Abstract
Objective To investigate the clinical characteristics, biochemical parameters, radiographic features and prognosis of malignant insulinomawith liver metastasis. Methods We retrospectively analyzed the clinical data of 4 cases of malignant insulinomaswith liver metastasis recruited in Peking Union Medical College Hospital from December 2016 to December 2018. Related literature were reviewed in this article. Results All the 4 cases manifested as Whipple triad with hypoglycemic symptoms gradually aggravated. They all met the criteria for the typical hyperinsulinemic hypoglycemia. Three patients had liver metastasis at the time of diagnosis. Qualitative diagnosis indicated that the ratio of fasting proinsulin to insulin was increased. All 4 patients undertook various radiographic examination. The sensitivity of pancreatic enhanced magnetic resonance imaging (MRI) was the highest in diagnosing primary pancreatic tumor and liver metastases (4/4). Abdominal ultrasound was not sensitive to primary pancreatic tumor (1/4), but sensitive to liver metastases (3/4). All 4 patients underwent insulinoma resection, of which 3 received hepatic metastases resection. Postoperative pathology finding was consistent with liver metastasis of neuroendocrine tumors. Ki-67 index was 1%-15%. Tumor grade was G1 in 2 patients, and G2 in the other 2 patients. Taken together the findings in the literature, it suggested that the increase of proinsulin/insulin ratio is of great significance in the diagnosis of malignant insulinoma. In the treatment of malignant insulinoma with hepatic metastasis, surgical resection of primary tumor and hepatic metastases yielded relative optimal prognosis. Conclusion The increase of proinsulin/insulin ratio is of great clinical significance in the diagnosis of malignant insulinoma. Enhanced pancreatic MRI is the most sensitive for both primary tumor and liver metastases. Surgical removal of primary and metastatic lesions is the most effective treatment to improve prognosis of malignant insulinoma with liver metastasis. Key words: Malignant insulinoma; Liver metastasis; Proinsulin/insulin ratio
Published Version
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call