Multiple Insulinomas Research Articles

Exérèse vidéolaparoscopique des insulinomes. Étude de cinq observations *

Study aim Evaluation of the feasibility of the videolaparoscopic resection in pancreatic insulinomas, and reporting of five cases. Patients and method From 1996 to 1998, a videolaparoscopic resection was attempted in five patients with sporadic, unique and benign insulinoma. The insulinoma was recognised and localised by preoperative ultrasonography in the pancreatic head ( n = 1), body ( n = 3) or tail ( n = 1). For the videolaparoscopic procedure, three to five trocars were necessary. Cephalic and corporeal insulinomas were approached through an opening of the gastrocolic ligament and caudal insulinoma required mobilisation of the splenic flexure of the colon and dissection of the splenic pedicle. Peroperative ultrasonography was not used. Results Four resections were exclusively performed with videolaparoscopy: three enuclations and one distal pancreatectomy with splenic preservation. The cephalic insulinoma could not be found by laparoscopic exploration and required a laparotomy to be recognised and enucleated; it was located further down than expected. There were no postoperative complications in four patients. One enucleation was complicated by a pancreatic fistula that required reoperation. All the patients were cured with a 6- to 16-month follow-up. Conclusion Selected insulinomas may be operated on with videolaparoscopy. Preoperative endoscopic ultrasonography is necessary for this selection. Videolaparoscopic approach is contraindicated in multiple insulinomas, in insulinomas located on the posterior wall or deeply located in the head of the pancreas, and in malignant tumors. Videolaparoscopic resection is mainly indicated in unique and benign insulinomas, superficially located on the anterior wall of the pancreas, to be resected by enucleation or distal pancreatectomy. Disadvantage of laparoscopic approach compared to conventional approach is the absence of palpation and difficulty to explore the whole pancreas; advantage is the lack of parietal incision and the good postoperative comfort.

Long-Term Results after Surgical Treatment of Organic Hyperinsulinism

43 patients were analyzed for their long-term results after operative treatment of organic hyperinsulinism. The average postoperative observation period totalled 7 years. In the case of solitary adenomas all patients were free of hypoglycemia symptoms and 3 patients required a second operation. In contrast to this only 1 out of 5 patients with multiple insulinomas was free of hypoglycemia symptoms. 1 patient had diabetes mellitus and in the other 3 patients eight operations have been necessary up to now; nevertheless, 1 of the patients had persistent hypoglycemic symptoms. The average survival time of patients with malignant islet cell tumors was 4 years even in cases with metastasis.

Surgery for benign insulinoma: An international review

In a multiinstitutional review, data on 396 patients with benign solitary or multiple insulinomas operated on in 15 centers were collected. In these 396 patients, 419 laparotomies (375 primary procedures and 44 reoperations) were performed. The rate of unnecessary laparotomies was 1.7%. Complications occurred after 132 operations (31.5%), requiring 27 reinterventions (6.4%). Ten (2%) patients died within 30 days of surgery. The success rate of first procedures in the centers was 94.9%. After reoperation, all but 2 (99.5%) of these patients were cured. The overall cure rate including those patients who had their primary operations elsewhere was 97.5%.

画像上２つの異なった所見を呈したすい多発性ｉｎｓｕｌｉｎｏｍａの１例

Insulinomaは外科的切除が原則であるが, 多発性発生の症例もあり, 外科的切除を困難なものとしている.今回われわれは, 異なった画像所見を呈した多発性insulinomaの1例を経験したので報告する.症例は26歳女性で, Wippleの3徴にてinsulinomaと確診し, 局在部位を検索した.腹腔動脈造影では膵体部に局在が疑われた.しかし, 腹部超音波検査, 超音波内視鏡では膵頭部に局在が疑われた.このため, Ca負荷経皮経肝門脈採血法を施行し, 膵体部と膵頭部に多発性のinsulinomaが疑がわれた.膵頭部, 膵体部の多発性insulinomaの可能性を考慮し, 開腹術を施行した.腫瘍は膵頭部, 膵体部ともに認められ切除した.組織診では膵頭部, 膵体部両腫瘍ともinsulinomaであり, 膵体部のinsulinomaは血管に富んでおり, 膵頭部の腫瘍は強度の硝子様変性を認めていた.画像上の相異は, この組織像の相違によるものと考えられた.

A Case of Multiple Endocrine Neoplasia(MEN) Type 1; The Immunohistochemical and Ultrastructural Studies of Its Tumors and the Analysis of Hormones in Tumor Extracts.

We reported a case of sporadic multiple endocrine neoplasia type 1, with multiple insulinoma, parathyroid adenoma, and pituitary tumor. Measurement of hormone contents and immunohistochemical studies of the pancreatic tumors showed that the tumors contained insulin, glucagon, somatostatin, and pancreatic polypeptide. Furthermore, the concentrations of these hormones were different in each tumor. Insulin extracted from the pancreatic tumors analyzed by reversed-phase high performance liquid chromatography revealed no structural abnormalities. On the other hand, in gel filtration evaluation of the extract of the parathyroid adenoma, it was found that the tumor extract contained a macromolecular parathyroid hormone (molecular weight 20,000 to 25,000).

多発性インスリノーマと副甲状腺腺腫を呈した多発性内分泌腺腫症 (MEN) I型の1例

多発性インスリノーマと副甲状腺腺腫を呈した多発性内分泌腺腫症 (MEN) I型の1例

Benign pancreatic insulinoma: preoperative and intraoperative sonographic localization.

Twenty-nine patients with surgically proved benign pancreatic insulinoma were studied by preoperative or intraoperative sonography. Twenty-five patients had solitary pancreatic tumors; four had multiple tumors. Six of the patients with solitary insulinomas and one of the patients with multiple insulinomas had undergone previous unsuccessful exploration. Preoperative sonography was performed in 24 patients with solitary insulinomas, and 15 (63%) were localized. Intraoperative sonography was performed in 22 patients with solitary insulinomas, and 19 (86%) were visualized without having been previously located by palpation. Four of these visible solitary tumors (18%) were not detected by palpation at surgery. All the solitary insulinomas were detected with the combination of palpation and intraoperative sonography. In each of the six patients with solitary insulinoma who had undergone previous surgery, the tumor was visible with intraoperative sonography, which also demonstrated nonpalpable insulinomas in two of the four patients with multiple tumors. Preoperative real-time sonography is a sensitive, noninvasive, inexpensive method for localization of insulinoma. Intraoperative high-frequency sonography is a highly sensitive method for the detection of insulinoma. Intraoperative sonography is also valuable to determine the relationship of the insulinoma to pancreatic and bile ducts and thereby facilitate safe enucleation.

Neuroendocrine tumors of the gut.

AbstractOf 75 patients with neuroendocrine tumors of the gut, 50 had functioning lesions, causing endocrine syndromes. These included 16 insulinomas, 13 gastrinomas, 5 vipomas (4 pancreatic, 1 adrenal), 4 corticotrophinomas, and 1 renal enteroglucagonoma. Three patients had mixed endocrine syndromes. Eight or 9 patients with pancreatic lesions had multiple endocrine adenopathy (MEA I), including 3 of 4 patients with multiple insulinomas and all 3 patients with malignant gastrinomas. Localization of the pancreatic insulinomas, vipomas, and mixed tumors by arteriography was excellent, but few gastrinomas were detected before operation. Eight patients developed the malignant carcinoid syndrome with metastases from primary tumors in the ileum (6 patients), bronchus, and stomach. Hepatic artery embolization provided palliative relief for several with this and some other syndromes. Twenty‐five patients had tumors that caused nonspecific features only. These included 18 appendicular carcinoids, 5 islet cell carcinomas, and 2 other apudomas (1 hepatic and 1 whose primary site is unknown). The importance of the latter is that they are more responsive to therapy and have a better prognosis than the more common acinar tumors. Over 40% of the patients had lesions that were cured surgically and over 80% obtained some benefit from treatment.

A Case of Multiple Insulinoma Demonstrated by Percutaneous Transhepatic Catheterization and Insulin Radioimmunoassay

A Case of Multiple Insulinoma Demonstrated by Percutaneous Transhepatic Catheterization and Insulin Radioimmunoassay

Feedback-controlled dextrose infusion during surgical management of insulinomas

Through the use of a feedback-controlled dextrose infusion system, we obtained continuous monitoring of the blood glucose level in a patient undergoing surgery for multiple pancreatic beta-cell tumors. In addition, this device infused dextrose at variable rates to maintain a predetermined euglycemic level of 90 mg/dl. Before locating the source of excessive insulin production, the maximum dextrose infusion rate of 400 mg/min was required; but after extirpation of multiple insulinomas, the dextrose-infusion rate declined whereas the blood glucose level rose above the preselected level These results emphasize the usefulness of a monitoring and infusion system not only in protecting the patient from the hazard of hypoglycemia under anesthesia but also as an aid in determining whether all insulin-secreting tumors have been removed.