Malignant insulinoma presenting a non-functioning metastatic liver tumor 14 years after resection of the primary tumor

Kobayashi, Masakazu; Kawa, Shigeyuki; Kobayashi, Masanori; Imai, Yutaka; Sodeyama, Takeshi; Kiyosawa, Kendo

doi:10.1007/s005350050195

Cited by 8 publications

(2 citation statements)

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“…We therefore advocate aggressive medical and surgical treatment to offer palliation and prolonged survival and in particular to avoid local complications. In addition, potentially curative treatment has been reported for malignant EPTs accompanied by limited metastases [12,17,24,25]. In our series, six patients with large tumors (4 -10 cm in diameter) and limited locally infiltrative disease have not shown recurrence for an average of 3 years postoperatively.…”

Section: Discussionmentioning

confidence: 63%

Surgical Strategy for Large or Malignant Endocrine Pancreatic Tumors

et al. 2000

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Endocrine pancreatic tumors (EPTs) are rare but have a remarkably better prognosis than adenocarcinoma of the pancreas. Patients with EPTs benefit from surgical and medical therapy, which may alleviate symptoms due to hormonal excess and increase survival. Patients with large or malignant EPTs with infiltrative disease may suffer from local complications, including gastrointestinal bleeding and obstruction and involvement of the superior mesenteric (SMV) and portal (PV) veins. Among 31 patients with operable and large or malignant EPTs, 7 had hormone-producing syndromes (insulin, glucagon), and 24 had clinically nonfunctioning EPTs. Surgery in these patients included vascular reconstruction of the SMV/PV (n = 4), resection of infiltrated adjacent organs (n = 5; stomach, transverse colon), or resection of concomitant liver metastases (n = 3). Four patients with conspicuously large insulinomas, and three with glucagonoma were successfully operated on with alleviation of hormonal symptoms. Among the 24 nonfunctioning EPTs, 5 patients had been explored earlier and their tumors judged inoperable due to locally invasive disease or misdiagnosis as pancreatic adenocarcinoma. The operations were performed with no mortality and low morbidity. We conclude that large and malignant EPTs with limited spread of disease may benefit from a combination of medical and surgical therapy.

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Section: Discussionmentioning

confidence: 63%

Surgical Strategy for Large or Malignant Endocrine Pancreatic Tumors

et al. 2000

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“…Patients with insulinomas often have a good prognosis if resection of the primary tumour can be effected. The appearance of a solitary non‐functioning metastasis has been described in a patient who had a malignant pancreatic insulinoma resected 14 years earlier (Kobayashi et al. , 1998) but equally the course can be rapidly progressive with the appearance of multiple metastases (Hesdorffer et al.…”

Section: Discussionmentioning

confidence: 99%

Radio‐frequency ablation for symptom control in a patient with metastatic pancreatic insulinoma

Scott

Hinwood

Donnelly

2002

Clinical Endocrinology

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Malignant insulinomas are very rare endocrine tumours with a variable clinical course. We describe a 51-year-old man who had two large insulinomas resected from the body of the pancreas and 19 years later, having again become symptomatic, was found to have hepatic metastases. Medical treatment with diazoxide and octreotide failed to control his symptoms, but repeated hepatic embolization effected both symptomatic and biochemical improvements for a further 5 years. When symptoms recurred but further embolization failed to control his symptoms the hepatic metastases were treated by outpatient percutaneous radio-frequency ablation. He remains symptom-free 18 months later and levels of insulin and pro-insulin have nearly normalized. The survival, with liver metastases, for 27 years in a man with a malignant insulinoma has not been described previously. Malignant insulinoma may follow a rather indolent course and symptoms respond well to locally destructive therapies. Hepatic embolization is less traumatic than hepatic lobe resection and radio-frequency ablation offers an alternative if vascular access to the tumour is no longer possible.

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Malignant insulinoma

Hirshberg

Cochran

Skarulis

et al. 2005

Cancer

146

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BACKGROUNDMalignant insulinoma occurs in a few patients with insulinoma. Due to the small sample of patients, there are little data regarding their clinical manifestation as well as the preferred treatment modalities. The aims of the current study were to summarize the National Institutes of Health experience during the last two decades and to conduct a critical review of the current literature.METHODSThe authors identified 10 patients with metastatic insulinoma.RESULTSThe patients presented with four patterns of clinical behavior. First, four patients presented with lymph node metastasis and, after surgical excision, maintained a prolonged tumor‐free survival. Second, four patients presented with metastatic disease to the liver, which appeared years after the initial diagnosis and presumed curative surgery. Third, one patient presented with a large α‐fetoprotein‐secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival. Various treatment modalities were used to control hypoglycemia. Short‐term benefits were most often achieved with embolization and diazoxide. Less successful modalities included radiofrequency ablation, radical debulking surgery, verapamil therapy, octreotide therapy, and chemotherapy.CONCLUSIONSThe current study, as well as others, suggested that metastatic insulinoma may have a variable natural history. After the initial surgical resection, the biology of the tumor, rather than any treatment modality, was most likely the major determinant of long‐term survival. Cancer 2005. © Published 2005 American Cancer Society.

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Malignant insulinoma presenting a non-functioning metastatic liver tumor 14 years after resection of the primary tumor

Cited by 8 publications

References 10 publications

Surgical Strategy for Large or Malignant Endocrine Pancreatic Tumors

Surgical Strategy for Large or Malignant Endocrine Pancreatic Tumors

Radio‐frequency ablation for symptom control in a patient with metastatic pancreatic insulinoma

Malignant insulinoma

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