Non-Beta Islet-Cell Carcinoma of the Pancreas, With Flushing Attacks and Diarrhea
WILLIAM H. SHAFER, M.D.
Department of General Internal Medicine
LAWRENCE J. McCORMACK, M.D.
Department of Anatomic Pathology
STANLEY O. HOERR, M.D.
Department of General Surgery
RECURRENT attacks of generalized flushing and hyperperistalsis are unusual manifestations of non-beta islet-cell tumor of the pancreas.1 Our report concerns a patient who had severe peptic ulcer disease, and recurrent attacks of flushing and diarrhea associated with a non-beta islet-cell carcinoma of the pancreas.
Report of a Case
A 63-year-old man was examined at the Cleveland Clinic in May, 1962, because of attacks of flushing, back pain, and diarrhea. In 1958 he noted the onset of recurrent flushing attacks that would last for from a few minutes to several hours. With mild attacks the flushing would involve mainly the face, and with severe episodes the entire body. The frequency of these attacks varied considerably, with apparently no definite precipitating cause. Associated with the flushing attacks were borborygmi, cramping lower abdominal pain, back and leg pain, followed by three or four loose, watery bowel movements. In 1960 he was admitted to a hospital and underwent an exploratory laparotomy; metastatic nodules were found in the liver; the pathologic diagnosis was probable carcinoid tumor, metastatic in the liver. Argentaffin stains of the nodules were negative, but the general appearance of the neoplastic cells and their grouping were suggestive of a poorly differentiated carcinoid tumor. A urinalysis for 5-hydroxyindoleacetic acid was normal. In May, 1961, he underwent an exploratory laparotomy and plication of a perforated duodenal ulcer. In November, 1961, he was readmitted to a hospital because of upper gastrointestinal bleeding probably due to active duodenal ulcer.
The physical examination at the Cleveland Clinic . . .