlos Casimiro
- Department of General Surgery, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
| | - Ana Lemos
- Department of Internal Medicine, Centro Hospitalar Tondela-Viseu, Epe, Viseu, PRT
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27
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Matsumoto S, Yamada E, Nakajima Y, Yamaguchi N, Okamura T, Yajima T, Yoshino S, Horiguchi K, Ishida E, Yoshikawa M, Nagaoka J, Sekiguchi S, Sue M, Okada S, Fukuda I, Shirabe K, Yamada M. Late-onset non-islet cell tumor hypoglycemia: A case report. World J Clin Cases 2021; 9:163-169. [PMID: 33511180 PMCID: PMC7809661 DOI: 10.12998/wjcc.v9.i1.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 11/13/2020] [Accepted: 11/29/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hypoglycemia due to non-insulin-producing tumors is referred to as non-islet cell tumor hypoglycemia (NICTH). As NICTH is a rare lesion, the natural course of NICTH is not well understood. We report a case of NICTH that was observed 30 years before the onset of hypoglycemia.
CASE SUMMARY A 50-year-old man was diagnosed with an abnormal right chest shadow during a routine X-ray examination, but no further examination was undertaken because the lesion appeared benign. Thirty years after the tumor discovery, the patient was admitted to the hospital with symptoms of severe hypoglycemia, which was diagnosed as NICTH based on a complete examination. The tumor was resected and found to be a solitary fibrous mass (15.6 cm × 13.7 cm × 10.4 cm); thereafter, the patient’s blood glucose levels normalized and he completely recovered.
CONCLUSION NICTH can have an acute onset, even if the tumor has been present and asymptomatic over a long time period.
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Affiliation(s)
- Shunichi Matsumoto
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Eijiro Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Yasuyo Nakajima
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Naoki Yamaguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Takashi Okamura
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Toshiki Yajima
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi 371-8511, Gunma, Japan
| | - Satoshi Yoshino
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Kazuhiko Horiguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Emi Ishida
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Masashi Yoshikawa
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Jun Nagaoka
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Sho Sekiguchi
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Mai Sue
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Shuichi Okada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
| | - Izumi Fukuda
- Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine Nippon Medical School, Tokyo 1138602, Japan
| | - Ken Shirabe
- Division of General Thoracic Surgery, Integrative Center of General Surgery, Gunma University Hospital, Maebashi 371-8511, Gunma, Japan
| | - Masanobu Yamada
- Department of Medicine and Molecular Science, Gunma University Graduate School of Medicine, Maebashi 371-8511, Gunma, Japan
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28
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Ramos N, Ramos R, Marialva C, Silva E. An urological cause of hypoglycaemia: A case report of the Doege-Potter syndrome. Arch Ital Urol Androl 2020; 92. [DOI: 10.4081/aiua.2020.4.392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/24/2020] [Indexed: 11/23/2022] Open
Abstract
The Doege-Potter syndrome is a rare paraneoplastic syndrome presenting with hypoglycaemia due to ectopic secretion of insulin-like growth factor II (IGF-II) from a solitary fibrous tumor. The underlying tumor can be benign or malignant and rarely present in extrapleural sites. We describe the case of a 83-year-old male diagnosed with a Doege-Potter syndrome due to a kidney tumor.
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Correa Bonito A, Muñoz-Hernández P, de la Hoz Rodríguez Á, Delgado Valdueza J, Martín Pérez E. Doege-Potter syndrome due to a hepatic solitary fibrous tumour. Cir Esp 2020; 100:S0009-739X(20)30358-4. [PMID: 33309282 DOI: 10.1016/j.ciresp.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 10/07/2020] [Accepted: 10/22/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Alba Correa Bonito
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España.
| | | | - Ángela de la Hoz Rodríguez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
| | - Jesús Delgado Valdueza
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
| | - Elena Martín Pérez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Madrid, España
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Primary Intrathoracic Sarcomas: A Review of Cross-sectional Imaging and Pathology. J Comput Assist Tomogr 2020; 44:821-832. [PMID: 33196594 DOI: 10.1097/rct.0000000000001097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The most common sarcomas in the thorax are metastasis from an extrathoracic primary malignancy. Primary intrathoracic sarcomas are rare albeit aggressive malignancies that are diagnosed on histopathology. Although a few imaging characteristics have been described that are common to sarcomas, it is still a diagnosis of exclusion as other tumors are much more common. Like elsewhere, primary thoracic sarcomas are also classified according to their histologic features. They are a rare group of tumors that can arise from the mediastinal structures, lung, pleura, or chest wall. On imaging, differentiating these from more common malignancies like lung cancer is difficult and often requires multimodality workup and tissue sampling. A few sarcomas are very specific to their locations, such as angiosarcoma in the right atrium, leiomyosarcoma in the pulmonary artery, where imaging has high accuracy for the diagnosis. Despite being nonspecific in a majority of cases, imaging plays a pivotal role in determining the organ of origin, tumor extent, invasion of adjacent structures, and thus help to assess the surgical resectability. Although sarcomas arising from chest wall are the most common primary sarcomas in the chest, they are excluded from this review to focus only on primary intrathoracic sarcomas. The article provides a comprehensive imaging and pathology review of the rare primary intrathoracic sarcomas, including but not limited to angiosarcoma, Kaposi sarcoma, fibrosarcoma, malignant transformation of fibrous tumor of pleura, sarcomatoid mesothelioma, leiomyosarcoma, and malignant small round blue cell tumors.Key points:Primary intrathoracic sarcomas are rare but clinically important.Imaging helps to determine local extent, invasion, metastases and appropriate site/mode of biopsy.Role of pathology is paramount in diagnosis and guiding treatment based on immunogenetic/molecular typing.
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A giant pelvic solitary fibrous tumor with Doege-Potter syndrome successfully treated with transcatheter arterial embolization followed by surgical resection: a case report. Surg Case Rep 2020; 6:299. [PMID: 33237401 PMCID: PMC7688842 DOI: 10.1186/s40792-020-01076-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 11/18/2020] [Indexed: 01/08/2023] Open
Abstract
Background Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege–Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege–Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection. Case presentation A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported. Conclusions Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege–Potter syndrome.
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Manzo CA, Asti E, Froiio C, Bruni B, Bonavina L. Refractory hypoglycemia associated with giant solitary fibrous tumor of the pleura (Doege–Potter syndrome). Eur Surg 2020. [DOI: 10.1007/s10353-020-00673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dong SS, Wang N, Yang CP, Zhang GC, Liang WH, Zhao J, Qi Y. Giant Cell-Rich Solitary Fibrous Tumor in the Nasopharynx: Case Report and Literature Review. Onco Targets Ther 2020; 13:6819-6826. [PMID: 32764969 PMCID: PMC7367732 DOI: 10.2147/ott.s252696] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/12/2020] [Indexed: 12/19/2022] Open
Abstract
Solitary fibrous tumors (SFTs) can occur in several locations outside the pleura, but rarely in the sinonasal tract, and particularly not in the nasopharynx. Herein, we describe an unusual case of giant cell-rich SFT (GCRSFT) occurring in the nasopharynx. A 64-year-old man experienced dizziness and headache for more than 10 years with no obvious cause. Computed tomography (CT) scan showed a 3.9 cm × 2 cm tumor on the posterior lateral wall of the left nasopharynx, and angiography revealed a hypervascular tumor fed by branches of the left carotid artery. Hence, preoperative embolization was performed, and then the tumor was endoscopically resected. The symptoms were relieved after the resection, and postoperative head CT and video laryngoscopy showed that the tumor was completely resected. We next characterized the specific pathological characteristics of the resected tumor. Histologically, the tumor was characterized by varying cellular proliferation of cytologically bland spindle cells within a collagenous stroma, with prominent interspersed branching vessels. Mitotic activity was low (2/50HPF), and there was no evidence of pleomorphism or tumor necrosis. Moreover, multinucleated giant cells with deep nuclear staining and distributed in pseudovascular spaces were found within the tumor. We ruled out the possibility that our case was giant cell fibroblastoma (GCF) by immunohistochemical analysis, showing that the tumor cells were positive for CD34, CD99, STAT6, and BCL-2, and that the Ki-67 labeling index was 3%, indicating that our case was SFT and not GCF. The patient's condition is generally good after a 14-month follow-up. This report serves to broaden the morphologic spectrum of GCRSFT and will help clinicians and pathologists better understand this entity to prevent misdiagnosis.
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Affiliation(s)
- Shuang-Shuang Dong
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
| | - Ning Wang
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
| | - Cui-Ping Yang
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
| | - Guo-Chang Zhang
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
| | - Wei-Hua Liang
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
| | - Jin Zhao
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
| | - Yan Qi
- Department of Pathology, Shihezi University School of Medicine and The First Affiliated Hospital to Shihezi University School of Medicine, Shihezi, Xinjiang 832002, People's Republic of China
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van Doorn J. Insulin-like growth factor-II and bioactive proteins containing a part of the E-domain of pro-insulin-like growth factor-II. Biofactors 2020; 46:563-578. [PMID: 32026557 PMCID: PMC7497164 DOI: 10.1002/biof.1623] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/15/2020] [Indexed: 12/13/2022]
Abstract
Insulin-like growth factor (IGF)-II is considered to function as an important fetal growth factor, which is structurally and functionally related to IGF-I and proinsulin. At least in vitro, IGF-II actions are mediated through the IGF-I receptor and to a lesser extent the insulin receptor. After birth, the function of IGF-II is less clear although in adults the serum level of IGF-II exceeds that of IGF-I several fold. The IGF-II gene is maternally imprinted, with exception of the liver and several parts of the brain, where it is expressed from both alleles. The regulation, organization, and translation of the IGF-II gene is complex, with five different putative promotors leading to a range of noncoding and coding mRNAs. The 180-amino acid pre-pro-IGF-II translation product can be divided into five domains and include a N-terminal signal peptide of 24 amino acid residues, the 67 amino acid long mature protein, and an 89 residues extension at the COOH terminus, designated as the E-domain. After removal of the signal peptide, the processing of pro-IGF-II into mature IGF-II requires various steps including glycosylation of the E-domain followed by the action of endo-proteases. Several of these processing intermediates can be found in the human circulation. There is increasing evidence that, besides IGF-II, several incompletely processed precursor forms of the protein, and even a 34-amino acid peptide (preptin) derived from the E-domain of pro-IGF-II, exhibit distinct biological activities. This review will focus on the current insights regarding the specific roles of the latter proteins in cancer, glucose homeostasis, and bone physiology. To address this topic clearly in the right context, a concise overview of the biological and biochemical properties of IGF-II and several relevant aspects of the IGF system will be provided.
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Affiliation(s)
- Jaap van Doorn
- Department of Genetics, Section Metabolic DiagnosticsUniversity Medical Center Utrecht, Utrecht UniversityUtrechtThe Netherlands
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35
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Paraneoplastic hypoglycaemia secondary to IGF-2 secretion from a metastatic gastrointestinal stromal tumour. ENDOCRINE AND METABOLIC SCIENCE 2020. [DOI: 10.1016/j.endmts.2020.100047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Solsi A, Pho K, Shojaie S, Findakly D, Noori T. Doege-Potter Syndrome and Pierre-Marie-Bamberger Syndrome in a Patient With Pleural Solitary Fibrous Tumor: A Rare Case With Literature Review. Cureus 2020; 12:e7919. [PMID: 32494533 PMCID: PMC7263730 DOI: 10.7759/cureus.7919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Solitary fibrous tumors (SFT) represent a unique subset of mostly benign heterogeneous tumors with mesenchymal cell origins. These tumors have been reported in the past as being mostly indolent, with a slowly evolving clinical course and low potential for malignancy. Although found systemically, the incidence of SFT arising intrathoracically, from the pleura of the lung, is relatively poorly documented in the medical literature. SFT is a rare phenomenon, but in even rarer circumstances, these tumors are associated with distinctive paraneoplastic syndromes, such as Pierre-Marie-Bamberger syndrome (PMBS) and Doege-Potter syndrome (DPS). PMBS presents as digital clubbing and hypertrophic pulmonary osteoarthropathy. DPS has been characterized as a non-islet cell tumor hypoglycemia due to the ectopic secretion of insulin-like growth factor 2 (IGF-2), a pattern seen in fewer than 5% of cases of SFT. Treatment is typically through surgical resection. In our research of the medical literature, we found only very few cases in which the association with SFT and both paraneoplastic syndromes were described. Here, we report an uncommon case of a 68-year-old male patient found to have an incidental right hemithoracic tumor with digital clubbing and intermittent severe episodes of fasting hypoglycemia after initially presenting with a syncopal episode.
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Affiliation(s)
- Anup Solsi
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Karen Pho
- Internal Medicine, University of Arizona College of Medicine, Phoenix, USA
| | - Shiva Shojaie
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Dawood Findakly
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
| | - Tarreq Noori
- Internal Medicine, Creighton University Arizona Health Education Alliance/Valleywise Health Medical Center, Phoenix, USA
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Costa LRR, Donelly CG, Crowe CM, Vaughan B, Alex CE, Aleman M. Electroencephalographic alterations in a mare with presumed intermittent neuroglycopenia caused by severe hypoglycaemia‐associated with nonislet cell tumour. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.12947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- L. R. R. Costa
- School of Veterinary Medicine, Veterinary Medicine and Epidemiology University of California‐Davis USA
| | - C. G. Donelly
- Veterinary Medical Teaching Hospital – Large Animal Clinic University of California‐Davis USA
| | - C. M. Crowe
- Neurology and Neurosurgery Service – Electrophysiology Laboratory University of California‐DavisUSA
| | - B. Vaughan
- Surgical and Radiological Sciences University of California‐DavisUSA
| | - C. E. Alex
- Veterinary Medical Teaching Hospital – Anatomic Pathology Service University of California‐Davis USA
| | - M. Aleman
- School of Veterinary Medicine, Veterinary Medicine and Epidemiology University of California‐Davis USA
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Pleural Solitary Fibrous Tumors-A Retrospective Study on 45 Patients. ACTA ACUST UNITED AC 2020; 56:medicina56040185. [PMID: 32316178 PMCID: PMC7230748 DOI: 10.3390/medicina56040185] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 04/12/2020] [Accepted: 04/14/2020] [Indexed: 12/20/2022]
Abstract
Introduction: The purpose of this paper is to study the type, the clinical presentation, and the best diagnostic methods for pleural solitary fibrous tumors (PSFTs), as well as to evaluate which is the most appropriate treatment, especially as PSFTs represent a rare occurrence in the thoracic pathology. Material and Method: A retrospective study was conducted on a group of 45 patients submitted to surgery between January 2015 and December 2019. In most cases, the diagnosis was established through imaging studies—thoracic computed tomography (CT) scan with or without contrast—but also using magnetic resonance imaging (MRI) or positron emission tomography (PET) scans when data from CT scans were scarce. All patients were submitted to surgery with curative intent. Results: Most patients included in this study were asymptomatic, with this pathology being more common in patients over 60 years of age, and more common in women. The occurrence of malignant PSFT in our study was 17.77% (8 cases). All cases were submitted to surgery with curative intent, with a single case developing further recurrence. In order to achieve complete resection en bloc resection of the tumor with the chest wall, resection was performed in two cases, while lower lobectomy, pneumectomy, and hemidiaphragm resection, respectively, were needed in each case. Postoperative mortality was null. Conclusion: Thoracic CT scan remains the most important imagistic investigation in diagnosing. MRI is superior to thoracic CT, especially in cases that involved the larger blood vessels within the thorax, spinal column, or diaphragm. Complete surgical resection is the gold standard in treatment of PSFT, and the prognosis in benign cases is very good.
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Layman PF, Davis-Merritt D, Neff P. Primary Functioning Neuroendocrine Tumor of the Appendix with Hypoglycemia Syndrome: A Case Report and Review of Neuroendocrine Tumors. Perm J 2020; 24:19.142. [PMID: 32240090 DOI: 10.7812/tpp/19.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Primary neuroendocrine tumors (NETs) of the appendix are uncommon, but when present are usually not hyperfunctioning. This case represents an extraordinarily rare primary hyperfunctioning NET of the appendix with a clinical presentation of symptomatic hypoglycemia in an otherwise healthy man. CASE PRESENTATION A previously healthy 34-year-old man was found to be symptomatically hypoglycemic in early 2018. After the workup, the apparent explanation was a tumor in his midappendix, for which he was referred to our surgical oncology service for resection. The patient's clinical course is described in detail, including imaging, as well as surgical and pathologic descriptions of the appendiceal NET. DISCUSSION A literature review demonstrates no other case series or reports of a primary hyperfunctioning NET of the appendix presenting with hypoglycemic crisis. The symptoms of tumor-induced hypoglycemia more typically arise with islet cell tumors, such as pancreatic NETs or insulinomas. We believe this case represents a nonislet cell tumor-induced hypoglycemia. This patient's elevated serum proinsulin level preoperatively implies secretion of proinsulin by the tumor. However, tumor-induced hypoglycemia caused by proinsulin has been described previously only in pancreatic tumors. This unique case adds knowledge to the possible glycemic endocrine effects of nonpancreatic NETs, specifically those that arise primarily in the appendix.
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Affiliation(s)
| | | | - Phillip Neff
- Surgery Department, Saint Joseph Hospital, Denver, CO.,Surgery Department, Kaiser Permanente Colorado, Denver
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Sorino C, Negri S, Spanevello A, Feller-Kopman D. The pleura and the endocrine system. Eur J Intern Med 2020; 72:34-37. [PMID: 31918926 DOI: 10.1016/j.ejim.2019.12.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 12/21/2019] [Accepted: 12/30/2019] [Indexed: 12/14/2022]
Abstract
The functioning of the pleura and the endocrine system are not entirely independent of each other. Some hormones can reach a greater concentration in the pleural exudate than in the blood. However, the clinical significance of this finding remains unknown. In some circumstances, hormonal changes are responsible for pathological manifestations in the pleura. Hypothyroidism is one of the most common diseases that can cause a pleural effusion, likely resulting from alterations in capillary permeability. The presence of ectopic endometrial tissue within the lung parenchyma, pleura, pericardium or diaphragm is known as thoracic endometriosis and is one of the causes of catamenial pneumothorax and /or catamenial hemothorax, which can affect women of childbearing age and arises within 72 h from the onset of menstruation. Treatment and prevention of recurrent catamenial pneumothorax / hemothorax usually requires an approach that combines surgery and hormone therapy. Malignant pleural effusion from breast cancer may contain estrogen receptor-positive cells. In such a case, endocrine treatment may be effective in reducing the amount of pleural fluid and the associated symptoms. Thyroid cancer and lymphangioleiomyomatosis (LAM) are further hormone-sensitive malignancies in which pleura is frequently involved. The solitary fibrous tumor of pleura (SFPT) is an example of a pleural disease that can cause hormonal balance disorders. It can lead to a rise in the releasing factor for growth hormone (GHRH), human beta chorionic gonadotropin (Beta-hCG), and insulin-like growth factor 2 (IGF2). The consequence of such hormonal imbalance include hypertrophic pulmonary osteoarthropathy, gynecomastia, and refractory hypoglycemia, respectively.
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Affiliation(s)
- Claudio Sorino
- Division of Pulmonology, Sant'Anna Hospital, Como, Italy; University of Insubria, Varese, Italy.
| | | | - Antonio Spanevello
- University of Insubria, Varese, Italy; Division of Pulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - David Feller-Kopman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins Hospital, USA
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Geng H, Ye Y, Jin Y, Li BZ, Yu YQ, Feng YY, Li JT. Malignant solitary fibrous tumor of the pancreas with systemic metastasis: A case report and review of the literature. World J Clin Cases 2020; 8:343-352. [PMID: 32047784 PMCID: PMC7000951 DOI: 10.12998/wjcc.v8.i2.343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 12/18/2019] [Accepted: 12/22/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Pancreatic solitary fibrous tumor (SFT) is a rare neoplasm of intermediate biological potential. So far, only 22 cases have been reported since 1999. All the cases, except one, exhibited benign features. Here, we report the first case of malignant pancreatic SFT with typical Doege-Potter syndrome, along with the clinical and pathologic evidence of its systemic metastasis.
CASE SUMMARY The patient was a 48-year-old man with a 1-year history of pancreatic and liver masses and refractory hypoglycemia. Increased uptake of the tracer fluorodeoxyglucose (FDG) was found in the liver and bones by fluorine-18 FDG positron emission tomography/computed tomography. After multidisciplinary discussion, a distal pancreatectomy procedure was performed, and histological examination showed a lesion composed of abundant heterogeneous spindle cells with localized necrosis. On immunohistochemistry evaluation, STAT6 was found to be diffusely expressed in the tumor. Based on the overall evidence, the patient was diagnosed with malignant pancreatic SFT with liver and bone metastases.
CONCLUSION The diagnosis of malignant SFT requires comprehensive evidence including clinical, immunohistochemistry, and histological features. This case may be presented as a reference for diagnoses and management of malignant pancreatic SFTs with systemic metastasis.
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Affiliation(s)
- Hao Geng
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yu Ye
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yun Jin
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Bai-Zhou Li
- Department of Pathology, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yuan-Quan Yu
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Yang-Yang Feng
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
| | - Jiang-Tao Li
- Department of General Surgery, The Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
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Guillen A, Ressel L, Finotello R, German AJ, Freeman A, Blackwood L. Non-islet-cell tumour hypoglycaemia in a cat with hepatocellular carcinoma. JFMS Open Rep 2019; 5:2055116919856129. [PMID: 31263567 PMCID: PMC6595665 DOI: 10.1177/2055116919856129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Case summary An 11-year-old male neutered domestic shorthair cat presented with behavioural changes. Physical examination revealed bradycardia and a cranial abdominal mass. The cat was persistently hypoglycaemic (1.2 mmol/l; reference interval [RI] 3.5–5.5 mmol/l) with decreased fructosamine concentration suggesting chronic hypoglycaemia, and decreased insulin concentration excluding insulinoma. Alanine aminotransferase activity was markedly increased (1219.31 U/l; RI 15–60 U/l). On staging CT a large, multilobulated hepatic mass was identified, with no evidence of metastatic disease. After surgical removal serum glucose concentration and heart rate quickly returned to within the RIs. Histopathology was consistent with a solid-to-trabecular, well-differentiated, hepatocellular carcinoma. There was no recurrence of signs or mass during 8 months of follow-up, and the cat was still alive 20 months after surgery. Relevance and novel information Non-islet-cell tumour hypoglycaemia (NICTH) is a rare but life-threatening paraneoplastic syndrome. In humans, hepatocellular carcinoma is the most common epithelial tumour causing NICTH, but these are uncommon in cats, and associated paraneoplastic hypoglycaemia has not been reported. Possible mechanisms include aberrant secretion of big insulin growth factor 2; however, this could not be confirmed. NICTH should be considered in the differential diagnosis of cats with persistent hypoglycaemia.
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Affiliation(s)
- Alexandra Guillen
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Lorenzo Ressel
- Department of Veterinary Pathology and Public Health, Institute of Veterinary Sciences, University of Liverpool, Neston, UK
| | - Riccardo Finotello
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Alexander J German
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Alistair Freeman
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
| | - Laura Blackwood
- Department of Small Animal Clinical Science, Institute of Veterinary Science, University of Liverpool, Neston, UK
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Alvarez Mavarez JD, Villanueva Montes MA, Rodríguez Seoane MR, Leung Shao M. Hypoglycemia as an Atypical Presentation of a Pleural Tumor. Arch Bronconeumol 2019; 55:652-654. [PMID: 31113672 DOI: 10.1016/j.arbres.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/12/2019] [Accepted: 04/15/2019] [Indexed: 10/26/2022]
Affiliation(s)
| | | | | | - Michelle Leung Shao
- Servicio de Cirugía torácica, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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44
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Wada Y, Okano K, Ando Y, Uemura J, Suto H, Asano E, Kishino T, Oshima M, Kumamoto K, Usuki H, Suzuki Y. A solitary fibrous tumor in the pelvic cavity of a patient with Doege-Potter syndrome: a case report. Surg Case Rep 2019; 5:60. [PMID: 30976927 PMCID: PMC6459447 DOI: 10.1186/s40792-019-0617-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A solitary fibrous tumor (SFT) is a mesenchymal lesion, which commonly develops in the thorax. Non-islet cell hypoglycemia is a rare paraneoplastic phenomenon caused by an extra-pancreatic tumor. We report a rare case of a pelvic SFT with severe hypoglycemia, which was considered to be Doege-Potter syndrome. CASE PRESENTATION A 72-year-old man was referred to our hospital for treatment of hypoglycemia and a large pelvic tumor. His blood glucose level was 52 mg/dl; serum insulin level, 1.0 μIU/ml; C-peptide level, 0.2 ng/ml; and insulin-like growth factor-I (IGF-I) level, 31 ng/ml. Contrast-enhanced computed tomography (CT) showed a 13-cm mass in the pelvic cavity. Magnetic resonance imaging (MRI) revealed a lobulated tumor with iso- and high-intensity areas combined in T2-weighted images. No clear invasion to any adjacent organs was identified. The tumor was resected, and hypoglycemic symptoms disappeared immediately. Pathological diagnosis was an SFT with malignant potential that secreted IGF-II and caused hypoglycemia. There has been no tumor recurrence during the 1 year of follow-up. CONCLUSION Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and hypoglycemia.
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Affiliation(s)
- Yukiko Wada
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Yasuhisa Ando
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Jun Uemura
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Hironobu Suto
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Eisuke Asano
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Takayoshi Kishino
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Minoru Oshima
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Kensuke Kumamoto
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Hisashi Usuki
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Kagawa University, 1750-1 Ikenobe, Miki-cho, Kita-gun, Kagawa 761-0793 Japan
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Agaimy A. Paraneoplastic disorders associated with miscellaneous neoplasms with focus on selected soft tissue and Undifferentiated/ rhabdoid malignancies. Semin Diagn Pathol 2019; 36:269-278. [PMID: 30819530 DOI: 10.1053/j.semdp.2019.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A variety of soft tissue and visceral neoplasms have been associated with constitutional symptoms and signs including fever, fatigue, arthritis and laboratory abnormalities such as elevated erythrocyte sedimentation rate, leukocytosis with marked neutrophilia, anemia, thrombocytosis and others. This review addresses three main neoplastic categories that are associated with specific paraneoplastic phenomena: (1) neoplasms having in common the presence of diffuse mixed inflammatory infiltration (closely simulating an inflammatory pseudotumor) and frequently associated with constitutional symptoms; (2) neoplasms with undifferentiated, anaplastic or rhabdoid cell morphology (frequently SWI/SNF-deficient) associated with diverse paraneoplastic manifestations; and (3) paraneoplasia associated with neoplasms carrying specific gene fusions such as solitary fibrous tumor (STAT6-NAB2 gene fusions), infantile fibrosarcoma and congenital mesoblastic nephroma (ETV6-NTRK3 gene fusions), and angiomatoid fibrous histiocytoma (EWSR1-CREB1 & EWSR1-ATF1 fusions).
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander-University Erlangen-Nürnberg, University Hospital Erlangen, Germany.
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Forster C, Roumy A, Gonzalez M. Solitary fibrous tumor of the pleura with Doege-Potter syndrome: Second recurrence in a 93-year-old female. SAGE Open Med Case Rep 2019; 7:2050313X18823468. [PMID: 30719313 PMCID: PMC6349974 DOI: 10.1177/2050313x18823468] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 12/14/2018] [Indexed: 11/16/2022] Open
Abstract
Solitary fibrous tumors are rare mesenchymal tumors most commonly arising from the pleura. When associated with paraneoplastic syndrome of hypoglycemia caused by the secretion of a high-molecular-weight form of insulin-like growth factor II, it is referred to as the Doege–Potter syndrome. Surgery with complete tumor resection is the only curative treatment. We present here the case of a 93-year-old female diagnosed with a Doege–Potter syndrome who underwent three repetitive surgical resections of recurrent solitary fibrous tumor.
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Affiliation(s)
- Céline Forster
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Aurélien Roumy
- Department of Cardiac Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Michel Gonzalez
- Division of Thoracic Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
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De Los Santos-Aguilar RG, Chávez-Villa M, Contreras AG, García-Herrera JS, Gamboa-Domínguez A, Vargas-Sánchez J, Almeda-Valdes P, Reza-Albarrán AA, Iñiguez-Ariza NM. Successful Multimodal Treatment of an IGF2-Producing Solitary Fibrous Tumor With Acromegaloid Changes and Hypoglycemia. J Endocr Soc 2019; 3:537-543. [PMID: 30788455 PMCID: PMC6371079 DOI: 10.1210/js.2018-00281] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 01/03/2019] [Indexed: 12/13/2022] Open
Abstract
Doege–Potter syndrome with acromegaloid facial changes is extremely rare. Uncooked cornstarch along with glucocorticoids have been used as supportive care in patients with non–islet cell tumor hypoglycemia (NICTH). Preoperative embolization of hepatic solitary fibrous tumors (SFT) with NICTH has yielded unsatisfactory results. Herein we present the case of a 61-year-old man with a 3-month history of severe frequent hypoglycemic episodes and acromegaloid facial changes. During a spontaneous hypoglycemia (26 mg/dL), laboratory values showed a hypoinsulinemic pattern with low levels of GH, IGFPB3, and an IGF2/IGF1 ratio of 8.5:1. Cross-sectional imaging revealed a large (16 × 13 × 11 cm) hepatic tumor, and cytology was consistent with SFT. A preoperative right portal embolization was performed in an effort to induce normal remnant liver hypertrophy to allow for safe tumor resection. After the procedure, uncooked starch treatment followed by prednisone was started, achieving complete remission of hypoglycemic episodes in the preoperative setting. He subsequently underwent partial hepatectomy. The histologic diagnosis was compatible with a potentially malignant SFT. The patient had an excellent outcome with complete remission of hypoglycemia, improvement of facial acromegaloid changes, and no further evidence of disease. To our knowledge, this is the first case of a patient with Doege–Potter syndrome with acromegaloid facial changes induced by a potentially malignant liver SFT, treated successfully with a multimodal approach consisting of uncooked cornstarch, low-dose prednisone, preoperative embolization, and complete surgical resection. The use of cornstarch and low-dose glucocorticoids may be an adequate treatment in advance of undergoing surgery.
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Affiliation(s)
- Ramón G De Los Santos-Aguilar
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Mariana Chávez-Villa
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alan G Contreras
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Juan S García-Herrera
- Department of Surgery, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Armando Gamboa-Domínguez
- Department of Pathology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Joel Vargas-Sánchez
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paloma Almeda-Valdes
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico.,Research Unit for Metabolic Diseases, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Alfredo A Reza-Albarrán
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Nicole M Iñiguez-Ariza
- Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Abstract
INTRODUCTION Solitary fibrous tumors (SFTs) are uncommon mesenchymal neoplasms and are particularly rare in the female genital tract. Doege-Potter syndrome is a paraneoplastic syndrome involving SFT-associated hypoglycemia. We report, for the first time, on a broad ligament SFT with Doege-Potter syndrome; additionally, we review 30 cases of women with SFTs reported in the literature. PATIENT CONCERNS A 37-year-old woman who presented with life-threatening hypoglycemia and a pelvic mass (16 × 15 × 15 cm). DIAGNOSES The patient was diagnosed with broad ligament SFT with Doege-Potter syndrome. INTERVENTIONS Tumor resection, sub-extensive hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy were performed, and 6 cycles of adjuvant chemotherapy were administered. OUTCOMES Serum glucose levels returned to normal as soon as the tumor was resected. Forty-3 months after operation, there was recurrence in the posterior peritoneal tissues. She underwent tumor resection and has remained tumor-free 28 months after this excision. CONCLUSION Even though it is extremely rare, SFT should be quickly identified to prevent undue treatment delay and avoid unnecessary examination; surgery and long-term follow-up are recommended. SFT can be considered a highly invasive cancer, and intraoperative bleeding may occur. Although no correlation between adjuvant therapy and improved prognosis was found, further studies are required because of the small number of cases reported to date.
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Affiliation(s)
- Sijing Chen
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Ying Zheng
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Lin Chen
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
| | - Qihua Yi
- Department of Gynecologic Oncology, West China Second Hospital, Sichuan University
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, China
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Bailly C, Bichali Alroumani M, Douane F, Ansquer C, Drui D. Metastatic Solitary Fibrous Tumor With Doege-Potter Syndrome: Hypoglycemia Treated by 90Y Radioembolization. Clin Nucl Med 2018; 43:e93-e95. [PMID: 29293132 DOI: 10.1097/rlu.0000000000001944] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Solitary fibrous tumor is a rare type of mesenchymal neoplasm that can be associated to a paraneoplastic severe hypoglycemia due to the overproduction of insulinlike growth factor type 2: Doege-Potter syndrome. When surgical resection is impossible or unsuccessful, alternative therapies were described with heterogeneous efficiency. We report the use of radioembolization with Y-labeled glass microspheres in this application. Regarding the excellent results obtained and the potential interest of peptide receptor radionuclide therapy suggested by overexpression of somatostatin receptors in our patient, the place of targeted radionuclide therapies deserves to be explored in this group of tumors.
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50
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Doege-Potter syndrome: When seizures and hypoglycemia collide. IRANIAN JOURNAL OF NEUROLOGY 2018; 17:86-88. [PMID: 30210734 PMCID: PMC6131338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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