Case Study

Insulinoma with hepatic metastasis in a 10 year old female spayed Lab mix

A 10-year-old FS Labrador mix was presented after having had a possible seizure lasting 20 minutes. Preliminary blood work performed in-house showed hypoglycemia, hypoalbuminemia, an elevated ALP enzyme activity, hypercalcemia, hyperphosphatemia, hypernatremia, and hypokalemia. An insulin blood concentration was decreased. An ACTH stimulation test was normal. The patient continued having seizures due to hypoglycemia for several weeks. Recheck blood chemistry sent out to a laboratory revealed hypoglycemia, hyperphosphatemia, elevated CK, hypokalemia, and hypernatremia.

Sonographic Differential Diagnosis

Small hepatic target lesion. Suspect metastatic disease, nodular hyperplasia, other neoplasia or minor abscessation.

Image Interpretation

A solitary hypoechoic target liver lesion was noted. Due to the clinical history, metastatic insulinoma is primarily considered especially given the target appearance. Surrounding parenchyma appeared unaffected.

DX

Epithelial neoplasm of endocrine origin (insulinoma,) possible hepatic metastases and hepatopathy

Outcome

The patient was humanely euthanized 10 days post diagnosis due to clinical decline.

Comments

Often insulinoma is found more easily in organs affected by metastasis than the pancreatic origin itself.

Clinical Differential Diagnosis

Para-neoplastic disease (certain hepatic neoplasms may be associated with hypoglycemia, such as a leiomyoma or leiomyosarcoma). Primary brain tumor causing prolonged seizure activity, which in turn led to hypoglycemia, is unlikely as the seizures continued following the original seizure.

Sampling

U/S-guided Tru-cut® biopsies. Biopsies of the liver, pancreas, and mesenteric lymph node showed a presumptive diagnosis of an epithelial neoplasm of endocrine origin (insulinoma) also affecting the mesenteric root with possible hepatic metastases, as well as moderate vacuolar and pigment hepatopathy.