Tumours and Hyperplasias of the Endocrine Pancreas

Abstract

Although Neve, in 1891, described an adenoma that he had found by chance in the head of the pancreas, the microscopic appearances that he recorded do not allow the modern reader to identify that tumour as an adenoma of islet cells, and the first recognition of an adenoma of islet cells is attributed to Nicholls in 1902. In 1903 Fabozzi described the pathological findings in five cases of carcinoma of the pancreas in each of which he found, and illustrated, microscopic appearances that seemed to show that the tumours had originated from islet cells, but his paper included no clinical information that might have distinguished his cases from cases of carcinoma of the exocrine pancreas. Nicholls, who found a peasized nodule by accident on the anterior surface of the pancreas, attributed no clinical significance to the lesion, and although similar tumours were soon found by others, it was not until insulin had been discovered that the possibility that tumours of islet tissue might be hormonally active was realised. In 1927 Wilder et al. described a case in which the patient, who was himself a doctor, suggested that his symptoms resembled the effects produced by excess of insulin. He was found to have a cystic tumour in the tail of his pancreas with metastases in the liver and lymph nodes. Alcoholic extracts of the cancer tissue in the liver had an insulin-like action when they were injected into rabbits.