554833

research-article2014

IJSXXX10.1177/1066896914554833International Journal of Surgical PathologyÜnal et al

Case Report

A Rare Complication of Gastric Bypass (Weight Loss) Surgery: Nesidioblastosis

International Journal of Surgical Pathology 2015, Vol. 23(1) 68­–70 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1066896914554833 ijs.sagepub.com

Betül Ünal, MD1, Özlem Ceren Uzun, MD1, Cumhur İbrahim Başsorgun, MD1, Okan Erdoğan, MD1, and Gülsüm Özlem Elpek, MD1

Abstract Here, we present the case of a 31-year-old woman patient who underwent distal pancreatectomy with the history of gastric bypass surgery for obesity. The final histopathological diagnosis of the lesion was nesidioblastosis. Nesidioblastosis is the most common cause of organic persistent hyperinsulinemic hypoglycemia in newborns; however, it is rare in adults. In adults, it is difficult to diagnose nesidioblastosis with only clinical findings. The definitive diagnosis of the disease depends on the histopathological examination of pancreatic tissue and the exclusion of insulinoma. Keywords nesidioblastosis, gastric bypass, weight loss, hyperinsulinemic hypoglycemia

Introduction Nesidioblastosis is a rare cause of organic persistent hyperinsulinemic hypoglycemia (PHH) in adults and it is characterized by the functional disorder of nonneoplastic β cells. Histologically abnormal β cells proliferate throughout the entire pancreas, without tumor formation, the condition being characterized by an increased number of islets associated with nuclear enlargement and hyperchromasia of β cells.1-5 Nesidioblastosis is the most common cause of organic PHH in newborns3; however, it is rare in adults. Although it is rare in adults, it may be confused with insulinoma, which is the most common cause of PHH in adults.1-5 The characteristics of disease show differences in newborns versus adults. This rare entity is an uncommon complication of weight loss surgery.6 Therefore, with the rising incidence of gastric bypass surgeries, it is important to understand the clinical picture of the disease. Here, we present a patient with a history of gastric bypass surgery performed for obesity who underwent distal pancreatectomy with the preoperative diagnosis of insulinoma. The histopathological examination revealed the diagnosis as “nesidioblastosis.”

Case Presentation A 31-year-old woman patient was admitted to our hospital with complaints of sweating, dizziness, and fatigue. In her history, we detected gastric bypass surgery performed for the treatment of obesity. In ongoing research there were not any findings associated with MEN-1 syndrome, familial pancreatic disease, or genetic abnormalities.

Laboratory analysis showed the following: blood glucose, 32 mg/dL; insulin, 1820 pmol/L; C-peptide, 8.65 nmol/L (normal level

A rare complication of gastric bypass (weight loss) surgery: nesidioblastosis.

Here, we present the case of a 31-year-old woman patient who underwent distal pancreatectomy with the history of gastric bypass surgery for obesity. T...
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