Diagnostic and treatment difficulties in insulinomas
Authors: Mariana Jinga, Irina I. Sima, Emilia Rusu, Aurelian E. Ranetti, Florentina Ionita Radu, Sandica Bucurica, Raluca S. Costache, Mihaita Patrasescu, Bogdan Macadon, Petrut Nuta, Vasile D. Balaban
Number of views: 209
Background: Neuroendocrine tumors of the pancreas (NTP) comprise a unique and
relatively rare group of tumors, of which gastrinoma and insulinoma are the most common types.
Insulinomas tend to be small, solitary and benign, with surgical resection curable in most cases.
Introduction: Insulinomas are localized preoperatively using conventional imaging studies as
transabdominal ultrasonography (US), computed tomography (CT), and/or magnetic resonance
Purpose: Endoscopic ultrasound (EUS) is a valuable tool in the diagnosis of insulinomas.
Goals & methods: We performed a retrospective study on 21 patients with insulinoma (6 male and
15 female, 25 to 73 years of age), who were hospitalized and operated on between 2003 and 2012
at “Dr. Carol Davila” Central Military Emergency University Hospital, Bucharest.
Results: US view was positive in 10% of patients (2 of 20), that presented proximal location. The
sensitivity of CT was unsatisfactory, 21.05% (4 positive results of 19). CT failed to detect liver
metastases, but identified nodal metastasis in one patient. MRI was performed in 18 patients and
was diagnostic in 11 of them, recording a detection sensitivity of 61.11%, including infracentimetric
tumor size. EUS has a high resolution which allows detection of lesions with very small
diameter is safe and minimally invasive. EUS was performed in all patients, being able to identify
formations in 17, was inconclusive in 3, showing a diagnosis sensitivity of 81%. Liver metastases
were demonstrated in 3 patients, one by US and all 3 by MRI.
- CT with intravenous iodinated contrast agent had a poor sensitivity in detecting the primary
tumors, was insensitive in detecting liver metastases, but showed metastases in lymph nodes.
- MRI has higher sensitivity than CT in detecting primary tumors, including insulinomas with
infracentimetric size, and is the imaging test of choice for possible liver metastases.
- EUS is the preoperative imaging test of choice