Preoperative imaging and localization of small sized insulinoma with EUS-guided fine needle tattoing: a case report (original) (raw)
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Gastrointestinal Endoscopy, 2002
Insulinomas, although rare, are the most common pancreatic neuroendocrine tumors with a prevalence of 0.8 to 0.9 per million population per year. 1 They originate from beta cells in the pancreas, secrete excessive amounts of insulin, and cause a distinct syndrome characterized by symptoms caused by hypoglycemia. They are generally benign, solitary, and intrapancreatic. 2,3 The only possibility for cure of these tumors is surgical excision. Preoperative localization may assist the identification of these tumors at surgery and improve operative results.
Preoperative detection of insulinomas: two case reports
Cases Journal, 2008
Background: Insulinoma is the most common endocrine tumor of the pancreas. Accurate preoperative detection and localization of insulinomas is essential for the appropriate selection of candidates for surgery. We present two cases with benign pancreatic insulinoma.
Pre- and intraoperative localization of insulinomas: Report of 22 observations
World Journal of Surgery, 1988
From a retrospective analysis of 22 cases of pancreatic insulinoma operated in our center, we have determined the predictive value of various pre-and intraoperative localization procedures. In 18 patients, solitary insulinomas were localized by selective arteriography (SA) in 55.5% of cases, by transhepatic catheterization with pancreatic venous sampling (THVS) in 64% of cases, but by ultrasonography (US) and computed tomography (CT) in only 11% of cases. The combination of SA and THVS allowed the preoperative localization of the tumor in 83% of cases. Intraoperative palpation, ultrasonography, and blood glucose monitoring localized a single tumor in all cases. When the insulinomas were multiple, the various preoperative investigations were not reliable. In the 4 cases of multiple insulin0ma, various investigations (SA, US, CT, THVS) localized only 8 (28%) tumors of 28. Intraoperative palpation was also unreliable. Only intraoperative ultrasonography and continuous blood glucose monitoring localize all multiple tumors (the diameter of the smallest tumor was 4 ram). These 2 intraoperative investigations are now the procedures of choice for the detection of small pancreatic insulinomas.
The Journal of Clinical Endocrinology & Metabolism, 2019
Introduction Diagnosis and pathological classifications is challenging in insulinomas Aim To characterize insulinoma patients with regard to localization of tumors, surgery outcomes and histopathology. Methods All patients with surgical resected sporadic insulinoma were included Results Eighty patients were included. Seven had a malignant tumor. 312 diagnostic examinations were performed: Endoscopic ultrasonography (EUS, n=59, sensitivity 70%), magnetic resonance imaging (n=33, sensitivity 58%), computed tomography (CT, n=55, sensitivity 47%), transabdominal US (n=45, sensitivity 40%), somatostatin receptor imaging (n=17, sensitivity 29%), 18F-FDG positron emission tomography/CT (n=1, negative), percutaneous transhepatic venous sampling (n=10, sensitivity 90%), arterial stimulation venous sampling (n=20, sensitivity 65%) and intra-operative US (n=72, sensitivity 89%). Fourteen tumors could not be visualized despite the use of numerous different imaging modalities. Invasive methods w...
Diagnostic Difficulties in Insulinomas. The Importance of Endoscopic Ultrasonography
Acta Endocrinologica (Bucharest), 2006
Insulinoma is the most common endocrine tumor of the pancreas. The diagnosis suspicion is usually based on clinical symptoms and is confirmed by biochemical tests. Because the majority of insulinomas have a small size, the real problem is the localization of these tumors before surgery. We present the diagnostic and therapy difficulties, the value of available imaging techniques as well as our experience in five consecutive insulinoma patients from our clinic.
Current health sciences journal, 2012
Insulinomas are benign insulin-secreting neuroendocrine tumors originating in the pancreatic beta cells. Symptoms are caused by hypoglycemia and clinical diagnosis is based on establishing their relationship to fasting, usually via a fasting test. The most conclusive imaging tests are endoscopic ultrasound (EUS) and CT. Surgery is the treatment of choice. A 33 year old male presented with a 2-year history of hunger which had intensified in the previous 6 months with added accompanying symptoms, culminating with an acute episode - loss of consciousness and seizures - which resolved after administering i.v. glucose. A fasting test was performed, with results suggestive for an insulinoma. Dual-phase CT showed a mass in the tail of the pancreas but no contrast enhancement. EUS was used for further assessment: B-mode showed a hypoechoic focal mass with a cystic component, on contrast enhancement the pattern was hypovascular, and elastography showed soft tissue. EUS fine needle aspiration...
Pitfalls in the surgical treatment of insulinoma
Surgery, 2002
Background. In the 75 years since an insulinoma was first described, the challenge for the surgeon has been one of localization. The combination of endoscopic ultrasound (EUS) or intraoperative ultrasound and operative palpation has led to nearly 100% success rate at primary operation in experienced institutions. However, 13% of patients at referral centers undergo reexploration, which has an increased morbidity. With more successful localization modalities, the operative failures have become more challenging than ever. Methods. During the past 35 years, we have treated 118 cases of sporadic insulinoma. Technical advances in EUS have led to preoperative identification of more than 90% of insulinomas. Despite this success we have become increasingly aware of the limitations of EUS in the surgical treatment of insulinoma. We present the pitfalls of 6 recent cases.
Journal of Gastrointestinal Surgery, 2009
Introduction Presently, the need for and choice of preoperative localization tests for insulinomas remain controversial. We report the results from a single institution experience whereby the management policy adopted was that of accurate preoperative localization before surgical exploration. Materials and Methods From 1990 to 2008, 17 patients with a clinical and biochemical diagnosis of an insulinoma who underwent surgery were retrospectively reviewed. The diagnosis of all insulinomas were confirmed pathologically. Results All tumors were localized preoperatively and an average of 2.2 preoperative localization studies including 1.4 noninvasive studies and 0.8 invasive studies were utilized per patient. Invasive localization modalities were more sensitive (92%) than noninvasive modalities in localizing insulinomas (71%). Intra-arterial calcium stimulation with hepatic venous sampling was the most sensitive invasive modality (100%), whereas magnetic resonance imaging was the most sensitive noninvasive modality (63%). Fifteen of 17 tumors (88%) were localized intraoperatively via inspection/palpation and/or intraoperative ultrasonography. Both insulinomas which were not localized intraoperatively were localized correctly to the distal pancreas via preoperative transhepatic portal venous sampling. None of the patients required a blind resection or surgical reexploration for failed localization. All 17 patients underwent complete surgical resection which included eight enucleations and nine distal pancreatectomies with a cure rate of 94% (16/17) at a median follow-up of 35 (range, 1-217) months. The postoperative morbidity and long-term outcome of enucleation was similar to distal pancreatectomy despite a higher rate of microscopic margin involvement. Conclusion Accurate preoperative localization of insulinomas is useful as it eliminates the need for blind distal pancreatectomy and avoids reoperation. Complete surgical resection is the treatment of choice, and whenever possible, a pancreas-sparing approach such as enucleation should be adopted.
Enucleation of Pancreatic Insulinomas with the use of Intraoperative Ultrasonography
Journal of Surgical Endocrinology
Tumor-induced hypoglycaemia is very rare, usually caused by a pancreatic beta cell tumor (insulinoma). Symptoms caused by inappropriate insulin secretion usually occur during fasting periods, they can be neurogenic or neuroglycopenic. The diagnosis usually takes up to 2-years, this is biochemical with imaging support. The only curative treatment for an insulinoma is surgical resection (enucleation or partial pancreatectomy). Objective: To show our experience in the diagnosis and treatment of insulinomas, mentioning diagnostic methods and location with Intraoperative Ultrasonography. Method: A retrospective analysis of five patients treated at the Clinical Hospital of the University of Chile between 2006 and 2015 was performed. Results: The average age was 49.2 years (SD 28). The average time between the onset of symptoms and diagnosis was 3.1 years. An imaging study was performed in all patients, with CT of the abdomen and pelvis, identifying a single tumor in all cases with an average size of 1.24 cm (SD 0.26 cm). Conclusion: Insulinoma should be suspected for symptomatic hypoglycemia, especially in non-diabetic patients. The use of ultrasonography allows to precisely orient the dissection avoiding pancreatic complications and the presence of remnants that could recur. Intraoperative US allows successful enucleation, avoiding morbid resections.