Neuroendocrine tumor of the pancreas with glucagon production

Background: Glucagonoma is a rare pancreatic tumor of islet alpha 2 cells. Fewer than 200 cases have been reported worldwide, with an estimated incidence of 1 in 20 million. In general, the disease is characterized by a well-defined clinical syndrome which typically shows as necrotic migratory erythema of the skin, weight loss, diabetes mellitus, anemia, cheilosis and stomatitis. Since pancreatic glucagonomas are predominantly located in the tail and findings of radiographic or sonographic examination can remain unspecific, patients often present already metastasis when diagnosis is first established. Case Report: We report the case of a 67-year-old mail with an extended malignant glucagonoma of the pancreas infiltrating already the hilus of the spleen and, additionally, presenting metastatic lesions in the liver and the left adrenal gland. A monohormonal expression of glucagon could be ascertained by serological and immunohistochemical analysis. The special feature of this case is that the tumor was not associated with the characteristic skin rash. Conclusion: An unclear migratory erythema combined with diabetes mellitus and stomatitis/cheilosis should lead to the differential diagnosis of glucagonoma. Isolated glucagonomas are very difficult to find out and often diagnosed already presenting metastasis.