Insulinoma with focal hepatic lesions: malignant insulinoma? (original) (raw)
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Insulinoma - diagnosis and treatment based on case description
Journal of Pre-Clinical and Clinical Research, 2012
A 56-year-old patient was admitted to the Department due to recurrence of symptoms: sudden weakness, dizziness, excessive sweating, palpitations, which cleared up after food intake. Physical examinations and initial diagnostic tests did not reveal any abnormalities. Abdominal ultrasonography and magnetic resonance showed a heterogenous tumour of the pancreas with features of insulinoma. The prolonged supervised fast test that was applied induced hypoglycaemic symptoms. The level of glucose and insulin was at the lower range of the fast test. The tumor was surgically removed, and the suspicion of insulinoma was confirmed by histopathologic examination.
Well-Differentiated Pancreatic Tumor/Carcinoma: Insulinoma
Neuroendocrinology, 2006
ferentiated endocrine tumors, with benign or uncertain behavior at the time of diagnosis; [2] well-differentiated endocrine carcinomas with low-grade malignant behavior, and [3] poorly differentiated endocrine carcinomas, with high-grade malignant behavior. Most insulinomas are classified as well-differentiated endocrine tumors, according to the WHO criteria (WHO 1), but occasionally they belong to the WHO 2 or 3 group .
A Clinicopathological Study of Malignant Insulinoma in a Contemporary Series
Pancreas, 2017
The aim of the study was to address the origin and natural history of malignant insulinoma. Methods: Retrospective review of medical records of patients diagnosed with insulinoma at Cedars-Sinai Medical Center between 2000 and 2015 was conducted. Hormonal expression in tumor specimens was examined by immunostaining. Results: All the 9 patients with malignant insulinoma (35% of 26 patients with insulinoma) already had liver metastasis at hypoglycemia presentation with bulky cumulative tumor burden. Six patients had de novo diagnosis, 2 had known metastatic nonfunctioning pancreatic neuroendocrine tumor, and 1 had a known pancreatic mass. Tumor grade at presentation was G1 in 4 patients, G2 in 4, and unknown in 1. Four patients died 2 to 32 months after presentation, all with extensive liver tumor involvement. Tumor expression of proinsulin and insulin was heterogeneous and overall infrequent. The proinsulin levels and proinsulin/insulin molar ratio in patients with malignant versus benign insulinoma were 334 versus 44 pmol/L and 2.1 versus 0.9, respectively. Conclusions: Malignant insulinoma seems to arise from and behave like nonfunctioning pancreatic neuroendocrine tumor oncologically but with metachronous hyperinsulinemic hypoglycemia. High proinsulin levels and proinsulin/insulin molar ratio may suggest malignant insulinoma.
Archives of Endocrinology and Metabolism, 2015
A 62-year-old man admitted to our outpatient clinic with two months of recurrent life threatening hypoglycemia episodes. He was diagnosed as malignant insulinoma with multiple metastases of liver and peripancreatic lymph nodes. Liver biopsy specimen was demonstrated grade 2 neuroendocrine tumor compatible with clinical and radiological results. He was followed under the treatment of continuous intravenous glucose infusion during the diagnostic procedures. He had a pancreatic lesion history measured 20 x 12 mm in diameter via the abdominal tomography examination approximately two years before the diagnosis. Unusual course of this case suggests the transformation of nonfunctioning pancreatic neuroendocrine tumor into functional insulin secreting tumor with metastases. The patient was found inoperable and started on chemotherapy.
Wheres the Insulinoma? A clinical case report
2009
The suspicion of an insulinoma in an individual with adrenergic symptoms and / or neuroglycopenia must be the first concern in the differential diagnosis of hypoglycaemia. Insulinoma is the most frequent endocrine tumor of the pancreas and appears at any age, being more frequent between 40 and 60 years. The diagnosis is clinical and can be difficult to make in the presence of doubtful symptoms of neuroglycopenia or adrenergic symptoms after meals. Whipple´s triad of-glycemia below 50 mg/dl and symptoms / signs of hypoglycaemia that revert with administration of glucose-is strongly suggestive of insulinoma, and when associated with blood insulin inadequately high, the diagnosis is of insulinoma. The authors describe the case of a 58-year-old male patient, with a clinical picture characterized by multiple episodes of confusion, migraine, bewilderment, irritability, agitation and diaphoresis, progressing for almost 8 months. The complaints were not properly evaluated initially and the patient was treated with sedative drugs. A fasting glycemia of 38 mg/dl made insulinoma a probable diagnosis and this was confirmed by the 72 hour fasting test. Difficulties arose, as usual, in locating the tumor with imaging methods (abdominal-pelvic ultrasound and computerized tomography scan, octreotide scan and endoscopic ultrasound) and only selective arteriography with catheterization of the branches of the celiac artery revealed the tumor, located in the head of the pancreas. Surgical treatment consisted of tumor enucleation. The histological findings confirmed the diagnosis of benign insulinoma. The peculiarities of the diagnosis and particularities of the image studies in insulinoma are discussed in this article.
Diagnostic and treatment difficulties in insulinomas
Romanian Journal of Military Medicine, 2015
Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types. Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases. Introduction: Insulinomas are localized preoperatively using conventional imaging studies as transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance imaging (MRI). Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas. Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and 15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012
Insulinoma and Metabolic Urgency Case Report
International Journal of Advanced Research, 2021
Insulinoma is a rare neuroendocrine tumor, occurring almost exclusively in the pancreas. Most often unique and benign in 90% of cases. Usually sporadic, 10% of lesions become part of type 1 multiple endocrine neoplasia. The main manifestation of insulinoma is hypoglycemia, which is a life-threatening metabolic emergency. The hypoglycemia occurring in this context are particularly serious and frequent with sometimes harmful cerebral consequences. Topographic diagnosis remains difficult due to the small size of the lesions justifying the importance of the preoperative imaging required for the location of the tumor. Enucleation is the surgical indication of choice in the presence of a sporadic insulinoma that is presumably benign. Pathological and immunohistochemical examination confirms the diagnosis of neuroendocrine tumor. Our observation is particular by the circumstances of discovery of the insulinoma, the severe nature of the symptoms.
Experience in the Approach to Insulinoma: A Case Series
Internal Medicine and Medical Investigation Journal, 2018
Introduction: Insulinomas are rare pancreatic neuroendocrine tumors derived from beta cells responsible for insulin secretion. These tumors are typically manifested by hypoglycemia signs and symptoms, which might be non-specific leading to a delay in the diagnosis. The present study describes the experience in the approach of patients with insulinoma at Fundación Valle del Lili, Cali, Colombia.Case Presentation: A retrospective search of patients with the diagnosis of insulinoma within the database of the pathology service was performed between March 2002 and February 2017. Parameters such as the lesion size and localization, the immunohistochemistry findings, the serum levels of glucose, the insulin and C-peptide levels, the presence of metastasis, and the development of diabetes after surgery were evaluated. A total of nine patients with a diagnosis of insulinoma were enrolled in the study. The cohort comprised of seven men and two women, aged 30–50 years. Whipple triad was presen...
Clinical presentation in insulinoma predicts histopathological tumour characteristics
Clinical endocrinology, 2015
Insulinomas are rare neuroendocrine tumours (NETs) of the pancreas, characterized clinically by neuroglycopenic symptoms during periods of substrate deficiency. The gold standard test for diagnosing an insulinoma is a 72-hour fast. However, the prognostic value of parameters in the standardized 72-hour fast on histopathological tumour criteria and clinical presentation has not been examined. In 33 patients diagnosed with an insulinoma records and data were investigated retrospectively. Histopathological tumour characteristics, including staging, grading and size, were reviewed. Grading was performed using Ki-67 index. Cut-off values for classical grading (Gclas ) were set at G1clas ≤2%, G2clas 3-20% & G3clas >20% and for modified grading (Gmod ) at G1mod <5%, G2mod 5-20% & G3mod >20%. When Gmod criteria were applied, the initial blood glucose was lower in GII/IIImod patients compared to GImod (2.8±0.8 vs 3.8±1.3mmol/l; p=0.046). Basal and end-of-fast levels of insulin (basa...