Laparoscopic approach for solitary insulinoma: a multicentre study

Background Surgical resection of insulinomas is the preferred treatment in order to avoid symptoms of hypoglycaemia. During the past years, advances in laparoscopic techniques have allowed surgeons to approach the pancreas and treat these lesions laparoscopically. We analysed the feasibility, safety, and outcome of patients undergoing laparoscopic resection of insulinomas in a large, retrospective, multicentre study.Methods Thirty-six patients with pancreatic insulinomas were enrolled in this study. All patients were suspected of having solitary insulinomas after preoperative localisation tests and underwent a laparoscopic approach. Patients, operating characteristics and outcome were analysed.Results Mean patient age was 48 years (range 20–77 years). Insulinomas were localised in the head (n=7), isthmus (n=2), body (n=14) or tail (n=13) of the pancreas before laparoscopic approach. Mean size of the lesions was 15.5 mm (range 4–25 mm). The surgical procedure was enucleation in 19 cases (52%), spleen-preserving distal pancreatectomy in 12 cases (33%), spleno-pancreatectomy in three cases (8%), one duodenopancreatectomy and one central pancreatectomy. Conversion rate was 30%. The reason for conversion in seven patients (63%) was the inability to localise the tumour during the laparoscopic procedure. In six of these cases laparoscopic ultrasonography was not performed. Mean operating time was 156 min (range 50–420 min). Postoperative course was uneventful in 23 patients (64%). Eleven patients (30%) developed specific complications of pancreatic surgery: intra-abdominal abscess (n=6) or pancreatico-cutaneous fistula (n=5). Mean duration of fistulae was 55 days (range 5–130 days) and all the fistulae were dry at follow-up. After a mean follow-up period of 26 months (range 2–87 months), 33 patients (91%) are free of symptoms, and three patients have been lost to follow-up.Conclusion The laparoscopic approach is safe to treat preoperatively localised insulinoma, with a morbidity rate comparable to that for the open approach. When the tumour is not found during laparoscopy, laparoscopic ultrasonography seems to be the most efficient tool to localise it and probably to prevent conversion.     

抑脂技术和动态增强MRI在胰岛素瘤诊断中的价值探讨

目的 探讨抑脂技术和动态增强MRI在胰岛素瘤术前定位诊断中的价值。方法 12例手术病理证实的胰岛素瘤患者术前行MR检查，扫描序列包括：横断面SE T1WI，快速自旋回波(FSE)T2WI，加脂肪抑制技术的T1WI和T2WI(即T1WI FS和T2WI FS)，快速多层面扰相梯度回波(FMPSPGR)序列作动态增强扫描。结果 在常规T1WI和T2WI序列仅检出4例肿瘤，表现为T1WI稍低信号和T2WI稍高信号。在T1WI FS上7例呈均匀低信号，显示清晰；在T2WI FS上6例病灶呈不同程度的高信号。快速动态增强扫描(FMPSPGR)检出11例肿瘤，在动脉期7例肿瘤明显强化呈高信号，4例轻度强化呈稍高信号，1例无明显强化呈等信号，胰腺实质期和门脉期6例仍呈高信号，6例呈等信号。与手术后病理结果比较，动态增强MRI对胰岛素瘤术前定位诊断准确率为91．7％(11／12)。结论 动态增强MRI是胰岛素瘤术前定位诊断敏感而准确的方法。     

Pancreatic neuroendocrine tumours

Pancreatic neuroendocrine tumours (PET) are rare neoplasms of the pancreas accounting for less than 5% of all primary pancreatic malignancies. Included in this group are insulinomas, gastrinomas, glucagonoma and somatostatinomas. Collectively these neoplasms are classified as functional PETs. Where a PET is not associated with a clinical syndrome due to hormone oversecretion, it is referred to as a non-functioning PET. Non-functioning PETs are pancreatic tumours with endocrine differentiation but lack a clinical syndrome of hormone hypersecretion.     

64层容积CT对胰岛素瘤的诊断

目的:探讨64层容积CT(64-sclice volume CT,VCT)扫描对胰腺内分泌肿瘤的诊断价值.方法:回顾性收集经手术和病理证实的6例胰岛素瘤,分析VCT扫描对胰岛素瘤显示的优势.结果:①6例胰岛素瘤作了手术切除,VCT探测胰岛素瘤敏感性为100%.②肿瘤动脉期均为明显或轻度强化,静脉期和延迟期2个呈等密度,4个为稍高密度影.③VCT的后处理技术有利于胰岛素瘤的显示.结论:多层CT(Multi-Slice CT,MSCT)扫描对探测胰岛素瘤有很高的敏感性和鉴别诊断价值.     

Value of intravenous digital subtraction angiography to demonstrate hypervascular endocrine tumors: Report of two cases

We describe two cases of hypervascular, endocrine tumors demonstrated by intravenous digital subtraction angiography (IV DSA), the first an insulinoma in the head of the pancreas and the second a pheochromocytoma of the left-side adrenal gland. The limitations of IV DSA to reveal these tumors is considered as well as the possible value of the modality as a screening procedure for endocrine neoplasms.     

Treatment of malignant insulinoma with streptozotocin

Summary Two patients with malignant insulinoma and hepatic metastases were treated with streptozotocin, administered directly into the celiac artery. Decreases in tumor size were documented radiographically. One patient was in a terminal state when first treated, but the other patient was in moderately good general health and responded well. Some side-effects, including renal tubular damage, were observed but were relatively minor. Streptozotocin therapy offers some benefit in patients with malignant insulinoma.Supported by grants (AM 05020 and AM 02456) from the United States Public Health Service. A portion of this work was conducted through the Clinical Research Center of the University of Washington supported by the NIH (Grant RR-37). (Dr. Stoll is the recipient of Special Fellowship 5 F3 AM 37, 832).     

Insulinoma with Fibrillar Inclusions and Acinar Cell Elements

Islet cell tumors associated with exocrine elements are rare. An insulinoma was removed from the head of the pancreas of a 33 -year-old woman. Ultrastructural and immunohistochemical studies demonstrated that, in addition to the endocrine cells, the tumor had a small population of cells with an acinar cell morphology. Rare cells exhibiting both endocrine and exocrine features (amphicrine cells) were also identified. Another unusual finding in this case was the presence of a large number of intracytoplasmic filamentous inclusions that, even though they have been observed in other neoplasms, have not previously been reported in endocrine tumors of the pancreas. The demonstration of cells with mixed endocrine features supports the concept that both the endocrine and exocrine portions of the components of the pancreas have a common embryologic origin.     

MR imaging appearance of insulinoma in an infant

Insulinoma is a very rare pancreatic neoplasm of childhood. Early recognition of insulinoma is important to ensure proper surgical treatment and prevent serious adverse neurological consequences. We describe here a case of insulinoma in an infant who presented with seizures and abnormal behaviour. Random blood glucose was found to be abnormally low (40 mg/dl). MRI showed a well-encapsulated mass (hypointense on T1-weighted and hyperintense on T2-weighted images) at the junction of the head and body of the pancreas. The tumour was successfully enucleated. Histopathology confirmed the diagnosis of insulinoma.     

灰阶超声造影与增强CT、MRI在胰岛素瘤诊断中的对比研究

目的 探讨超声造影、增强CT和MRI对胰岛素瘤术前定位诊断的价值.方法 回顾性分析31例有明确术后病理诊断的胰岛素瘤患者的影像学资料.在术前31例患者均进行了超声造影检查,30例进行了增强CT检查,28例进行了MRI检查.结合手术病理结果,比较分析以上3种影像学方法对胰岛素瘤术前诊断的价值.结果 超声造影、增强CT及MRI对胰岛素的检出率分别为96.8%、63.3%、96.2%,超声造影高于增强CT(P=0.0018),与MRI结果一致(P=0.1828).结论 超声造影诊断胰岛素瘤的准确率较高,在胰岛素瘤的术前诊断中具有较大潜力.