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Print ISSN: 1792-0981 Online ISSN: 1792-1015
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October-2026 Volume 32 Issue 4

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Case Report

Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report

  • Authors:
    • Mesut Pekmez
    • Ümit Özçelik
    • Kemal Yandakçi
    • Alper Bilal Özkardeş
  • View Affiliations / Copyright

    Affiliations: Lokman Hekim University School of Medicine, Department of General Surgery, Lokman Hekim University Training and Research Hospital, Sincan, Ankara 06930, Turkiye
  • Article Number: 261
    |
    Published online on: August 4, 2026
       https://doi.org/10.3892/etm.2026.13256
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Abstract

Endogenous hyperinsulinemic hypoglycemia in adults is most commonly caused by insulinoma, whereas adult‑onset nesidioblastosis represents a rare etiology that can closely mimic insulinoma both clinically and biochemically. In the present study, a rare case of focal, non‑exophytic, nodular adult‑onset nesidioblastosis that was initially diagnosed as insulinoma was reported. A 25‑year‑old non‑diabetic woman presented with a one‑year history of recurrent fasting and postprandial hypoglycemia episodes. The patient fulfilled Whipple's triad and a supervised 72‑h fast verified endogenous hyperinsulinism. Conventional imaging modalities, including computed tomography and magnetic resonance imaging, failed to reveal a pancreatic lesion. However, endoscopic ultrasonography (EUS) detected a 7.3x7.1 mm non‑exophytic, hypoechoic nodular lesion in the pancreatic tail. Based on the above findings, a preoperative diagnosis of insulinoma was considered and the patient underwent spleen‑preserving distal pancreatectomy. Histopathological evaluation revealed focal nodular nesidioblastosis, characterized by ductulo‑insular complexes, architectural disorganization, absence of a fibrous capsule and hyperplastic islet cells with a low Ki‑67 proliferative index. The patient has remained free of hypoglycemic episodes for >18 months postoperatively. This case underscores the diagnostic challenge of distinguishing focal adult‑onset nesidioblastosis from insulinoma before surgery, particularly when a small, non‑exophytic pancreatic lesion could be identified by EUS.
View Figures

Figure 1

Endoscopic ultrasonography image
showing a 7.3x7.1 mm hypoechoic nodular mass in the tail of the
pancreas.

Figure 2

Pathology and IHC analysis. (A)
Histology indicates enlarged and irregular hyperplastic islet cells
mixed with pancreatic ducts (ductuloinsular complexes) (H&E
staining; magnification, x4; scale bar, 500 nm). (B) IHC staining
of synaptophysin highlighted the hyperplastic islet cells mixed
with pancreatic ducts (ductuloinsular complexes) (magnification,
x4; scale bar, 500 nm). (C) Histology at larger magnification
(H&E staining; magnification, x10; scale bar, 100 nm). (D) IHC
at larger magnification (magnification, x10; scale bar, 100 nm).
IHC, immunohistochemistry.

Figure 3

Immunohistochemistry staining of Ki67
highlighted the low proliferation index in the hyperplastic islet
cells (magnification, x20; scale bar, 50 µm).
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Copy and paste a formatted citation
Spandidos Publications style
Pekmez M, Özçelik Ü, Yandakçi K and Özkardeş AB: Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report. Exp Ther Med 32: 261, 2026.
APA
Pekmez, M., Özçelik, Ü., Yandakçi, K., & Özkardeş, A.B. (2026). Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report. Experimental and Therapeutic Medicine, 32, 261. https://doi.org/10.3892/etm.2026.13256
MLA
Pekmez, M., Özçelik, Ü., Yandakçi, K., Özkardeş, A. B."Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report". Experimental and Therapeutic Medicine 32.4 (2026): 261.
Chicago
Pekmez, M., Özçelik, Ü., Yandakçi, K., Özkardeş, A. B."Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report". Experimental and Therapeutic Medicine 32, no. 4 (2026): 261. https://doi.org/10.3892/etm.2026.13256
Copy and paste a formatted citation
x
Spandidos Publications style
Pekmez M, Özçelik Ü, Yandakçi K and Özkardeş AB: Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report. Exp Ther Med 32: 261, 2026.
APA
Pekmez, M., Özçelik, Ü., Yandakçi, K., & Özkardeş, A.B. (2026). Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report. Experimental and Therapeutic Medicine, 32, 261. https://doi.org/10.3892/etm.2026.13256
MLA
Pekmez, M., Özçelik, Ü., Yandakçi, K., Özkardeş, A. B."Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report". Experimental and Therapeutic Medicine 32.4 (2026): 261.
Chicago
Pekmez, M., Özçelik, Ü., Yandakçi, K., Özkardeş, A. B."Adult‑onset focal nodular non‑exophytic nesidioblastosis mimicking insulinoma detected by endoscopic ultrasonography: A case report". Experimental and Therapeutic Medicine 32, no. 4 (2026): 261. https://doi.org/10.3892/etm.2026.13256
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