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Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia

  • Case reports of interest
  • Published:
Journal of Hepato-Biliary-Pancreatic Surgery

Abstract

Sarcomas of the liver are rare. We report a case of intractable hypoglycemia secondary to a solitary fibrous tumor that underwent malignant transformation into a fibrosarcoma. A 70-year-old man presented with a hepatic mass and tumor-associated hypoglycemia which was resistant to medical management. Blood tests were remarkable only for elevated serum insulin-like growth factor (IGF)-2. The hypoglycemia resolved following resection of a solitary fibrous tumor surrounded by a high-grade fibrosarcoma. Real time reverse transcriptase polymerase chain reaction (RT-PCR) measured elevated levels of IGF2 mRNA in both the solitary fibrous tumor and the fibrosarcoma. Immunoblotting demonstrated a series of bands in the size range of pro-IGF2. Unfortunately, disseminated metastases developed 1 year later, concurrent with a recurrence of hypoglycemia, marked again by elevation of serum IGF2. Solitary fibrous tumors of the liver have a real risk of malignant transformation. The severity of the tumor-associated hypoglycemia may parallel the tumor burden and activity. The syndrome is the systemic effect of IGF2 secreted by the tumor. Surgery can treat the hypoglycemia syndrome and the underlying malignancy.

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Authors and Affiliations

  1. Department of Surgery, MUHC-Royal Victoria Hospital, 687 Pine Avenue West, S 10.26, Montreal, Quebec, H3A 1A1, Canada

    Gabriel Chan, Peter J. Horton & Peter Metrakos

  2. Lawson Health Research Institute, St. Joseph's Health Care, London, Ontario, Canada

    Sandra Thyssen & David J. Hill

  3. McGill Nutrition and Food Science Centre, MUHC-Royal Victoria Hospital, Montreal, Quebec, Canada

    Marie Lamarche & Errol B. Marliss

  4. Department of Pathology, MUHC-Montreal General Hospital, Montreal, Quebec, Canada

    Ayoub Nahal

Authors
  1. Gabriel Chan
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  2. Peter J. Horton
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  3. Sandra Thyssen
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  4. Marie Lamarche
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  5. Ayoub Nahal
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  6. David J. Hill
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  7. Errol B. Marliss
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  8. Peter Metrakos
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Chan, G., Horton, P., Thyssen, S. et al. Malignant transformation of a solitary fibrous tumor of the liver and intractable hypoglycemia. J Hepatobiliary Pancreat Surg 14, 595–599 (2007). https://doi.org/10.1007/s00534-007-1210-0

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  • DOI: https://doi.org/10.1007/s00534-007-1210-0

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