Diffuse nesidioblastosis diagnosed on a Ga-68 DOTATATE positron emission tomography/computerized tomography

Arun, Sasikumar; Mittal, Bhagwant Rai; Shukla, Jaya; Bhattacharya, Anish; Kumar, Praveen

doi:10.4103/0972-3919.119547

Cited by 3 publications

(1 citation statement)

References 9 publications

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“…The somatostatin receptor scintigraphy has a sensitivity of 60% for the detection of insulinoma since approximately only two thirds of them express this receptors, however the expression of the GLP-1 receptors in these tumors exceeds 70%, especially in those with benign behavior, therefore the scintigraphy of GLP-1 receptors allows a more precise localization of small lesions with greater sensitivity and specificity and could discriminate tumor behavior, since these receptors are only expressed in 36% of malignant insulinomas [20] . Another useful imaging study for the differentiation between a focal and a diffuse pattern is PET-CT with dihydroxyphenylalanine (18F-DOPA), in which 96% of diagnostic accuracy is reported in the differentiation between both and 100% for the focal location [21] . The NCCN recommends the 68Galium-dotatate PET/CT to locate the insulinoma.…”

Section: Discussionmentioning

confidence: 99%

A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

2020

IJCR

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Introduction: Nesidioblastosis is a hyperplasia of the beta cells that causes persistent hyperinsulinemic hypoglycemia, unfortunately, it is difficult to diagnose through imaging studies. Case presentation: A 68-year-old woman with palpitations, diaphoresis, dizziness and alterations in the level of consciousness that improve with food intake. Laboratories: glucose 35.0 mg/dl, insulin 12.5 mUI/ml, proinsulin 14.1 pmol/L and peptide C 2.55 ng/ml. Octreoscan reveals an abnormal epigastric uptake area and the tomography shows a focal hypervascular lesion in pancreatic body of 12×11 mm. A distal pancreatectomy was performed without palpating the tumor in transoperative period, and a diffuse nesiodioblastosis was reported in the histopathological study. The patient persists with hypoglycemia and an additional pancreatic resection was performed, resecting 90% of the organ. Although an insulinoma was not located in the piece, an area surrounded by connective tissue was observed where islet hyperplasia was more accentuated. Discussion: The pathophysiology of nesidioblastosis is unknown, its main differential diagnosis is insulinoma and this should be suspected when the tumor can not be identified. Most agree that a pancreatectomy that involves 60-80% of the total organ can control glucose levels with low risk of diabetes and pancreatic insufficiency. Conclusion: The nesidioblastosis should be suspected when a hyperinsulinemic hypoglycemia is difficult to control and when a tumor can not be identified. The extension of the pancreatectomy should be individualized and if an insulinoma is not localized and a nesidioblastosis is suspected, an intraoperative histopathological examination with frozen section evaluation for the margins could determine the extent of pancreatectomy.

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Section: Discussionmentioning

confidence: 99%

A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

2020

IJCR

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Laparoscopic near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia in infants and children

et al. 2021

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Striking Visualization of Diffuse Congenital Nesidioblastosis on Ga-68 DOTATATE PET/CT

Canbaz

Aydın

Meydan

et al. 2019

Mirt

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Nesidioblastosis", later renamed as "persistent hyperinsulinemic hypoglycemia of infancy" presents as either focal or diffuse neo-differentiation of pancreatic Langerhans islet cells from the ductal epithelium. Differentiation of focal disease from diffuse involvement is crucial for optimal disease management. The current methods used to differentiate the two forms pre-operatively are invasive techniques. The definite role of imaging modalities to differentiate diffuse versus focal form has not yet been proven. Herein, we report a 15 day-old infant having diffuse nesidioblastosis, successfully demonstrated by Ga-68 DOTATATE positron emission tomography/computed tomography imaging that was histopathologically confirmed.

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Diffuse nesidioblastosis diagnosed on a Ga-68 DOTATATE positron emission tomography/computerized tomography

Cited by 3 publications

References 9 publications

A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

Laparoscopic near-total pancreatectomy for persistent hyperinsulinemic hypoglycemia in infants and children

Striking Visualization of Diffuse Congenital Nesidioblastosis on Ga-68 DOTATATE PET/CT

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