Nonfunctioning islet cell carcinoma of the pancreas with an initial appearance of massive hemorrhage

Diagnosis of nonfunctioning tumors is difficult, since they often lack apparent clinical signs and symptoms. Here we report nonfunctioning islet cell carcinoma of the pancreas with massive hemorrhage. A 57-year-old woman who had sudden severe abdominal pain and high fever was admitted to our hospital. A series of examinations after admission revealed cystic tumor located at the tail of the pancreas and a hematoma adjacent to the tumor. The plasma levels of hormones, except for prolactin, were normal. After antibiotic treatment, blood transfusion, and other conservative therapy had produced a stable condition, operation was performed. The operation revealed a tumor measuring 6.2×7.8×7.2 cm located at the pancreatic tail and a hematoma 3.2×2.7×2.5 cm adjacent to the tumor. Distal pancreatectomy, including the tumor, combined with splenectomy and removal of the hematoma, was carried out. The surgical specimen showed a nonfunctioning islet cell carcinoma arising from the pancreatic tail; this tumor had ruptured and was bleeding. Seventeen months after the operation, the patient is alive without recurrence or symptoms. The major characteristic in this patient was the sudden severe abdominal pain and shock due to bleeding from the tumor, which features may not have been reported in the literature.