Occult Sporadic Insulinoma: Localization and Surgical Strategy

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2008 Jan 22

PMID 18205253

Citations 30

Authors

Bassam Abboud

Joe Boujaoude

Affiliations

Soon will be listed here.

Abstract

Insulinomas continue to pose a diagnostic challenge to physicians, surgeons and radiologists alike. Most are intrapancreatic, benign and solitary. Biochemical diagnosis is obtained and imaging techniques to localize lesions continue to evolve. Surgical resection is the treatment of choice. Despite all efforts, an occult insulinoma (occult insulinoma refers to a biochemically proven tumor with indeterminate anatomical site before operation) may still be encountered. New localization preoperative techniques decreases occult cases and the knowledge of the site of the mass before surgery allows to determine whether enucleation of the tumor or pancreatic resection is likely to be required and whether the tumor is amenable to removal via a laparoscopic approach. In absence of preoperative localization and intraoperative detection of an insulinoma, blind pancreatic resection is not recommended.

Citing Articles

A Long Way to Find a Small Tumor: The Hunt for an Insulinoma.

Arjunan D, Grossman A, Singh H, Rai R, Bal A, Dutta P JCEM Case Rep. 2024; 2(11):luae192.

PMID: 39465233 PMC: 11505447. DOI: 10.1210/jcemcr/luae192.

Mechanism and recent updates on insulin-related disorders.

Kumar S, Senapati S, Bhattacharya N, Bhattacharya A, Maurya S, Husain H World J Clin Cases. 2023; 11(25):5840-5856.

PMID: 37727490 PMC: 10506040. DOI: 10.12998/wjcc.v11.i25.5840.

Insulinoma with peripheral neuropathy: a case report.

Vinhosa Bastos Jr M, da Silva Caires I, Boschi Portella R, Nascimento Martins R, Reverdito R, Reverdito S J Med Case Rep. 2023; 17(1):241.

PMID: 37308982 PMC: 10262407. DOI: 10.1186/s13256-023-03963-5.

The incidence of insulinoma in Western Sweden between 2002 and 2019.

Svensson E, Muth A, Hedenstrom P, Ragnarsson O Ann Gastroenterol. 2022; 35(4):434-440.

PMID: 35784630 PMC: 9210785. DOI: 10.20524/aog.2022.0707.

Insulinoma-Accurate Preoperative Localization Is the Key to Management: An Initial Experience.

Sharma A, Varshney P, Kasliwal R, Nagar A, Venkatatelikicherla K, Sarin S Indian J Surg Oncol. 2022; 13(2):403-411.

PMID: 35782810 PMC: 9240150. DOI: 10.1007/s13193-022-01534-6.

References

Gutelius B, Korytkowski M, Carty S, Hamad G . Diagnosis and minimally invasive resection of an insulinoma: report of an unusual case and review of the literature. Am Surg. 2007; 73(5):520-4. View

Goletti O, Celona G, Monzani F, Caraccio N, Zocco G, Lippolis P . Laparoscopic treatment of pancreatic insulinoma. Surg Endosc. 2003; 17(9):1499. DOI: 10.1007/s00464-002-4273-7. View

Bernard B, Capello A, van Hagen M, Breeman W, Srinivasan A, Schmidt M . Radiolabeled RGD-DTPA-Tyr3-octreotate for receptor-targeted radionuclide therapy. Cancer Biother Radiopharm. 2004; 19(2):173-80. DOI: 10.1089/108497804323071940. View

McAuley G, Delaney H, Colville J, Lyburn I, Worsley D, Govender P . Multimodality preoperative imaging of pancreatic insulinomas. Clin Radiol. 2005; 60(10):1039-50. DOI: 10.1016/j.crad.2005.06.005. View

Norton J . Intraoperative methods to stage and localize pancreatic and duodenal tumors. Ann Oncol. 1999; 10 Suppl 4:182-4. View

Doppman J, Chang R, Fraker D, Norton J, Alexander H, Miller D . Localization of insulinomas to regions of the pancreas by intra-arterial stimulation with calcium. Ann Intern Med. 1995; 123(4):269-73. DOI: 10.7326/0003-4819-123-4-199508150-00004. View

Warner R, ODorisio T . Radiolabeled peptides in diagnosis and tumor imaging: clinical overview. Semin Nucl Med. 2002; 32(2):79-83. DOI: 10.1053/snuc.2002.31020. View

Aoki T, Sakon M, Ohzato H, Kishimoto S, Oshima S, Yamada T . Evaluation of preoperative and intraoperative arterial stimulation and venous sampling for diagnosis and surgical resection of insulinoma. Surgery. 1999; 126(5):968-73. DOI: 10.1016/s0039-6060(99)70040-1. View

Kwekkeboom D, Teunissen J, Bakker W, Kooij P, de Herder W, Feelders R . Radiolabeled somatostatin analog [177Lu-DOTA0,Tyr3]octreotate in patients with endocrine gastroenteropancreatic tumors. J Clin Oncol. 2005; 23(12):2754-62. DOI: 10.1200/JCO.2005.08.066. View

10.

Tseng L, Chen J, Won J, Tseng H, Yang A, Wang S . The role of intra-arterial calcium stimulation test with hepatic venous sampling (IACS) in the management of occult insulinomas. Ann Surg Oncol. 2007; 14(7):2121-7. DOI: 10.1245/s10434-007-9398-4. View

11.

Gines A, Vazquez-Sequeiros E, Soria M, Clain J, Wiersema M . Usefulness of EUS-guided fine needle aspiration (EUS-FNA) in the diagnosis of functioning neuroendocrine tumors. Gastrointest Endosc. 2002; 56(2):291-6. DOI: 10.1016/s0016-5107(02)70196-x. View

12.

Toniato A, Meduri F, Foletto M, Avogaro A, Pelizzo M . Laparoscopic treatment of benign insulinomas localized in the body and tail of the pancreas: a single-center experience. World J Surg. 2006; 30(10):1916-9. DOI: 10.1007/s00268-005-0645-1. View

13.

Ramage J, Davies A, Ardill J, Bax N, Caplin M, Grossman A . Guidelines for the management of gastroenteropancreatic neuroendocrine (including carcinoid) tumours. Gut. 2005; 54 Suppl 4:iv1-16. PMC: 1867801. DOI: 10.1136/gut.2004.053314. View

14.

Virgolini I, Traub-Weidinger T, Decristoforo C . Nuclear medicine in the detection and management of pancreatic islet-cell tumours. Best Pract Res Clin Endocrinol Metab. 2005; 19(2):213-27. DOI: 10.1016/j.beem.2004.09.001. View

15.

McLean A, Fairclough P . Endoscopic ultrasound in the localisation of pancreatic islet cell tumours. Best Pract Res Clin Endocrinol Metab. 2005; 19(2):177-93. DOI: 10.1016/j.beem.2004.11.012. View

16.

Marks V, Teale J . Hypoglycemic disorders. Clin Lab Med. 2001; 21(1):79-97. View

17.

Jyotsna V, Rangel N, Pal S, Seith A, Sahni P, Ammini A . Insulinoma: Diagnosis and surgical treatment. Retrospective analysis of 31 cases. Indian J Gastroenterol. 2006; 25(5):244-7. View

18.

DELCORE R, FRIESEN S . Gastrointestinal neuroendocrine tumors. J Am Coll Surg. 1994; 178(2):187-211. View

19.

Brandle M, Pfammatter T, Spinas G, Lehmann R, Schmid C . Assessment of selective arterial calcium stimulation and hepatic venous sampling to localize insulin-secreting tumours. Clin Endocrinol (Oxf). 2001; 55(3):357-62. DOI: 10.1046/j.1365-2265.2001.01335.x. View

20.

Jaroszewski D, Schlinkert R, Thompson G, Schlinkert D . Laparoscopic localization and resection of insulinomas. Arch Surg. 2004; 139(3):270-4. DOI: 10.1001/archsurg.139.3.270. View