Menéndez-Skertchly AL, Ortiz-Hidalgo C, Quijano-Orvañanos F, Cervantes-Monteil F, Chousleb-Kalach A, Padilla-Longoria R, Godoy-Valdés S, Vidal-González P, Herrera MF

Language: Spanish
References: 37
Page: 296-301
PDF size: 110.35 Kb.

ABSTRACT

Objectives: To analyze presentation, diagnosis and treatment of islet cell tumors at the ABC Medical Center. Materials and methods: Medical records of the 7 patients with endocrine tumors diagnosed between 1995 and 2005 were reviewed and analyzed, with emphasis to clinical, biochemical and radiological characteristics, surgical treatment and outcome. Results: There were 3 insulinomas, 1 gastrinoma, 1 VIPoma, and 2 non-functioning tumors. All insulinomas presented the Whipple’s triad. The tumor was localized before surgery in 2 cases. In all patients intraoperative ultrasound confirmed the tumor and enucleation was performed in all three. The patient with gastrinoma was diagnosed by endoscopy in the presence of metastatic disease, therefore no surgical treatment was performed. The patient with VIPoma, presented the typical secretory diarrhea. A tumor in the pancreatic head was found and it was resected by pancreaticoduodenectomy. Histology revealed a malignant lesion. Both non functioning tumors were found by imaging studies, one benign tumor was treated by central pancreatectomy and the other was malignant and underwent distal en-block pancreatectomy. Immunohistochemistry was positive for VIP in the benign lesion. Two of the 3 malignant tumors have died and one is alive with recurrent disease. Conclusions: Distribution of islet cell tumors in our series followed the usual patterns. In all functioning lesions hormonal production was identified before surgery. Imaging studies localized the tumor in 7 of the 8 patients. Surgical resection cured all benign tumors.

REFERENCES

1. Lozano-Salazar R, Herrera MF, Hernández-Ortíz J, Campuzano M. Tumores endocrinos del páncreas. Rev Gastroenterol Mex 1997; 62: 212-7.

2. Canto JA, Herrera MF, Gamboa A y cols. Los tumores endocrinos del páncreas en una institución mexicana. Rev Invest Clin 1997; 49: 25-30.

3. Mullan MH, Gauger PG, Thompson NW. Endocrine tumours of the pancreas: review and recent advances. ANZ J Surg 2001; 71: 475-82.

4. Bieligk S, Jaffe BM. Islet cell tumors of the pancreas. Surg Clin North Am 1995; 75: 1025-40.

5. Burgos L, Burgos ME. Tumores endocrinos del páncreas. Rev Med Chile 2004; 132: 627-34.

6. Chun J, Doherty GM. Pancreatic endocrine tumors. Curr Opin Oncol 2001; 13: 52-6.

7. Doi R, Komoto I, Nakamura Y, et al. Pancreatic endocrine tumor in Japan. Pancreas 2004; 28: 247-52.

8. Howard TJ, Stabile BE, Zinner MJ, et al. Anatomic distribution of pancreatic endocrine tumors. Am J Surg 1990; 159: 258-64.

9. Lozano SRR, Herrera MF. Insulinoma. En: Campuzano M, Herrera MF, Uscanga LF, Robles G (eds.). Pancreas. McGraw-Hill Interamericana; 2000, p. 459-66.

10. Doppman JL, Shawker TH, Millar DL. Localization of islet cell tumors. Gastroenterol Clin North Am 1989; 18: 793-804.

11. Wamsteker EJ, Gauger PG, Thompson N, Scheiman JM. EUS detection of pancreatic endocrine tumors in asymptomatic patients with type 1 multiple endocrine neoplasia. Gastrointest Endosc 2003; 58: 531-5.

12. Galiber AK, Reading CC, Charboneau JW, et al. Localization of pancreatic insulinoma: comparison of pre and intraoperative US with CT and angiography. Radiology 1988; 166: 405-8.

13. Grant CS, van Heerden J, Charboneau JW, et al. Insulinoma. The value of intraoperative ultrasonography. Arch Surg 1988; 123: 843-8.

14. Ardengh JC, Rosenbaum P, Ganc AJ, et al. Role of EUS in the preoperative localization of insulinomas compared with spiral CT. Gastrointest Endosc 2000; 51: 552-5.

15. Owen NJ, Sohaib SA, Peppercorn PD, et al. MRI of pancreatic neuroendocrine tumours. Br J Radiol 2001; 74: 968-73.

16. Sheth SH, Fishman EK. Imaging of uncommon tumors of the pancreas. Radiol Clin North Am 2002; 40: 1273-87.

17. Ardengh JC, de Paulo GA, Ferrari AP. EUS-guided FNA in the diagnosis of pancreatic neuroendocrine tumors before surgery. Gastrointest Endosc 2004; 60: 378-84.

18. Azimuddin K, Chamberlain RS. The surgical management of pancreatic neuroendocrine tumors. Surg Clin North Am 2001; 81: 511-25.

19. Finlayson E, Clark O. Surgical treatment of insulinomas. Surg Clin North Am 2004; 84: 775-85.

20. Rothmund M, Angelini L, Brunt LM, et al. Surgery for benign insulinomas: an international review. World J Surg 1990; 14: 393-9.

21. Menegaux F, Schmitt G, Mercadier M, Chigot JP. Pancreatic insulinomas. Am J Surg 1993; 165: 243-8.

22. Hirshberg B, Libutti SK, Alexander HR, et al. Blind distal pancreatectomy for occult insulinoma, an inadvisable procedure. J Am Coll Surg 2002; 194: 761-4.

23. Berends FJ, Cuesta MA, Kazemier G, et al. Laparoscopic detection and resection of insulinomas. Surgery 2000; 128: 386-91.

24. Chan C, Podgaetz E, Torres-Villalobos G, et al, Central pancreatectomy as an indication for various benign pancreatic tumors. Am Surg 2004; 70: 304-6.

25. Iacono C, Bortolasi L, Serio G. Indications and technique of central pancreatectomy- early and late results. Arch Surg 2005; 390: 266-71.

26. Goldstein MJ, Toman J, Chabot JA. Pancreaticogastrostomy: a novel application after central pancreatectomy. J Am Coll Surg 2004; 198: 871-6.

27. Herrera MF. Syllabus, 88th Annual Clinical Congress, American College of Surgeons Oct 2002, p 15.

28. Gramática L Jr, Herrera MF, Mercado-Luna A, et al. Videolaparoscopic resection of insulinomas: experience in two institutions. World J Surg 2002; 26: 1297-300.

29. Viola KV, Sosa JA. Current advances in the diagnosis and treatment of pancreatic endocrine tumors. Curr Opin Oncol 2005; 17: 24-27.

30. Chetty R, Asa SL. Pancreatic endocrine tumors: an update. Adv Anat Pathol 2004; 11: 202-10.

31. Doppman JL, Miller DL, Chang R, et al. Intraarterial calcium stimulation test for detection of insulinomas. World J Surg 1993; 17: 439-43.

32. Zeiger MA, Shawker TH, Norton JA. Use of intraoperative ultrasonography to localize islet cell tumors. World J Surg 1993; 17: 448-54.

33. Bottger TC, Junginger T. Is preoperative radiographic localization of islet cell tumors in patients with insulinoma necessary? World J Surg 1993; 17: 427-32.

34. McHenry CR. What’s new in general surgery: endocrine surgery. J Am Coll Surg 2002; 195: 364-71.

35. Rosch T, Lightdale CJ, Botet JF, et al. Localization of pancreatic endocrine tumors by endoscopic ultrasonography. N Engl J Med 1992; 326: 1721-6.

36. Norton JA, Shawker TH, Doppman JL, et al. Localization and surgical treatment of occult insulinomas. Ann Surg 1990; 212: 615-20.

37. Grant CS. Insulinoma. In: Doherty G, Skögseid B (eds.). Textbook of surgical endocrinology. Lippincott Williams & Wilkins; 2001, p. 345-59.