Recurrence of Non-Hodgkin Lymphoma at the Insulin Injection Site: Case Report

Authors

  • Orhan Türken Department of Oncology, Maltepe University Hospital, Istanbul, Turkey.
  • Şükrü Yıldırım Department of Pathology, Maltepe University Hospital, Istanbul, Turkey.
  • Gözde Şanlı Department of General Surgery, Maltepe University Hospital, Istanbul, Turkey.
  • Rahmi Çubuk Department of Radiology, Maltepe University Hospital, Istanbul, Turkey.
  • Ghayda Jarrar Faculty of Medicine, Maltepe University, Istanbul, Turkey.

DOI:

https://doi.org/10.52609/jmlph.v4i4.158

Keywords:

Insulin, Insulin-like growth factor, Lymphoma, Neoplasm, Non-Hodgkin, Regular

Abstract

This study sheds light on the effect of insulin, insulin-like growth factors (IGF), and their signalling receptors (IR and IGF-1R) on the progression of lymphoma. We report a case of a 64-year-old male with type 2 diabetes mellitus and a prior diagnosis of diffuse large B-cell non-Hodgkin lymphoma (DLBCL) treated with chemotherapy and local radiotherapy. Incredibly, four years post-treatment, the patient's DLBCL relapsed in the subcutaneous fatty tissue adjacent to the deltoid muscle of both the proximal left and right upper extremities, which were the sites he used to inject insulin. Insulin/IGF dysregulation can lead to tumour growth via angiogenesis. This mechanism is not limited to lymphoma and may contribute to the development of various types of cancer. While it is possible that DLBCL may have developed at the injection site either coincidentally, as a result of chronic inflammation, or potentially due to other factors that promote tumour growth, as we suggest in our case presentation, it is beneficial to emphasise the importance of tumour screening in diabetic patients, especially those receiving insulin injections. We therefore believe that regular screening of the insulin injection site should be included in routine consultations for these patients.

References

Sapkota S, Shaikh H. Non-Hodgkin Lymphoma. [Updated 2023 Feb 24]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559328/

Ababneh HS, Abramson JS, Johnson PC, Patel CG. Assessing the role of radiotherapy in patients with refractory or relapsed high-grade B-cell lymphomas treated with CAR T-cell therapy. Radiother Oncol. 2022 Oct;175:65-72. doi: 10.1016/j.radonc.2022.08.007. Epub 2022 Aug 8. PMID: 35952976.

Szablewski L. Insulin Resistance: The Increased Risk of Cancers. Curr Oncol. 2024 Feb 13;31(2):998-1027. doi: 10.3390/curroncol31020075. PMID: 38392069; PMCID: PMC10888119.

Weroha SJ, Haluska P. The insulin-like growth factor system in cancer. Endocrinol Metab Clin North Am. 2012 Jun;41(2):335-50, vi. doi: 10.1016/j.ecl.2012.04.014. PMID: 22682634; PMCID: PMC3614012.

Leroith D, Scheinman EJ, Bitton-Worms K. The Role of Insulin and Insulin-like Growth Factors in the Increased Risk of Cancer in Diabetes. Rambam Maimonides Med J. 2011 Apr 30;2(2):e0043. doi: 10.5041/RMMJ.10043. PMID: 23908801; PMCID: PMC3678929.

Kasprzak A. Insulin-Like Growth Factor 1 (IGF-1) Signaling in Glucose Metabolism in Colorectal Cancer. Int J Mol Sci. 2021 Jun 16;22(12):6434. doi: 10.3390/ijms22126434. PMID: 34208601; PMCID: PMC8234711.

Monteiro M, Zhang X, Yee D. Insulin promotes growth in breast cancer cells through the type I IGF receptor in insulin receptor deficient cells. Exp Cell Res. 2024 Jan 1;434(1)

Yu F, Huang D, Kuang Y, Dong J, Han Q, Zhou J, Teng X. IRS1 promotes thyroid cancer metastasis through EMT and PI3K/AKT pathways. Clin Endocrinol (Oxf). 2024 Mar;100(3):284-293. doi: 10.1111/cen.15005. Epub 2024 Jan 3. PMID: 38172081.

Duraiyarasan S, Adefuye M, Manjunatha N, Ganduri V, Rajasekaran K. Colon Cancer and Obesity: A Narrative Review. Cureus. 2022 Aug 1;14(8):e27589. doi: 10.7759/cureus.27589. PMID: 36059323; PMCID: PMC9433794.

Achlaug L, Somri-Gannam L, Meisel-Sharon S, Sarfstein R, Dixit M, Yakar S, Hallak M, Laron Z, Werner H, Bruchim I. ZYG11A Is Expressed in Epithelial Ovarian Cancer and Correlates With Low Grade Disease. Front Endocrinol (Lausanne). 2021 Jun 18;12:688104. doi: 10.3389/fendo.2021.688104. PMID: 34220714; PMCID: PMC8249937.

Shahriyari L. A new hypothesis: some metastases are the result of inflammatory processes by adapted cells, especially adapted immune cells at sites of inflammation. F1000Res. 2016 Feb 16;5:175. doi: 10.12688/f1000research.8055.1. PMID: 27158448; PMCID: PMC4847566.

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Published

2024-10-18

How to Cite

Türken, O. . ., Yıldırım, Şükrü ., Şanlı, G., Çubuk, R., & Jarrar, G. (2024). Recurrence of Non-Hodgkin Lymphoma at the Insulin Injection Site: Case Report. The Journal of Medicine, Law & Public Health, 4(4), 494–500. https://doi.org/10.52609/jmlph.v4i4.158

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Section

Case Report