Malignant insulinoma

Abstract

BACKGROUNDMalignant insulinoma occurs in a few patients with insulinoma. Due to the small sample of patients, there are little data regarding their clinical manifestation as well as the preferred treatment modalities. The aims of the current study were to summarize the National Institutes of Health experience during the last two decades and to conduct a critical review of the current literature.METHODSThe authors identified 10 patients with metastatic insulinoma.RESULTSThe patients presented with four patterns of clinical behavior. First, four patients presented with lymph node metastasis and, after surgical excision, maintained a prolonged tumor‐free survival. Second, four patients presented with metastatic disease to the liver, which appeared years after the initial diagnosis and presumed curative surgery. Third, one patient presented with a large α‐fetoprotein‐secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival. Various treatment modalities were used to control hypoglycemia. Short‐term benefits were most often achieved with embolization and diazoxide. Less successful modalities included radiofrequency ablation, radical debulking surgery, verapamil therapy, octreotide therapy, and chemotherapy.CONCLUSIONSThe current study, as well as others, suggested that metastatic insulinoma may have a variable natural history. After the initial surgical resection, the biology of the tumor, rather than any treatment modality, was most likely the major determinant of long‐term survival. Cancer 2005. © Published 2005 American Cancer Society.

Insulinoma in childhood: clinical, radiological, molecular and histological aspects of nine patients

“…This observation is in contrast to the better response to diazoxide in adults, before surgery (7,8,9).…”

Strategy for the Surgical Management of Insulinomas: Analysis of 52 Cases

“…Patients with a malignant insulinoma should undergo formal pancreatic resection. An aggressive approach is recommended in the presence of metastatic disease; if appropriate, surgery should be combined with lymph node dissection and/or hepatic tumor reduction [7, 8, 37]. Of our 4 patients, 3 are alive, and 1 survived for more than 3 years.…”

“…Danforth et al [38] demonstrated a median disease-free survival after curative resection of 5 years, with a recurrence rate of 63%. After initial surgical resection, the biology of the tumor, rather than any treatment modality, was most likely the major determinant of the long-term survival [8]. …”

“…Surgical procedures include tumor enucleation, partial or total pancreatic resection, and pancreatoduodenectomy (Whipple’s operation). If malignancy is suspected, metastatic tumor resection and/or lymph node dissection is mandatory [8, 9]. In recent years, laparoscopic resection of pancreatic insulinomas has been performed successfully and provides patients with the benefits of minimally invasive surgery [10,11,12].…”

Surgical treatment of pancreatic endocrine tumours in Italy: results of a prospective multicentre study of 262 cases

“…Present knowledge regarding PET treatment comes, for the most part, from small, retrospective, uncontrolled studies. Moreover, many reports involve highly selected patients (surgical series of resected patients [6,7], oncological series of mainly metastatic patients [8,9] and series focused on benign functioning neoplasms [10,11]), thus making it difficult to understand the relative frequency of different treatments and to compare their results.…”