Pitfalls in diagnosing a small cystic insulinoma: a case report

Šumarac-Dumanović, Mirjana; Mićić, Dragan; Krstić, Miodrag; Georgiev, Maja; Diklić, Aleksandar; Tatic, Svetislav; Stamenkovic-Pejkovic, Danica; Kendereški, Aleksandra; Cvijović, Goran; Pavlović, Aleksandra

doi:10.1186/1752-1947-1-181

Cited by 3 publications

(1 citation statement)

References 14 publications

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“…Typically, CPETs are often non-functioning and more likely to be associated with multiple endocrine neoplasia type 1 (MEN-1) [4,5,6,7,8,9,10]. Nevertheless, some insulinomas, gastrinomas and glucagonomas with cystic morphology have been described [11,12,13,14]. Diagnosis of CPETs still remains challenging because of the difficulty in distinguishing them from other cystic neoplasms such as serous or mucinous cystadenomas and intraductal papillary mucinous tumors [15,16].…”

Section: Introductionmentioning

confidence: 99%

Pancreatic Cystic Endocrine Tumors: A Different Morphological Entity Associated with a Less Aggressive Behavior

Boninsegna¹,

Partelli²,

D'Innocenzio³

et al. 2010

Neuroendocrinology

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Background: Cystic pancreatic endocrine tumors (CPETs) are rare lesions and their biological features have been scarcely investigated. Aim: To compare clinical and pathological features of resected non-functioning sporadic CPETs (NF-CPETs) with solid pancreatic endocrine tumors (SPETs) in a single-institution experience. Methods: All patients with a pathologically confirmed diagnosis of sporadic non-functioning pancreatic endocrine tumors who underwent curative resection between 1990 and 2008 were included. A comparison of demographic, clinical and pathological characteristics between CPETs and SPETs was made. Univariate and multivariable analyses were performed to identify preoperative predictors of carcinoma (non-functioning pancreatic endocrine carcinoma). Results: Twenty-one (11.5%) patients with a histological diagnosis of NF-CPET were identified. The median age was 60 years (IQR 46.5–73.5 years) and a diagnosis of carcinoma (non-functioning pancreatic endocrine carcinoma) was made in 3 (14.3%) cases. In the comparison with NF-SPETs, no differences were found in terms of gender (p = 0.75), age (p = 0.81), presenting symptoms (p = 0.43), localization of the tumors (p = 0.46) and type of resection (p = 0.31). The incidence of non-functioning pancreatic endocrine carcinoma was significantly lower in the NF-CPET versus the NF-SPET group (14.3 vs. 40.4%, p = 0.04). By univariate analysis, preoperative predictors of non-functioning pancreatic endocrine carcinoma included the presence of symptoms (OR 3.96, 95% CI 2.06–7.63) and an increase in the absolute value of radiological diameter (OR 1.05, 95% CI 1.03–1.07). A cystic morphology of the lesion turned out to be a negative predictor of carcinoma (OR 0.25, 95% CI 0.70–0.87). These results were confirmed by multivariable analysis. Conclusions: NF-CPETs have a measurable propensity to be benign. In those patients affected by small and asymptomatic NF-CPET a more conservative surgical approach or a follow-up policy could be considered.

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Section: Introductionmentioning

confidence: 99%

Pancreatic Cystic Endocrine Tumors: A Different Morphological Entity Associated with a Less Aggressive Behavior

Boninsegna¹,

Partelli²,

D'Innocenzio³

et al. 2010

Neuroendocrinology

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Successful Localization and Resection of Small Pancreatic Cystic Insulinoma Using Intraoperative Near-Infrared Fluorescence Imaging

Kou

Chong

et al. 2020

Pancreas

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Pancreatic cystic insulinoma is an uncommon tumor. Perioperative localization remained challenging if the tumor is atypical with cystic feature or in small size. Near-infrared (NIR) imaging is a technique by injecting fluorescent dye intravenously, which accumulates to the target lesion and creating signal by laser sources. The signal helps surgeons to identify the lesion during operation, but little experience has been reported regarding the use of imaging NIR technique for localizing cystic insulinoma. We present a 29-year-old female patient with a symptomatic pancreatic cystic insulinoma (1.2 cm) as assessed by clinical symptom, laboratory evidence, and magnetic resonance cholangiopancreatography. With an aid of NIR imaging technique, this cystic tumor was localized easily at operation. Also, the fluorescence imaging visualized the tumor part, guided us to identify the safe margin, and preserved the normal pancreatic structure. Pathologic report confirmed that the tumor was a well-differentiated cystic insulinoma. This case demonstrates that pancreatic cystic insulinoma in small size can be intraoperatively localized by NIR imaging, a relatively safe and easy technique.

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Cystic pancreatic neuroendocrine tumors (cPNETs): a systematic review and meta-analysis of case series

Hurtado-Pardo¹,

Cienfuegos²,

Ruiz‐Canela³

et al. 2017

Rev Esp Enferm Dig

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Cystic pancreatic neuroendocrine tumors represent 13% of all neuroendocrine tumors. The aim of this study is to analyze the phenotype and biologic behavior of resected cystic neuroendocrine tumors. A systematic review and meta-analysis were conducted until September 2016 using a search in Medline, Scopus, and EMBASE with the terms "cystic pancreatic endocrine neoplasm", "cystic islets tumors" and "cystic islets neoplasms". From the 795 citations recovered 80 studies reporting on 431 patients were selected. 87.1% (n = 387) were sporadic tumors and 10.3% (n = 40) corresponded to multiple endocrine neoplasia endocrine type 1. Were diagnosed incidentally 44.6% (n = 135). Cytology was found to have a sensitivity of 78.5%. Were non-functional tumors 85% (n = 338), and among the functional tumors, insulinoma was the most frequent. According to the European Neuroendocrine Tumor Society staging, 87.8% were limited to the pancreas (I-IIb), and 12.2% were advanced (III-IV). Disease-free survival at 5 years in stages (I-IIIa) and (IIIb-IV) was 91.5% and 54.2%, respectively; and was significantly lower (p = 0.0001) in functional tumors. In patients with multiple endocrine neoplasia there was a higher incidence of functional (62.5%) and multifocal (28.1%) tumors. Disease-free survival at 5 and 10 years was 60%. Cystic pancreatic neuroendocrine tumors exhibit phenotypical characteristics which are different to those of solid neuroendocrine tumors.

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Pitfalls in diagnosing a small cystic insulinoma: a case report

Cited by 3 publications

References 14 publications

Pancreatic Cystic Endocrine Tumors: A Different Morphological Entity Associated with a Less Aggressive Behavior

Pancreatic Cystic Endocrine Tumors: A Different Morphological Entity Associated with a Less Aggressive Behavior

Successful Localization and Resection of Small Pancreatic Cystic Insulinoma Using Intraoperative Near-Infrared Fluorescence Imaging

Cystic pancreatic neuroendocrine tumors (cPNETs): a systematic review and meta-analysis of case series

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