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Case history: The patient was a 42 y/o male with a 6-month history of multiple attacks of dizziness, confusion and fainting which used to be relieved by eating food. His general and systemic examination was non-contributory.

Fasting blood sugar done twice was 51 and 49 mg/dL. His fasting serum Insulin level was elevated at 26.8 mIU/L (Ref. range 2-25 mIU/L). Serum C-peptide level was also elevated at 6.06 ng/mL (Ref. range 0.81 -3.5 ng/mL).

Abdominal computed tomography (CT) scan with contrast revealed a well-defined hypervascular lesion involving uncinate process of pancreas measuring 15 mm in diameter. MRI studies did not reveal any lesions in pituitary, thyroid or liver.

A distal pancreactectomy was performed and tumor located in the uncinate process of pancreas was removed. The photograph shows resected pancreatic portion with a well-circumscribed round to oval tumor (upper right) measuring 1.2 cm in diameter. The microscopic examination showed insulinoma with cells arranged in gyriform and trabecular patterns.

Case courtesy of: Dr. Sanjay D. Deshmukh (Professor of Pathology) & Dr. J. M. Gadekar (Head of Surgery Dept.), Dr. Vithalrao Vikhe Patil Medical College & Hospitals, Ahmednagar, India.

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