Insulinoma: A Recurrent Pancreatic Tumor Amendable to Computed Tomography–Guided Ethanol-Lipiodol Injection

Abstract

Insulinomas are rare, with an annual incidence of 1–4 people per mission. Insulinomas are the most common functioning endocrine neoplams of the pancreas. Endoscopic ultrasound has both diagnostic and therapeutic yield in undifferentiated pancreatic tumors. We present a case of a recurrent insulinoma, refractory to surgical and medical management diagnosed with endoscopic ultrasound. Our case uniquely conveys a successful, alternative approach to addressing symptomatic insulinomas refractory to surgical or medical management through computed tomography–guided percutaneous ethanol-lipiodol injection.

Comment on: Insulinoma in tuberous sclerosis: an entity not to be missed

“…This may confirm the important role of these new techniques in localization and characterization of the lesion and its proper management with a specific role of the intraoperative ultrasonography. 1 , 2 Previously, however, the sensitivity of imaging techniques was doubtful and the outcomes were disappointing. 3 …”

“…Classically, the clinical manifestations of hypoglycemia and laboratory workups including blood glucose levels are fundamental to the diagnosis of insulinomas. 2 , 3 However, the laboratory profile of the current patient was not mentioned and it would be better to present it relative to the chronological events of diagnosis and interventions. This issue may provide a reason that the hypoglycemic status was not diagnosed until the lesion was incidentally seen by imaging.…”

“…This may help in revolutionizing the surgical role with the advancement of surgical techniques in the management of these lesions. 2 …”

“…This may confirm the important role of these new techniques in localization and characterization of the lesion and its proper management with a specific role of the intraoperative ultrasonography. 1,2 Previously, however, the sensitivity of imaging techniques was doubtful and the outcomes were disappointing. 3 Besides the very rare disease associations, this case was unique in that the patient had an interesting surgical history including laparoscopic total proctocolectomy for familial adenomatous polyposis, renal angioembolization for angiomyolipoma, and other endoscopic interventions.…”

“…This may help in revolutionizing the surgical role with the advancement of surgical techniques in the management of these lesions. 2 To overcome unfavorable practical scenarios in the management of these very rare cases, the underlying pathogenesis and disease behavior or natural course should be understood comprehensively. From a practical perspective, this rare association between tuberous sclerosis and insulinoma should be considered in those patients, especially when they present with unexplained manifestations such as hypoglycemia or deteriorating neurocognitive symptoms.…”