Association of insulinoma with subcutaneous nodular fat necrosis

A 57-year-old man first noted tender subcutaneous nodules on his extremities and abdomen. Six months later symptoms of insulin hypersecretion became evident and hyperinsulinemia was documented. An exploratory laparotomy revealed an islet cell tumor measuring 12 cm in diameter extending anteriorly from head of the pancreas with metastases in the liver. Evidence of parathyroid and pituitary hormone hypersecretion suggests that the insulinoma may be part of a multiple endocrine neoplasia syndrome. Histological examination of the subcutaneous nodules revealed the characteristic histology of nodular fat necrosis. This is the first report of the association of an insulin-secreting islet cell carcinoma with subcutaneous nodular fat necrosis.