Preoperative Tumor Studies Using MRI or CT in Patients with Clinically Suspected Insulinoma

Daneshvar, Keivan; Grenacher, Lars; Mehrabi, Arianeb; Kauczor, Hans‐Ulrich; Hallscheidt, Peter

doi:10.1159/000330208

Cited by 17 publications

(9 citation statements)

References 18 publications

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“…CECT scan (arterial phase), magnetic resonance imaging, DOTATATE scan, angiography and endoscopic ultrasonography are some of them. [ 9 10 11 12 13 14 ] CECT (thin multislice arterial phase) was the mainstay investigation. Insulinomas are hypervascular and hence hyperenhancing in arterial phase.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Dalvi¹,

Garale²,

Takalkar³

et al. 2018

J Min Access Surg

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Background:Insulinomas are the most common pancreatic neuroendocrine neoplasms. In spite of adequate pre-operative localisation, conventional surgical methods rely on intraoperative palpation. Intraoperative ultrasonography (IOUS) is said to aid in accurate localisation, decreases morbidity. Laparoscopic removal of pancreatic endocrine neoplasms is beneficial due to magnification and minimal invasion; however, in the absence of IOUS, error of judgement may lead to conversion to open surgery, thereby relying on ‘palpation method’ to localise the tumour. We combined laparoscopic surgical removal of insulinomas using an innovative method of ‘laparoscopic finger palpation’ with intraoperative blood glucose monitoring and frozen section for surgical cure.Materials and Methods:Patients were evaluated and investigated by the department of endocrinology and referred for surgical management of insulinoma. Pre-operative localisation of insulinoma was done by either contrast-enhanced computerised tomography angiogram – arterial and venous phase, or endoscopic ultrasound (EUS) or DOTATATE scan. Intraoperative localisation was done by laparoscopic dissection and ‘laparoscopic finger palpation’. After enucleation, the specimen was sent for frozen section, and in the interim period, serial monitoring of blood glucose was done by the anaesthetist. Maintenance of glucose levels for more than 45 min after enucleation and confirmation of neuroendocrine tumour on frozen section was the end point of surgical procedure.Results:A total of 19 patients were subjected to laparoscopic removal of solitary insulinomas. Enucleation was performed in 16 patients successfully. In three patients, laparoscopic distal pancreatectomy was performed. Three patients had pancreatic duct leak, of which two patients responded to conservative approach and the third patient required drainage by USG-guided pigtail catheter. All patients are cured of their disease and no patient has had recurrence so far.Conclusion:Multidisciplinary approach involving laparoscopic palpation, frozen sections and intraoperative blood sugar monitoring helps laparoscopic management of solitary insulinomas without IOUS.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Dalvi¹,

Garale²,

Takalkar³

et al. 2018

J Min Access Surg

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“…The images are particularly useful to rule out the presence of insulinomas 24,25 . This could be identified with ultrasonography, endosonography, computed tomography or abdominal MRI 24,25 .…”

Section: Discussionmentioning

confidence: 99%

“…This could be identified with ultrasonography, endosonography, computed tomography or abdominal MRI 24,25 . However, these procedures fail to define whether the HC lesion is focal or diffuse, which is crucial to decide the treatment, plan the extension of pancreatic resection and evaluate the prognosis [25][26][27][28] .…”

Section: Discussionmentioning

confidence: 99%

Hiperinsulinismo congénito del recién nacido: A propósito de un caso clínico

Sáez

Pattillo

Orellana

et al. 2017

Rev. chil. pediatr.

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Congenital hyperinsulinism (HC) is the most frequent cause of persistent hypoglycemia in the newborn and it is characterized by an inappropriately elevated insulin level in presence of hypoglycemia. Initial management is medical treatment, but if it fails, partial pancreatectomy is the surgical procedure of choice. Objective: To report a case of a newborn with CH to aware on this condition and update its multidisciplinary management. Case report: The case of a full term newborn with severe symptomatic hypoglycemia unresponsive to medical treatment is reported. Ultrasonography and abdominal MRI were normal, Gallium 68 PET/CT showed uptake in the body of the pancreas. Laparoscopic corporocaudal pancreatectomy was performed. The patient resolved hypoglycemia and was discharged without incidents. Genetic study was consistent with focal CH, confirmed later by biopsy. Discussion: This case report exposes the clinical presentation of CH and its diagnosis. It emphasizes on the surgical treatment and the advantages of minimally invasive technique.

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“…Pre-operative localization of insulinomas may not be easy in most cases. MRI and computed tomography scans seem to be equally effective even in insulinomas of less than 1 cm in diameter and the sensitivity has been reported to be about 40 to 100% (12)(13)(14). In the case presented, we were able to detect the 9.6 × 8.3 × 7.3 cm lesion in the pancreas or multiple metastatic lesions in the liver most of which were 1 cm or smaller by MRI alone.…”

Section: Discussionmentioning

confidence: 99%

Metastatic Insulinoma in a 16-Year-Old Adolescent Male With Men-1: A Case Report and Review of the Literature

Cemeroğlu

Racine

Kleis

et al. 2016

AACE Clinical Case Reports

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Objective: Multiple endocrine neoplasia type 1 (MEN-1) is an autosomal dominant condition associated with various combinations of endocrine and nonendocrine tumors. Insulinomas are rare endocrine tumors in the pediatric age group and may be associated with MEN-1 in 10% of cases. Malignant insulinomas only constitute 5 to 10% of all the insulinomas and are exceedingly rare in children. There are only 11 cases of malignant insulinoma reported in the literature in the pediatric age group. Methods: We are reporting a 16-year-old adolescent male who presented with symptoms of hypoglycemia for the 4 months prior to referral. Results: He was diagnosed with malignant insulinoma with multiple metastases to liver and was treated with surgical resection followed by octreotide treatment. He had additional findings consistent with the diagnosis of MEN-1, including elevated prolactin levels combined with a 4 to 5 mm pituitary lesion possibly due to prolactinoma and mildly elevated calcium levels with a parathyroid ultrasound demonstrating a parathyroid adenoma on the left side measuring 8 × 6 × 4 mm in diameter. He has been free of symptoms and radiologic findings of recurrence of insulinoma 1-year post surgery. Conclusion: Malignant insulinoma is extremely rare in children, but should be considered in cases of hyperinsulinemic hypoglycemia. MEN-1 should also be considered because insulinoma may be the first finding of MEN-1. Surgical resection is the treatment of choice. Somatostatin analog is a safe and effective treatment in children in cases with metastatic insulinoma when residual tumor is present.

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Preoperative Tumor Studies Using MRI or CT in Patients with Clinically Suspected Insulinoma

Cited by 17 publications

References 18 publications

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Laparoscopic surgery for solitary insulinoma in the absence of IOUS

Hiperinsulinismo congénito del recién nacido: A propósito de un caso clínico

Metastatic Insulinoma in a 16-Year-Old Adolescent Male With Men-1: A Case Report and Review of the Literature

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