A 70-year-old man presented with a 4-month history of a painless, firm lower abdominal pelvic mass. Laboratory evaluation demonstrated persistent severe hypoglycemia with suppressed insulin and C-peptide concentrations, suggesting nonislet-cell tumor hypoglycemia. Contrast-enhanced computed tomography revealed a large pelvic mass exhibiting marked heterogeneous enhancement and extensive liquefactive necrosis (arrow, Figure 1a). Cinematic rendering further delineated prominent feeding vessels arising from the internal iliac artery (Figure 1b). Complete surgical excision was performed, and histopathological examination confirmed a malignant solitary fibrous tumor (Figure 1c). Blood glucose levels normalized rapidly following resection, increasing intraoperatively to 11.46 mmol/L and declining to 6.23 mmol/L by postoperative day 1, with sustained normoglycemia thereafter. Collectively, these findings established the diagnosis of Doege–Potter syndrome. The hypoglycemia was attributed to tumor-derived insulin-like growth factor II, which activates insulin receptors and suppresses hepatic gluconeogenesis. This case underscores computed tomography's diagnostic value in localizing occult extrathoracic insulin-like growth factor II-secreting tumors. Images and histopathological findings in a 70-year-old man with a malignant pelvic solitary fibrous tumor causing Doege–Potter syndrome. (a) Contrast-enhanced computed tomography image demonstrating a well-circumscribed pelvic mass with heterogeneous enhancement and central liquefactive necrosis (arrow). (b) Cinematic rendering image depicting the tumor's feeding vessels arising from the internal iliac artery. (c) Hematoxylin and eosin-stained photomicrograph showing increased tumor cell density with diffuse cellular distribution, lightly stained nuclei, focal nuclear vacuolation, and identifiable mitotic figures (original magnification × 200). Wenhui Ma: writing – original draft, writing – review and editing. Cong Huang: writing – review and editing. The authors have nothing to report. The authors have nothing to report. The authors have nothing to report. The patient provided written informed consent at the time of study enrollment. The authors declare no conflicts of interest. Data are available from the authors upon reasonable request.
Ma et al. (Tue,) studied this question.