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D SK, S SG, Wahab AJ. Pseudoglucagonoma Syndrome Following Frey's Surgery: A Case Report of a Rare Presentation. Cureus 2024; 16:e58076. [PMID: 38738007 PMCID: PMC11088536 DOI: 10.7759/cureus.58076] [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] [Received: 02/28/2024] [Accepted: 04/11/2024] [Indexed: 05/14/2024] Open
Abstract
Pseudoglucagonoma syndrome is defined as the presence of necrolytic migratory erythema in the absence of a glucagon-secreting tumor. Necrolytic migratory erythema is the hallmark of glucagonoma syndrome but can also occur due to pancreatitis, pancreatic insufficiency, gastrointestinal dysfunction, inflammatory bowel disease, celiac disease, malabsorption disorders, nutritional deficiencies, hepatocellular dysfunction, and hypoalbuminemia. Pseudoglucagonoma syndrome is extremely rare, and the diagnosis is often delayed, resulting in delayed treatment. We report a rare case of pseudoglucagonoma syndrome in a malnourished male patient following Frey's surgery. The patient presented with a skin rash which gradually progressed over 20 days with diffuse hair loss. On cutaneous examination, multiple irregular erythematous and eroded plaques surrounded by a hyperpigmented scaly border were present over the dorsal aspect of the lower limbs, upper limbs, gluteal region, and genitals. Routine investigations showed normocytic normochromic anemia, neutropenia, lymphocytosis, dyslipidemia, and hypoalbuminemia. Rapid resolution of the skin lesions was observed with improved nutrition.
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Affiliation(s)
- Sai Kavya D
- Department of Dermatology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Sukesh Gautam S
- Department of Dermatology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
| | - Afthab Jameela Wahab
- Department of Dermatology, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS) Saveetha University, Chennai, IND
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Garcia S, Canela Ynoa SJ, Concepción AM, De Sá Ribeiro FA. Hepatic Glucagonoma in a Post-bariatric Female Patient: A Case Report. Cureus 2023; 15:e46724. [PMID: 38021839 PMCID: PMC10631158 DOI: 10.7759/cureus.46724] [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: 10/08/2023] [Indexed: 12/01/2023] Open
Abstract
Glucagonomas, neuroendocrine tumors originating from the pancreas marked by excessive glucagon secretion, present a diagnostic challenge due to their rarity and diverse symptomatology. In this report, we present a 47-year-old female with a history of bariatric surgery, diabetes mellitus, and deep vein thrombosis who exhibited weight loss, anemia, migratory necrolytic erythema on the lower limbs and groin, and fecal incontinence. Imaging revealed liver secondary lesions without an identifiable primary tumor. After undergoing surgery, a pathologic examination of the excised tissue confirmed that the lesions were a glucagonoma. This case underscores the imperative of how common side effects of bariatric surgery could mask symptoms, delaying the diagnosis of glucagonomas.
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Affiliation(s)
- Sophia Garcia
- General Surgery, Instituto de Pós Graduação Médica Carlos Chagas, Rio de Janeiro, BRA
| | - Saly J Canela Ynoa
- General Surgery, Instituto de Pós Graduacão Médica Carlos Chagas, Rio de Janeiro, BRA
| | - Arturo M Concepción
- General Surgery, Instituto de Pós Graduação Médica Carlos Chagas, Rio de Janeiro, BRA
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Abdelli W, Alaoui F, Souissi A, Sassi W, Chelly I, Haouet S, Mokni M. Case of delayed diagnosis of necrolytic migratory erythema. Clin Case Rep 2021; 9:e05179. [PMID: 34938555 PMCID: PMC8665690 DOI: 10.1002/ccr3.5179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/22/2022] Open
Abstract
Necrolytic migratory erythema (NME) is a rare cutaneous paraneoplastic manifestation of glucagonoma. We report a case of a woman with a 6-year history of delayed diagnosis of glucagonoma. This case highlights the atypical clinical features of NME which makes the diagnosis difficult.
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Affiliation(s)
| | | | | | - Wiem Sassi
- Dermatology Department ‐ Rabta HospitalTunisTunisia
| | - Ines Chelly
- Anatomopathology Department – Rabta HospitalTunisTunisia
| | - Slim Haouet
- Anatomopathology Department – Rabta HospitalTunisTunisia
| | - Mourad Mokni
- Dermatology Department ‐ Rabta HospitalTunisTunisia
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Miulescu R, Balaban DV, Sandru F, Jinga M. Cutaneous Manifestations in Pancreatic Diseases-A Review. J Clin Med 2020; 9:E2611. [PMID: 32806580 PMCID: PMC7464368 DOI: 10.3390/jcm9082611] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 02/07/2023] Open
Abstract
Pancreatic pathology, comprising acute and chronic pancreatitis, autoimmune pancreatitis and pancreatic neoplasms, primarily presents with gastrointestinal symptoms and signs; however, it is well recognized that it can also associate a wide range of extra-digestive features. Among these systemic manifestations, cutaneous involvement plays an important role both as a diagnostic clue for the pancreatic disease itself and serving as a prognostic factor for the severity of the condition. Recognition of these cutaneous signs is, however, far from being satisfactory, all the more as some of them are relatively rare. In the current review, we discuss skin involvement in pancreatic diseases, referring to pancreatic panniculitis, cutaneous hemorrhagic manifestations, skin metastasis, acanthosis nigricans, livedo reticularis, necrolytic migratory erythema and cutaneous fistula. We highlight the clinical characteristics, treatment and prognostic value of these lesions. Better awareness among medical specialties other than dermatology is needed for detection of the skin clues associated with pancreatic pathology.
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Affiliation(s)
- Raluca Miulescu
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
| | - Daniel Vasile Balaban
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
| | - Florica Sandru
- Dermatology Department, Elias University Emergency Hospital, 011461 Bucharest, Romania; (R.M.); (F.S.)
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
| | - Mariana Jinga
- Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania;
- Gastroenterology Department, “Dr. Carol Davila” Central Military Emergency University Hospital, 010825 Bucharest, Romania
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Gualtieri B, Hertl M. Tumorerkrankungen an der Haut erkennen – paraneoplastische Hauterkrankungen. Internist (Berl) 2020; 61:860-868. [DOI: 10.1007/s00108-020-00831-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Shen C, He J, Le X, Zheng L, Cao D. Application of Somatostatin, Chemotherapy Combined with TAE in Heterogeneous Glucagonoma Presented with Necrolytic Migratory Erythema. Onco Targets Ther 2019; 12:11339-11344. [PMID: 31920326 PMCID: PMC6929939 DOI: 10.2147/ott.s237634] [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] [Received: 11/07/2019] [Accepted: 12/07/2019] [Indexed: 02/05/2023] Open
Abstract
Glucagonoma, a rare neuroendocrine tumor of the pancreas, which is often misdiagnosed because of non-characteristic clinical manifestations. In addition, the treatment has not been well established for this disease so far. We here report a case of glucagonoma previous misdiagnosed as recurrent erythema. In this case, necrolytic migratory erythema was the main clinical manifestation, and he received surgical resection after admission although with liver metastasis. Postoperative pathological results showed that the heterogeneity of proliferative index in primary (Ki-67: 5~10%) and metastatic (Ki-67: 25~30%) tumors were obviously observed. One month postoperatively, abdominal CT and MRI showed multiple liver metastasis (type III) again. Interestingly, the skin rash was obviously improved after treatment with somatostatin combined with chemotherapy (octreotide, temozolomide and capecitabine). Subsequently, the patient received transarterial embolization (TAE). Up to now, no progression was noted for liver metastasis. Due to its rarity, clinical diagnosis is challenging; thus, further understanding of the disease by clinicians is helpful for early diagnosis and treatment, so as to improve the prognosis of patients.
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Affiliation(s)
- Chaoyong Shen
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Jiaoxue He
- Department of Oncology, Wenjiang District People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Xiaoyan Le
- Department of Oncology, Wenjiang District People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Linmao Zheng
- Department of Pathology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
| | - Dan Cao
- Department of Abdominal Oncology, Cancer Center of West China Hospital, Sichuan University, Chengdu 610041, Sichuan, People's Republic of China
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Nasher O, Hall NJ, Sebire NJ, de Coppi P, Pierro A. Pancreatic tumours in children: diagnosis, treatment and outcome. Pediatr Surg Int 2015; 31:831-5. [PMID: 26174862 DOI: 10.1007/s00383-015-3727-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 12/24/2022]
Abstract
PURPOSE Pancreatic tumours in children are exceedingly rare and as a result constitute a diagnostic and therapeutic challenge to paediatric surgeons. We reviewed our experience with these rare entities. METHODS Retrospective single institution study on all paediatric pancreatic tumours over a period of 38 years (1973-2011) and literature review. We recorded data relating to the clinical features at presentation, diagnostic evaluation, treatment and outcome. RESULTS Fourteen patients were identified (eight male). The most common symptoms at presentation were abdominal pain, anorexia and vomiting. Two cases were discovered incidentally. There were 12 primary and 2 metastatic tumours. Tumour types were solid pseudopapillary neoplasm (n = 6), insulinoma (n = 3), pancreatoblastoma (n = 1), congenital pancreatic cyst (n = 1), Burkitt lymphoma of the pancreas (n = 1) and metastatic lesions of other primary tumours (n = 2). Twelve were treated with surgical resection including 2 laparoscopically. Post-surgical complications included acute pancreatitis (n = 2) and pancreatic pseudocyst (n = 2). There was one death from a metastatic tumour and treatment is ongoing in one patient. The remainder has survived. CONCLUSION Paediatric pancreatic tumours are rare entities and are usually benign. Clinical symptoms are often non-specific and presentation may be late due to tumour inactivity in case of endocrine neoplasms. For most tumours, surgical resection is the optimal treatment which may be successfully performed laparoscopically when the lesion is in the body or tail of the pancreas. Long-term outcome is generally good.
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Affiliation(s)
- Omar Nasher
- Department of Paediatric Surgery, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London, UK
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LV WEIFU, HAN JIANKUI, LIU XIN, WANG SHICUN, PAN BO, XU AO. Imaging features of glucagonoma syndrome: A case report and review of the literature. Oncol Lett 2015; 9:1579-1582. [PMID: 25789004 PMCID: PMC4356379 DOI: 10.3892/ol.2015.2930] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 01/22/2015] [Indexed: 12/04/2022] Open
Abstract
Glucagonoma syndrome appears as an extremely rare neuroendocrine tumour, with few studies ever having detailed its imaging manifestations. In particular, the magnetic resonance imaging (MRI) features of the lesion have not yet been reported. The present study describes a 54-year-old male who presented with uncontrollable skin erythema and weight loss that had been apparent for two years, and diabetes mellitus that had been apparent for five years. The glucagon level was 180 pg/ml. The plain abdominal computed tomography (CT) scan revealed a solid tumour in the neck of the pancreas, which was slightly reinforced during the arterial phase of the enhanced CT scan. Upon MRI, the lesion exhibited a low signal on T1-weighted imaging, and a slightly high signal on T2-weighted and half-Fourier acquisition single-shot turbo spin echo sequence imaging, which measured ~4.5×3.0×3.0 cm in size. Upon diffusion-weighted imaging, the lesion demonstrated heterogeneous hyperintensity, which was mildly enhanced during the arterial phase and washed out during the portal venous phase of gadopentetate dimeglumine-enhanced MRI. 18F-fludeoxyglucose (18F-FDG) positron emission tomography (PET)-CT identified a mild uptake of 18F-FDG by the lesion. The patient was diagnosed with glucagonoma syndrome, and a distal pancreatectomy and splenectomy were subsequently performed. Microscopy revealed that the tumour cells exhibited nest- and belt-like arrangements. The immunohistochemical staining identified positive reactions for glucagon, synaptophysin and chromogranin A, which are consistent with a diagnosis of glucagonoma. Following surgery, the symptoms disappeared and the glucagon level returned to normal. In conclusion, imaging examinations are useful for determining the location and size of a glucagonoma. In particular, MRI is able to identify the distinctive morphological features of the lesion. Immunohistochemical staining provides diagnostic evidence based upon the neuroendocrine features.
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Affiliation(s)
- WEI-FU LV
- Positron Emission Tomography/Computed Tomography Center, Qilu Hospital, First Affiliated Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
- Department of Radiology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - JIAN-KUI HAN
- Positron Emission Tomography/Computed Tomography Center, Qilu Hospital, First Affiliated Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - XIN LIU
- Positron Emission Tomography/Computed Tomography Center, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - SHI-CUN WANG
- Positron Emission Tomography/Computed Tomography Center, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - BO PAN
- Positron Emission Tomography/Computed Tomography Center, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui 230001, P.R. China
| | - AO XU
- Department of Pathology, Affiliated Anhui Provincial Hospital of Anhui Medical University, Hefei, Anhui 230001, P.R. China
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Silva JAD, Mesquita KDC, Igreja ACDSM, Lucas ICRN, Freitas AF, Oliveira SMD, Costa IMC, Campbell IT. Paraneoplastic cutaneous manifestations: concepts and updates. An Bras Dermatol 2013; 88:9-22. [PMID: 23538999 PMCID: PMC3699944 DOI: 10.1590/s0365-05962013000100001] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2011] [Accepted: 10/16/2012] [Indexed: 12/31/2022] Open
Abstract
The skin often signals systemic changes. Some neoplastic diseases that affect
internal organs may trigger several cutaneous manifestations. Although these
dermatoses are relatively unusual, the recognition of some typical paraneoplastic
dermatoses may lead to the early diagnosis of a neoplasm and determine a better
prognosis. In this review article, we discuss the paraneoplastic cutaneous
manifestations strongly associated with neoplasms, which include acanthosis nigricans
maligna, tripe palms, erythema gyratum repens, Bazex syndrome, acquired
hypertrichosis lanuginosa, necrolytic migratory erythema, Leser-Trélat sign and
paraneoplastic pemphigus. We also review the clinical manifestations of each
condition and include updated knowledge on disease pathogenesis.
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Tseng HC, Liu CT, Ho JC, Lin SH. Necrolytic migratory erythema and glucagonoma rising from pancreatic head. Pancreatology 2013; 13:455-7. [PMID: 23890147 DOI: 10.1016/j.pan.2013.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/08/2013] [Accepted: 03/16/2013] [Indexed: 12/11/2022]
Abstract
Glucagonoma syndrome encompasses necrolytic migratory erythema (NME), hyperglucagonemia, diabetes mellitus, anemia, weight loss, glossitis, angular cheilitis, steatorrhea, diarrhea, venous thrombosis, and neuropsychiatric disturbance. Of all the symptoms, NME is a rare skin disorder which is pathognomonic for glucagonoma. We present a 61-year-old woman diagnosed initially as pancreatic head adenocarcinoma with liver metastasis prior to the skin eruption. From the dermatologic finding and other clues, glucagonoma was diagnosed finally.
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Affiliation(s)
- Han-Chi Tseng
- Department of Dermatology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Grewal P, Salopek TG. Is necrolytic migratory erythema due to glucagonoma a misnomer? A more apt name might be mucosal and intertriginous erosive dermatitis. J Cutan Med Surg 2012; 16:76-82. [PMID: 22513058 DOI: 10.2310/7750.2011.10134] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND In dermatology, many conditions are given names that ultimately prove to be a misnomer (eg, mycosis fungoides, pyogenic granuloma). For most misnomers, continued use of the inappropriate word(s) rarely results in a delay in diagnosis and/or treatment. An argument can be made that the term necrolytic migratory erythema (NME) due to glucagonoma results in a delay in diagnosis, often with fatal consequences. OBJECTIVE We reviewed the literature of the past 30 years concerning the dermatologic and histologic findings of NME in association with glucagonoma. The most striking feature evident in nearly all reported cases is the presence of mucosal lesions and annular, eroded, eczematous patches and plaques of intertriginous areas. CONCLUSION We propose the renaming of the eruption associated with glucagonoma to one that emphasizes its unique localization to the mucosa and intertriginous areas: mucosal and intertriginous erosive dermatitis. It is hoped that this will lead to a more timely recognition of the condition and a possible improvement in prognosis.
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Affiliation(s)
- Parbeer Grewal
- Division of Dermatology and Cutaneous Sciences, Department of Medicine, University of Alberta, Edmonton, AB
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Castro PG, de León AM, Trancón JG, Martínez PA, Alvarez Pérez JA, Fernández Fernández JC, García Bernardo CM, Serra LB, González González JJ. Glucagonoma syndrome: a case report. J Med Case Rep 2011; 5:402. [PMID: 21859461 PMCID: PMC3171381 DOI: 10.1186/1752-1947-5-402] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 08/22/2011] [Indexed: 01/23/2023] Open
Abstract
Introduction Glucagonoma syndrome is a rare paraneoplastic phenomenon, with an estimated incidence of one in 20 million, characterized by necrolytic migratory erythema, hyperglucagonemia, diabetes mellitus, anemia, weight loss, glossitis, cheilitis, steatorrhea, diarrhea, venous thrombosis and neuropsychiatric disturbances in the setting of a glucagon-producing alpha-cell tumor of the pancreas. Necrolytic migratory erythema is the presenting manifestation in the majority of cases, so its early suspicion and correct diagnosis is a key factor in the management of the patient. Case presentation We present the case of a 70-year-old Caucasian woman with glucagonoma syndrome due to an alpha-cell tumor located in the tail of the pancreas, successfully treated with surgical resection. Conclusion Clinicians should be aware of the unusual initial manifestations of glucagonoma. Early diagnosis allows complete surgical resection of the neoplasm and provides the only chance of a cure.
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Affiliation(s)
- Pablo Granero Castro
- Department of General Surgery and Gastroenterology, Hospital Universitario Central de Asturias, Oviedo, Spain.
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Shi W, Liao W, Mei X, Xiao Q, Zeng Y, Zhou Q. Necrolytic Migratory Erythema Associated With Glucagonoma Syndrome. J Clin Oncol 2010; 28:e329-31. [PMID: 20530273 DOI: 10.1200/jco.2009.25.7113] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Weimin Shi
- Shanghai First People's Hospital, Jiao Tong University, Shanghai, China
| | - Wanqing Liao
- Chang Zheng Hospital, Secondary Military Medical University, Shanghai, China
| | - Xingyu Mei
- Tong Ji Hospital, Tong Ji University, Shanghai, China
| | - Qin Xiao
- Tong Ji Hospital, Tong Ji University, Shanghai, China
| | - Yu Zeng
- Tong Ji Hospital, Tong Ji University, Shanghai, China
| | - Qun Zhou
- Hua Dong Hospital, Fu Dan University, Shanghai, China
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