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Nair RP, Gupta AK, Pareek P, Devnani B, Bairwa SK, Garg PK, Aggarwal D, Sharma S, Mittal T. Is Hypoglycemia Secondary to Metastatic Retroperitoneal Sarcoma -A Therapeutic Challenge? Case Report and Review of Literature. Curr Probl Cancer 2023; 47:100961. [PMID: 37263114 DOI: 10.1016/j.currproblcancer.2023.100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/27/2023] [Accepted: 04/12/2023] [Indexed: 06/03/2023]
Abstract
Most soft tissue sarcomas afflict the extremities; however, the retro peritoneum can also be affected rarely. Retroperitoneal sarcomas are relatively asymptomatic. Although tumor-induced hypoglycemia is rare in tumors other than insulinomas, extrapancreatic tumors are a subset that displays this phenomenon. The occurrence of hypo-insulinemic hypoglycemia with low GH and IGF-1 should prompt consideration of the secretion of a hypoglycemic substance impeding the secretion of insulin and GH, such as IGF-2 or one of its related substances. The present case report is of a 38-year-old male with retroperitoneal round cell sarcoma with liver metastasis with severe symptomatic hypoglycemia who was managed with multipronged symptomatic therapy and oncological management after which he had shown significant improvement in hypoglycemic episodes and symptom profile. A literature review revealed our case report to be the first reported case of a young male (preponderance in the older population) with hypoglycemia associated with retroperitoneal sarcoma which presented with liver metastasis and the only one treated with Gemcitabine /Docetaxel. The presence of these features might point toward a poorer prognosis in a disease with an already dismal course. All these points towards the need for further research regarding intensified oncological treatment after evidence-based prognostication of high-risk groups and modalities for the management of symptomatic hypoglycemia such as Somatostatin analogs and glucagon which aid in symptom control.
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Affiliation(s)
- Rishi P Nair
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
| | - Atul Kumar Gupta
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India.
| | - Puneet Pareek
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
| | - Bharti Devnani
- Department of Radiation Oncology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Pawan K Garg
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India
| | - Divya Aggarwal
- Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Smily Sharma
- Department of Diagnostic & Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India
| | - Tushar Mittal
- Department of Pathology and Lab Medicine, AIIMS, Jodhpur, Rajasthan, India
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Nishiwaki N, Mikuriya Y, Takatsu F, Ochiai R, Kakishita T, Kobayashi N, Kobatake T, Hato S, Teramoto N, Nagao M, Fukuda I, Ohta K. Surgical resection of a retroperitoneal liposarcoma producing insulin-like growth factor II: a case report. Surg Case Rep 2023; 9:19. [PMID: 36752872 PMCID: PMC9908783 DOI: 10.1186/s40792-023-01589-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Tumor-produced high molecular weight insulin-like growth factor-II (big insulin-like growth factor-II) is considered to cause non-islet cell tumor hypoglycemia. This paper presents a case of surgically resected retroperitoneal liposarcoma that produced big insulin-like growth factor-II. CASE PRESENTATION Here, we report the case of a 62-year-old woman who presented with an abdominal mass and hypoglycemia. Non-islet cell tumor hypoglycemia due to retroperitoneal liposarcoma was suspected. After complete resection of the tumor, the patient's hypoglycemia improved and big insulin-like growth factor-II disappeared in the molecular weight analysis of serum insulin-like growth factor-II by western blotting. The patient had no tumor recurrence or reappearance of hypoglycemia 16 months after the operation without any adjuvant therapy. CONCLUSIONS Although insulin-like growth factor-II-producing tumors are generally large and difficult to operate on, surgical resection is currently the most effective and only treatment; thus, it is essential to attempt resection aggressively.
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Affiliation(s)
- Noriyuki Nishiwaki
- Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken, 791-0280, Japan.
| | - Yoshihiro Mikuriya
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Fumiaki Takatsu
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Ryoji Ochiai
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Tomokazu Kakishita
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Naruyuki Kobayashi
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Takaya Kobatake
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Shinji Hato
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Norihiro Teramoto
- grid.415740.30000 0004 0618 8403Department of Pathology, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
| | - Mototsugu Nagao
- grid.410821.e0000 0001 2173 8328Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Izumi Fukuda
- grid.410821.e0000 0001 2173 8328Department of Endocrinology, Metabolism and Nephrology, Graduate School of Medicine, Nippon Medical School, Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Koji Ohta
- grid.415740.30000 0004 0618 8403Department of Gastroenterological Surgery, National Hospital Organization, Shikoku Cancer Center, 160, Ko, Minamiumemoto-machi, Matsuyama-shi, Ehime-Ken 791-0280 Japan
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Igarashi Y, Hirukawa H, Nakano T, Morimoto Y, Fukuda S, Tada T. Well-differentiated liposarcoma causing non-islet cell tumor hypoglycemia. Int Cancer Conf J. [PMID: 35669897 PMCID: PMC9163218 DOI: 10.1007/s13691-022-00550-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/06/2022] [Indexed: 10/18/2022] Open
Abstract
Non-islet cell tumor hypoglycemia (NICTH) is a paraneoplastic syndrome that causes severe hypoglycemia. The tumor involved produces high-molecular-weight insulin-like growth factor-II (IGF-II). NICTH can be caused by various benign and malignant tumors. However, NICTH due to liposarcoma (LPS) is rare. A 38-year-old man was brought to the hospital emergency department with complaints of vomiting and unconsciousness. His abdomen was distended, and a large tumor was palpable. He had severe hypoglycemia that required continuous glucose infusion. Radiological examination revealed a large 40-cm mass that filled the abdominal cavity, and LPS of the mesentery was suspected. Laboratory data showed low levels of insulin, C-peptide, and IGF-I concentrations. Subsequently, an LPS-induced NICTH was suspected. Complete resection of the tumor and the encased small intestine was performed. The pathological diagnosis was well-differentiated liposarcoma (WDLPS). The Western immunoblot showed that the high-molecular-weight IGF-II confirmed in the serum preoperatively, had almost disappeared postoperatively. Based on these findings, NICTH caused by a WDLPS was diagnosed. The postoperative course was uneventful. In the last 4 years since the primary operation, the patient had not experienced further hypoglycemia symptoms. Here, we report a case of NICTH caused by a large WDLPS. NICTH should be considered in patients with both severe hypoglycemia and large tumors. In these cases, appropriate treatment including semi-urgent surgery should be provided.
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