301 Morphometric Analysis of Pancreatic Islet Cells: Two Cases of Nesidioblastosis Following Sleeve Gastrectomy. (11th January 2018)

• Record Type: Journal Article
• Authors: Vormittag, Erica; Guzman, Grace; Giulianotti, Pier; Al Rasheed, Mohamed Rizwan Haroon; Setty, Suman
• Is Part Of: American journal of clinical pathology. Volume 149(2018)Supplement 1
• Page Start: S127
• Page End: S128
• Publication Date: 2018-01-11
• Subjects: Diagnosis, Laboratory -- Periodicals; Pathology -- Periodicals; 616.07
• DOI: 10.1093/ajcp/aqx123.300
• Languages: English
• ISSNs: 0002-9173

Abstract

Abstract: Introduction: Nesidioblastosis is a rare cause of non-insulinoma pancreatogenous hypoglycemia most commonly found in children. Idiopathic adult-onset cases have been described in the literature, but most recently adult onset nesidioblastosis has been described following gastric bypass surgery. At our institution, we have two such cases. Methods: Morphometric analysis of these two cases and two age- and gender-matched controls was performed. H&E sections were scanned using a whole slide scanner, and the outlines of the islets were traced using manual inspection. Refinement to the islet surface areas was performed using image-processing techniques. Analysis of islet area and ratio of endocrine to exocrine surface area was performed. Results: The mean islet area of the first nesidioblastosis case was 2.0777 x 10 4, while the normal control had a mean area of 8.6457 x 10 3 . The second case had a mean islet area of 1.7323 x 10 4, and the normal control had a mean islet area of 8.7521 x 10 3 . Thus, on average, the ratio of endocrine to exocrine area was observed to be larger by 3- to 15-fold in nesidioblastosis. A trend towards alteration in nuclear size and density was also observed which would require further study in a larger cohort. Conclusion: In summary, using morphometric analysis, hyperplasia of the islet cells is observed to occur in a subset of adult individuals after sleeve gastrectomy. This suggests possible alterations in growth hormone production, as reported in pediatric nesidioblastosis, requiring further study in adults post gastric bypass surgery subjects.