Malignant insulinoma: a rare presentation of a rare tumor - 22/08/11
Doi : 10.1016/j.gie.2007.06.026
Steven Armbruster, MD, Colleen Dorrance, DO
Department of Gastroenterology, Department of Internal Medicine and Oncology, National Naval Medical Center, Bethesda, Maryland
James F. Pingpank, MD
Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
Jayde E. Kurland, MD
Department of Gastroenterology, Department of Internal Medicine and Oncology, National Naval Medical Center, Bethesda, Maryland, USA
| Commentary The neuropsychiatric presentations of insulinoma from glycopenia are varied, bizarre, and often difficult to diagnose. Indeed, the median delay from the time of symptom onset to diagnosis is 1.5 years. Insulinoma is not common, with an incidence of 1 to 4 per million persons, and about 5% to 10% of these tumors are malignant. One cannot depend entirely on SRS for diagnosis because only about 50% of insulinomas exhibit receptor positivity. Of note, the favorable findings of <2% Ki-67 positive tumor cells and <2 mitoses per high power field indicated a decreased risk of malignant behavior. Malignant insulinoma has a median survival of only 2 years without surgical intervention; however, with surgery, survival approaches 71% at 5 years if metastases are resectable. Mae West once said, “too much of a good thing is wonderful,” but I doubt she was musing about insulin levels and insulinomas. Here again is an example of nature gone awry. Yes, we all need insulin, and yes, the excess of insulin led to the correct diagnosis, but too much of this good thing is not only not wonderful, the consequences of such a surfeit can be fatal. Lawrence J. Brandt, MD Associate Editor for Focal Points |
© 2007
American Society for Gastrointestinal Endoscopy. Publié par Elsevier Masson SAS. Tous droits réservés.
Vol 66 - N° 6
P. 1228-1229 - décembre 2007 Retour au numéro
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