Hypoglycemia unmasking a giant pulmonary solitary fibrous tumor: a case report.

backgroundHypoglycemia may result from multiple clinical conditions which are categorized based on clinical status. The first principal step in clinical diagnostic evaluation is measurement of plasma insulin, c-peptide, pro-insulin, and beta-hydroxybutyrate levels. One of the rare causes of hypoglycemia is a group of disorders known as non-islet cell tumor hypoglycemia (NICT), which results from the paraneoplastic secretion of insulin-like growth factor 2 (IGF-2). In rare cases, Solitary fibrous tumors SFTs are associated with recurrent hypoglycemia and represent the most frequent subtype of NICT. CASE PRESENTATION: We report a 66-year-old Iranian (Middle Eastern) man who presented with recurrent episodes of hypoglycemia, and significant unintentional weight loss. Laboratory workup revealed low insulin, C-peptide, and IGF-1 levels. Imaging studies identified a massive right thoracic mass with near-complete collapse of the right lung. Histopathological evaluation confirmed the diagnosis of solitary fibrous tumor with positive immunohistochemical staining for STAT6 and CD34. The tumor was surgically resected. Postoperatively, the patient recovered uneventfully, with resolution of hypoglycemic episodes.

conclusionThis case highlights the importance of considering SFT and NICTH in patients with unexplained hypoglycemia and low insulin/C-peptide levels. Timely imaging and histopathological evaluation are crucial, as surgical resection can be curative.