A B Câmara-de-Souza1, M T K Toyoshima2, M L Giannella3, D S Freire4, C P Camacho5, D M Lourenço6, M S Rocha7, T Bacchella8, R Jureidini8, M C C Machado8, M Q Almeida9, M A A Pereira4. 1. Unidade de Endocrinologia Geral, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil. Electronic address: alexbcdsouza@gmail.com. 2. Serviço de Endocrinologia e Metabologia, Instituto do Câncer do Estado de São Paulo (ICESP), Brazil. 3. Unidade de Diabetes, Serviço de Endocrinologia e Metabologia, HCFMUSP, Brazil. 4. Unidade de Endocrinologia Geral, Serviço de Endocrinologia e Metabologia, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), Brazil. 5. Serviço de Endocrinologia e Metabologia, Universidade 9 de Julho, Brazil. 6. Unidade de Genética, Serviço de Endocrinologia e Metabologia, HCFMUSP, Brazil. 7. Serviço de Radiologia, HCFMUSP, Brazil. 8. Serviço de Cirurgia do Aparelho digestivo, HCFMUSP, Brazil. 9. Serviço de Endocrinologia e Metabologia, Instituto do Câncer do Estado de São Paulo (ICESP), Brazil; Unidade de Suprarrenal, Serviço de Endocrinologia e Metabologia, HCFMUSP, Brazil.
Abstract
BACKGROUND/ OBJECTIVES: Insulinoma is a rare pancreatic tumor and, usually, a benign disease but can be a malignant one and, sometimes, a highly aggressive disease. The aim of this study was to determine differences between benign and malignant tumors. METHODS: Retrospective study of 103 patients with insulinoma treated in a tertiary center. It was analyzed demographic, clinical, laboratory, localization and histologic analysis of tumor and follow up data of subjects in order to identify differences between individuals benign and malignant disease. RESULTS: Almost all patients (87%) had a benign tumor and survival rates of 100% following pancreatic tumor surgery. Those with malignant tumors (13%) have a poor prognosis, 77% insulinoma-related deaths over a period of 1-300 months after the diagnosis with a survival rate of 24% in five years. The following factors are associated with an increased risk of malignant disease: duration of symptoms < 24 months, fasting time for the occurrence of hypoglycemia < 8 h, blood plasma insulin concentration ≥ 28 μU/mL and C-peptide ≥ 4.0 ng/mL at the glycemic nadir and tumor size ≥ 2.5 cm. CONCLUSIONS: Our data help to base the literature about these tumors, reinforcing that although insulinoma is usually a single benign and surgically treated neoplasia, the malignant one is difficult to treat. We highlight the data that help predict a malignancy behavior of tumor and suggest a long follow up after diagnosis in these cases.
BACKGROUND/ OBJECTIVES:Insulinoma is a rare pancreatic tumor and, usually, a benign disease but can be a malignant one and, sometimes, a highly aggressive disease. The aim of this study was to determine differences between benign and malignant tumors. METHODS: Retrospective study of 103 patients with insulinoma treated in a tertiary center. It was analyzed demographic, clinical, laboratory, localization and histologic analysis of tumor and follow up data of subjects in order to identify differences between individuals benign and malignant disease. RESULTS: Almost all patients (87%) had a benign tumor and survival rates of 100% following pancreatic tumor surgery. Those with malignant tumors (13%) have a poor prognosis, 77% insulinoma-related deaths over a period of 1-300 months after the diagnosis with a survival rate of 24% in five years. The following factors are associated with an increased risk of malignant disease: duration of symptoms < 24 months, fasting time for the occurrence of hypoglycemia < 8 h, blood plasma insulin concentration ≥ 28 μU/mL and C-peptide ≥ 4.0 ng/mL at the glycemic nadir and tumor size ≥ 2.5 cm. CONCLUSIONS: Our data help to base the literature about these tumors, reinforcing that although insulinoma is usually a single benign and surgically treated neoplasia, the malignant one is difficult to treat. We highlight the data that help predict a malignancy behavior of tumor and suggest a long follow up after diagnosis in these cases.
Authors: Wenzel M Hackeng; Willemien Schelhaas; Folkert H M Morsink; Charlotte M Heidsma; Susanne van Eeden; Gerlof D Valk; Menno R Vriens; Christopher M Heaphy; Els J M Nieveen van Dijkum; G Johan A Offerhaus; Koen M A Dreijerink; Lodewijk A A Brosens Journal: Endocr Pathol Date: 2020-06 Impact factor: 3.943