Glucagonoma of the pancreas is a rare
tumor with distinct clinical manifestations, such as
necrolytic migratory erythema,
weight loss,
anemia,
diabetes mellitus, and hypoamino-acidemia. We report the case of a 68-year-old Japanese man who underwent curative resection for malignant
glucagonoma of the pancreas diagnosed through
anemia and
diabetes mellitus. The patient had had
diabetes mellitus for 20 years.
Anemia was diagnosed in 1998. On admission, the
hemoglobin level was 8.3g/dl, but the levels of serum
iron,
vitamin B12, and
erythropoietin and, the number of reticulocytes were within normal limits. The levels of
carcinoembryonic antigen (CEA),
carbohydrate antigen (CA)19-9, and DUPAN-2 were also within normal limits, and exocrine function of the pancreas (PFD, 75%) was normal. Ultrasonography (US) revealed a hypoechoic
tumor in the distal pancreas. Computed tomography (CT) demonstrated a high-density area 4 cm in diameter with calcification. The serum
glucagon level was very high (2360 pg/ml), but the levels of other
hormones such as
somatostatin or
gastrin were within normal limits, while
insulin was low.
Glucagonoma of the pancreas was diagnosed, and distal
pancreatectomy with
splenectomy was performed. Histological examination revealed a malignant endocrine
tumor,which was immunohistochemically positive for
chromogranin A and
glucagon. Two months after the operation, the serum
glucagon level had decreased to within normal limits and the
hemoglobin level had increased to 10.4 g/dl. The case of
glucagonoma reported here was found through diagnostic examinations of
anemia and treated by surgical resection, by which the patient's
anemia was largely alleviated. Therefore, we recommend checking patients who have
diabetes mellitus and
anemia in order to diagnose and treat
glucagonoma in its early stage.