Malignant apudoma of the liver with symptomatic intractable hypoglycemia

This report documents a case of a fatal primary malignant neoplasm of the liver with metastases to the lymph nodes of the porta hepatis and the pubic bone. Profound, intractable hypoglycemia was seen during the course of the disease. No immunoassayable insulin was found in the blood during episodes of severe, symptomatic hypoglycemia. The neoplasm was composed of uniform polygonal cells with distinct cytoplasmic borders growing in broad strands with a tendency toward nesting and was morphologically similar to neoplasms of neural crest derivation. The presence of osmophilic, membrane-bound granules in the neoplastic cells was documented by ultrastructural studies. The tentative conclusion that the hypoglycemia was produced by the secretion of a substance with insulin-like activity, probably a polypeptide, by the secretory granules in the neoplastic cells is supported by clinical and laboratory data.