Insulinoma of the pancreas

Insulinoma in Iran: a 20-year review

BACKGROUND

The time between onset of symptoms of insulinoma to diagnosis ranges from 10 days to more than 20 years. To help physicians make an earlier diagnosis, we defined the clinical, imaging and paraclinical characteristics of insulinoma in cases from seven referral hospitals in Iran over two decades.

METHODS

The medical records of 68 cases with biochemical or histological evidences of insulinoma were reviewed.

RESULTS

More males were affected (53%). The mean age at diagnosis was 39 +/- 15.3 years. The mean duration of symptoms was 39.9 +/- 59.3 months. Eighty-four percent of patients had been initially misdiagnosed as cereberovascular accident (CVA), epilepsy, conversion disorder, and others). Neuroadrenergic symptoms were observed in 89.6% and and neuroglycopenic symptoms in 97% of patients. Mean diameter of tumours was 2.9 cm (range, 1 cm to 8.5 cm). Of 52 pathologically confirmed cases of insulinoma, 43 tumours (87.8%) were single and 49 (94.2%) were benign. Fifty-five patients had undergone surgery, with a successful outcome in 44 (80%).

CONCLUSION

The high incidence of neuroglycopenic symptoms suggest the clinical impression of insulinoma when patients present with a suggestive clinical syndrome. The clinical impression is essential to decrease the frequent delay in the diagnosis of insulinoma.

Magnetic resonance cholangiopancreatography for postoperative follow-up of intraductal papillary-mucinous tumors of the pancreas

BACKGROUND

After resection of an intraductal papillary-mucinous tumor (IPMT), benign tumors or portions of the resected tumor are sometimes left in place to avoid total pancreatectomy. We evaluated the role of magnetic resonance cholangiopancreatography (MRCP) in postoperative follow-up.

METHODS

Twenty-two patients underwent MRCP 0.5 to 6.5 years after pancreatic resection for IPMT.

RESULTS

Two patients with surgical margin involvement of the main pancreatic duct showed mildly enhanced ductal dilatation due to anastomotic stenosis. In 4 patients with residual IPMT of the branch ducts, postoperative MRCP demonstrated no changes. MRCP revealed new IPMT 1 year after surgery in 1 patient. No patients showed intraductal or intracystic mural nodules postoperatively. In 3 patients with postoperative pancreatitis or recurrent abdominal discomfort, MRCP demonstrated ductal dilatation and poor secretin-stimulated pancreatic secretion into the gastrointestinal tract, which suggested pancreatoenterostomic stenosis.

CONCLUSIONS

MRCP is useful for postoperative follow-up of IPMT, in terms of investigating residual or recurrent IPMT and evaluating postpancreatectomy long-term complications.