INS and metastatic malignant neoplasm in the lymph nodes: Hirshberg et al. compared survivors of a long course of disease and patients with a poor prognosis and discovered that the two groups were almost indistinguishable in terms of their pathomorphology, insulin levels, and proinsulin levels and that neither liver metastasis nor lymph node metastasis was a factor that contributed to a poor prognosis [7].