Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma

Andreassen, Mikkel; Ilett, Emma Elizabeth; Wiese, Dominik; Slater, Emily P.; Klose, Marianne; Hansen, Carsten P.; Gercke, Norman; Langer, Seppo W.; Kjær, Andreas; Maurer, Elisabeth; Federspiel, Birgitte; Kann, Peter Herbert; Bartsch, Detlef K.; Knigge, Ulrich

doi:10.1210/jc.2019-01204

Cited by 33 publications

(43 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The immunoistochemical determination of insulin was positive in 78.6% of our cases. The negative immunostaining for insulin in the remaining (21.4%) tumors does not exclude the diagnosis of insulinoma and it can be attributed to the rapid release of insulin and correlates to the severity of the syndrome, as already reported in previous studies (24,25).…”

Section: Discussionmentioning

confidence: 61%

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Veltroni

Cosaro

Spada

et al. 2020

European Journal of Endocrinology

View full text Add to dashboard Cite

Introduction Management of malignant insulinomas is challenging due to the need to control both hypoglycaemic syndrome and tumor growth. Literature data is limited to small series. Aim of the study To analyze clinico-pathological characteristics, treatments and prognosis of patients with malignant insulinoma. Materials and methods Multicenter retrospective study on 31 patients (male: 61.3%) diagnosed between 1988 and 2017. Results The mean age at diagnosis was 48 years. The mean NET diameter was 41 ± 31 mm, and 70.8% of NETs were G2. Metastases were widespread in 38.7%, hepatic in 41.9% and only lymph nodal in 19.4%. In 16.1% of the cases, the hypoglycaemic syndrome occurred after 46 ± 35 months from the diagnosis of originally non-functioning NET, whereas in 83.9% of the cases it led to the diagnosis of NET, of which 42.3% with a mean diagnostic delay of 32.7 ± 39.8 months. Surgical treatment was performed in 67.7% of the cases. The 5-year survival rate was 62%. Overall survival was significantly higher in patients with Ki-67 ≤10% (P = 0.03), insulin level <60 µU/mL (P = 0.015) and in patients who underwent surgery (P = 0.006). Peptide Receptor Radionuclide Therapy (PRRT) was performed in 45.1%, with syndrome control in 93% of patients. Conclusions Our study includes the largest series of patients with malignant insulinoma reported to date. The hypoglycaemic syndrome may occur after years in initially non-functioning NETs or be misunderstood with delayed diagnosis of NETs. Surgical treatment and Ki67 ≤10% are prognostic factors associated with better survival. PPRT proved to be effective in the control of hypoglycaemia in majority of cases.

show abstract

Section: Discussionmentioning

confidence: 61%

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Veltroni

Cosaro

Spada

et al. 2020

European Journal of Endocrinology

View full text Add to dashboard Cite

show abstract

“…MRT 56-90% (Morganstein et al 2009, Luo et al 2016, Wei et al 2016, Zhu et al 2017, Fu et al 2018) Multiphase CT 44-74% (Morganstein et al 2009, Tavcar et al 2014, Imperiale et al 2015, Téllez-Ávila et al 2015, Luo et al 2016, Moreno-Moreno et al 2016, Morera et al 2016, Prasad et al 2016, Wei et al 2016, Zhu et al 2017, Fu et al 2018, Nakuz et al 2018, Andreassen et al 2019) EUS 70-100% (Morganstein et al 2009, Tavcar et al 2014, Imperiale et al 2015, Téllez-Ávila et al 2015, Luo et al 2016, Moreno-Moreno et al 2016, Morera et al 2016, Prasad et al 2016, Wei et al 2016, Zhu et al 2017, Fu et al 2018, Nakuz et al 2018, Andreassen et al 2019) ASVS 65-100% (Morganstein et al 2009, Tavcar et al 2014, Imperiale et al 2015, Téllez-Ávila et al 2015, Luo et al 2016, Moreno-Moreno et al 2016, Morera et al 2016, Prasad et al 2016, Wei et al 2016, Zhu et al 2017…”

Section: Sensitivity References Amentioning

confidence: 99%

Innovative imaging of insulinoma: the end of sampling? A review

Christ

Antwi

Fani

et al. 2020

Endocrine-Related Cancer

View full text Add to dashboard Cite

Receptors for the incretin glucagon-like peptide-1 (GLP-1R) have been found overexpressed in selected types of human tumors and may, therefore, play an increasingly important role in endocrine gastrointestinal tumor management. In particular, virtually all benign insulinomas express GLP-1R in high density. Targeting GLP-1R with indium-111, technetium-99m or gallium-68-labeled exendin-4 offers a new approach that permits the successful localization of small benign insulinomas. It is likely that this new non-invasive technique has the potential to replace the invasive localization of insulinomas by selective arterial stimulation and venous sampling. In contrast to benign insulinomas, malignant insulin-secreting neuroendocrine tumors express GLP-1R in only one-third of the cases, while they more often express the somatostatin subtype 2 receptors. Importantly, one of the two receptors appears to be always overexpressed. In special cases of endogenous hyperinsulinemic hypoglycemia (EHH), that is, in the context of MEN-1 or adult nesidioblastosis GLP-1R imaging is useful whereas in postprandial hypoglycemia in the context of bariatric surgery, GLP-1R imaging is probably not helpful. This review focuses on the potential use of GLP-1R imaging in the differential diagnosis of EHH.

show abstract

“…A large prospective observational study or RCT comparing different surgical strategies could overcome this issue, but would be unrealistic owing to the rarity of the disease. Furthermore, identification of insulinoma on pathology is challenging because NF‐pNETs might also express insulin and some insulinomas might not express insulin, as also observed here. Future use of enhancer signatures might differentiate more accurately between pNET subtypes in MEN1.…”

Section: Discussionmentioning

confidence: 67%

Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort

Beek¹,

Nell²,

Verkooijen

et al. 2020

British Journal of Surgery

View full text Add to dashboard Cite

Background Insulinomas are found in 10–15 per cent of patients with multiple endocrine neoplasia type 1 (MEN1) and lead to life‐threatening hypoglycaemia. Surgical outcome and the optimal surgical strategy for MEN1‐related insulinoma are unknown. Methods Patients with MEN1‐related insulinomas were identified in 46 centres in Europe and North America between 1990 and 2016. Insulinomas were considered localized if the lesion was in the pancreatic head or body/tail. Patients with pancreatic neuroendocrine tumours throughout the pancreas were suspected of having multifocal insulinoma. The primary outcome was postoperative hypoglycaemia, defined as persistent hypoglycaemia, or recurrent hypoglycaemia caused by a new insulinoma or insulin‐producing liver metastases. Hypoglycaemia‐free survival was estimated by the Kaplan–Meier method. Results Ninety‐six patients underwent resection for MEN1‐related insulinoma. Sixty‐three and 33 patients had localized and multifocal insulinomas respectively. After a median follow‐up of 8 (range 1–22) years, one patient (1 per cent) had persistent disease and six (6 per cent) had developed recurrent disease, of whom four had a new insulinoma. The 10‐year hypoglycaemia‐free survival rate was 91 (95 per cent c.i. 80 to 96) per cent. Of those with localized disease, 46 patients underwent pancreatic resection and 17 enucleation. One of these patients had persistent disease and one developed recurrent insulinoma. Among patients with multifocal disease, three developed new insulinomas and two developed insulin‐producing liver metastases. Conclusion Surgery for MEN1‐related insulinoma is more successful than previously thought.

show abstract

Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma

Cited by 33 publications

References 27 publications

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Clinico–pathological features, treatments and survival of malignant insulinomas: a multicenter study

Innovative imaging of insulinoma: the end of sampling? A review

Surgery for multiple endocrine neoplasia type 1-related insulinoma: long-term outcomes in a large international cohort

Contact Info

Product

Resources

About