Abstract
This paper deals with a patient presented with hypoglycemia associated with a giant breast tumor.
A 69-year-old woman was brought into the hospital because of a giant mass in the left breast in July, 2008. She had noticed the mass since about 2 years earlier, and malodorous secretion from the mass for about these six months. The mass which was movable freely was about soccer-ball sized, and had a sarcomatous appearance, with ulceration through the skin. A breast CT scan revealed a high-density bulky mass in the left breast without axillary lymph node swelling and it was suspected to have expanded to the left pectoral muscles and skin. On biopsy examination, the mass was diagnosed as phyllodes tumor. During hospital stay, she suddenly had an attack of consciousness loss (JCS III-300) 20 days after admission, when the serum blood sugar level was 34 mg/dl. She was successfully treated with injection of glucose. We suspected that hypoglycemia might be related to the giant mass in the left breast, and performed left mastectomy with resection of the left major and minor pectoral muscles on August 24 days after admission. The resected tumor weighed 3900 g, measured 27×22×14 cm. The resected specimen had leaf-like papillary protrusions of stromal connective tissue lined with epithelium and duct-like element, and was diagnosed as borderline type of phyllodes tumor. After removal of the tumor, the blood sugar level was gradually normalized, and she was in a healthy condition. These events suggested that the patient's hypoglycemia was associated with the giant phyllodes tumor that consumed glucose, generally named non-islet cell tumor hypoglycemia (NICTH).
