Of the many functioning islet-cell tumors of the pancreas that have been reported, approximately 10% have metastasized to lymph nodes, liver, or elsewhere. In some of these cases the metastases have produced insulin,1-3 whereas in others the metastatic processes apparently have been inert.4 In most instances death has occurred within a short time after the diagnosis of frank islet-cell carcinoma was made. In at least two instances the patient survived for a considerable time. Holman's5 patient lived 16 years from the onset of symptoms, and Brunschwig's6 patient lived 47 months after an operation which revealed a pancreatic tumor and metastasis to the liver.
Our report concerns a man with proved islet-cell carcinoma of the pancreas with metastasis to the liver and peritoneum who has had symptoms suggestive of hypoglycemia for approximately 25 years, and from whom an islet-cell tumor was first removed 15 years ago. Metastasis