Granulomatous Insulitis as a Cause of Acute-Onset Insulin-Dependent Diabetes Mellitus in a Patient With a Pancreatic Endocrine Carcinoma. (October 2016)

• Record Type: Journal Article
• Authors: Saab, Jad; Qin, Lihui; Jessurun, Jose
• Is Part Of: International journal of surgical pathology. Volume 24:Number 7(2016)
• Page Start: 648
• Page End: 652
• Publication Date: 2016-10
• Subjects: diabetes mellitus -- endocrine tumor -- granulomatous insulitis -- pancreas; Pathology, Surgical -- Periodicals; 617.07
• DOI: 10.1177/1066896916648770
• Languages: English
• ISSNs: 1066-8969

Abstract

Autoimmune destruction of β cells is the cause of most cases of type 1 diabetes mellitus. Lymphocytic insulitis has been documented in the early phases of this disease as well as in recurrent diabetes after pancreas transplantation and in certain viral infections. We report a unique case of granulomatous insulitis in a patient with an endocrine tumor of the pancreas that clinically manifested as acute-onset insulin-dependent diabetes mellitus. Granulomata were present in islets with complete disappearance of β cells, as well as in the primary tumor, metastases, and lymph nodes. We postulate that these granulomata represent a sarcoid-like reaction to the tumor with secondary injury to nonneoplastic endocrine cells through a mechanism of molecular mimicry.