Intra Abdominal malignant soft tissue Tumour producing blood sugar

Published: Manish Kumar Sinha (6) on TUE 22 Mar 2011 | Word Count: 508 | Comments (0)

A 64-year-old Woman presented to us with complaints increase abdominal diameter and tight fitting clothes day. Since details of history, we came to know that she was a known diabetic taking insulin to combat hyperglycemia. Since the last few months, she had frequent episodes of blood sugar and ultimately have to stop insulin. Even without treatment of diabetes and with proper diet, her blood sugar level fell often down to 30-40% of the gm, and she had to take instant glucose to correct blood sugar.

In order to increase abdominal diameter was her abdominal sonography made which showed large intra-abdominal tumour, accurate Web site, the country of origin is not defined. Due to increase the size of the tumor she had terrible back pain and could not sit long duration. She does not have upper or lower GI symptoms, urinary symptoms or jaundice. She was mentioned by his doctor at Dehradun Dharamshila Cancer Hospital. We examined her further with CECT abdomen and thorax and relevant blood tests. Her serum insulin was low, in spite of blood sugar. Tumour was enormous, and involves the colon, spleen, pancreas and stomach. Further decision was taken to remove the tumour. Seven k.g. tumour measuring around 50 CSM's maximum length was removed. En bloc resection of tumour with transverse colon splenic flexure, decending colon, body and tail of the pancreas, the spleen, part of the whole stomach near the fundus and greater curvature and left perinephric fat was performed correctly. Ends finally colo-colic anastomosis in single layer, closure of pancreatic lymph nodes, butt and repair of the stomach were carried out. Patient recovered uneventfully and resumed to oral diet 7th postoperative day. Postoperatively her blood sugar in diabetic came to the area and managed with insulin in the usual dose. The final Histopathology report is higher grades Sarcoma (Leiomyosarcoma). She requires chemotherapy in the adjuvant setting.

Discussion:-blood sugar due to tumour islet cell tumor usually attributed to (Insulinoma) originates in the pancreas. Insulinomas are characterized by fasting blood sugar and the neuroglycopenic symptoms. Episodic nature of the hypoglycemic attacks are caused by intermittent insulin secretion by tumor. The majority of intrapancreatic insulinomas are benign, and lonely. It never achieves such enormous size to produce blood sugar. Enormous size intra-abdominal tumor with features in blood sugar point against non islet cell tumor blood sugar (NICTH). Blood sugar due to NICTH in most of the reported cases is due to Insulin like growth factor (IGF) separated by mesenchymal tumor. IGF lowers blood sugar levels, which in turn gives negative feedback to lower serum insulin level as occurred in this case. After removal of the tumor blood sugar rose to normal and diabetic level that supports the presence of IGF. The extent of surgery was massively in this case, and there are chances of pancreatic lymph nodes, Fistula, postsplenectomy anastomotic dehiscence, septicemia, subphrenic abscess, pneumonia and deep vein thrombosis. This patient recovered uneventfully and resume its normal diet 7th postoperative day and discharged. Due to demand high grade nature of Sarcom she chemotherapy in the adjuvant setting.

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