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Surgical Management, Preoperative Tumor Localization, and Histopathology of 80 Patients Operated on for Insulinoma

2019; Oxford University Press; Volume: 104; Issue: 12 Linguagem: Inglês

10.1210/jc.2019-01204

1945-7197

Mikkel Andreassen, Emma Elizabeth Ilett, Dominik Wiese, Emily P. Slater, Marianne Klose, Carsten Palnæs Hansen, Norman Gercke, Seppo W. Langer, Andreas Kjær, Elisabeth Maurer, Birgitte Federspiel, Peter Herbert Kann, Detlef K. Bartsch, Ulrich Knigge,

Neuroblastoma Research and Treatments

Abstract Introduction Diagnosis and pathological classification of insulinomas are challenging. Aim To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma. Methods Patients with surgically resected sporadic insulinoma were included. Results Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n = 33; sensitivity, 58%), CT (n = 55; sensitivity, 47%), transabdominal ultrasonography (US; n = 45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a. Conclusion Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.