I have treated more than a hundred patients with insulinoma some with liver metastasis but in every case we found tumors in the pancreas.

No. But, although most insulinomas are located in the pancreas, very rare ectopic cases (combination of an insulinoma in ectopic pancreatic tissue) have been described in spleen, perisplenic tissue and duodenum. Preoperative diagnosis and localisation may be challenging.

In one of my insulinoma cases we found a insulinoma in the ovary without any other tumor however in a meticulous search for pancreatic lesion s we found a very tiny lesion that was not detected by image methods however since PETCT with gallium 68 was not available at that time we can not say that this is the case of your patient

Its a really interesting case however I bilieve a close follow up of the pancreas is mandatory.

We plan to publish this case and now we’re searching for the same cases. I want to preprint the paper before and will be glad to discuss about it

I think you must wait before publishing this case A new reserch about an pancreatic tumor must be performed Since the pancreatic tumor if there is one must be a malignant lesion it may produce a small amount of insulin therefore a carefully search for a pancreatic tumor must be performed before you report this case

I think this is a very intersting case, we have seen quite a few cases of nets located in the Liver without any extrahepatic primary, but none was a insulinoma. I believe there should be a extrahepatic primary, but because of size and growth pattern like diffuse or infiltrative type of growth imaging studies may fail to show the primary. I think the case can be published to share your experience

If this tumor is actually a primary insulinoma of the liver it must be published however you must wait a few months to be sure that there is not a primary pancreatric tumor .If the pancreatic tumor does exist it may be of course malignant and with small size In these cases the tumor produces small amounts of insuline and therefore the patient may not have hypoglycemia

There are already 12 month desease free survival without any signs of hypoglycemia.. The last CT and MRI were done a month ago and there are no pathologies were revieled. We’re planning to make the Galium contrasted PET CT in a next few weeks

I agree that after the PETCT with Gallium 68 negative for NET you must publish your case

Dear colleagues

I have a middle-aged female with attacks of hypoglycemia.

The physician sent her to me for the abdominal US.

Nothing could be noted in the pancreas, but incidentally, I found an irregular liver cyst.

I sent her for an MRI.

MRI shows complex liver cyst with enhancing wall and enhancing mural nodules

Now I am confused about this liver lesion, is its the cause of hypoglycemia?

Is it an ectopic insulinoma?

Ayrat Kaldarov

Marcel C Machado

Absominal US can’t be the method - of - choise in the daiagnistic of pancreatuc insulinoma. The giid results shows the combination of contrasted CT+MRI. ASVS can be used to confirm the pancreatigenic hyperinsulinism

I published many years ago a primary non function neuroendocrine tumor of the liver therefore a primary insulina of the liver though very rare may exist I will wait a bit more and then publish the case

Thank you @Marcel

I will wait for the result of surgery and histopathology and inform you.