BACKGROUND Ectopic insulinoma is a rare entity that is difficult to diagnose before surgery. This article reports two cases of ectopic insulinoma. CASE PRESENTATION Two patients manifested recurrent hypoglycemia with a typical Whipple triad. In terms of the qualitative diagnosis, the oral glucose tolerance test (OGTT) suggested a diagnosis of hyperinsulinemic hypoglycemia. However, preoperative imaging did not show a significant mass in the pancreas. In one patient, preoperative abdominal enhanced volume perfusion computed tomography (CT), somatostatin receptor imaging and 99mTc-HYNIC-TOC SPECT/CT revealed a mass with a rich blood supply anterior to the duodenum. In the other patient, preoperative enhanced CT, magnetic resonance imaging (MRI) and 68Ga-Exendin-4 PET/CT showed a mass above the spleen. After surgical removal of the tumor, both patients received a confirmed diagnosis of neuroendocrine tumors by postoperative pathology. The symptoms of hypoglycemia were relieved after surgery, and the blood glucose level was significantly increased. CONCLUSION Ectopic insulinoma is difficult to locate before surgery. 68Ga-Exendin-4 PET/CT has a high diagnostic value. Surgical removal of the lesion is main treatment.

中文翻译：

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异位胰岛素瘤：病例报告。

背景技术异位胰岛素瘤是一种罕见的实体，很难在手术前进行诊断。本文报道了两例异位胰岛素瘤。病例介绍两名患者表现出典型的Whipple三联征反复发作的低血糖症。在定性诊断方面，口服葡萄糖耐量试验（OGTT）建议诊断为高胰岛素性低血糖症。但是，术前影像学检查未显示胰腺有明显肿块。在一名患者中，术前腹部增大体积的计算机断层扫描（CT），生长抑素受体成像和99mTc-HYNIC-TOC SPECT / CT显示十二指肠前有大量血液供应。在另一例患者中，术前增强CT，磁共振成像（MRI）和68Ga-Exendin-4 PET / CT显示脾脏上方有肿块。手术切除肿瘤后，两名患者均通过术后病理证实了神经内分泌肿瘤的确诊。手术后低血糖症状缓解，血糖水平明显升高。结论异位胰岛素瘤很难在手术前定位。68Ga-Exendin-4 PET / CT具有很高的诊断价值。手术切除病变是主要治疗方法。