Malignant insulinoma : Spectrum of unusual clinical features

Malignant insulinoma occurs in a few patients with insulinoma. Due to the small sample of patients, there are little data regarding their clinical manifestation as well as the preferred treatment modalities. The aims of the current study were to summarize the National Institutes of Health experience...

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Bibliographic Details
Published in:Cancer 2005-07, Vol.104 (2), p.264-272
Main Authors: HIRSHBERG, Boaz, COCHRAN, Craig, SKARULIS, Monica C, LIBUTTI, Steven K, ALEXANDER, H. Richard, WOOD, Bradford J, CHANG, Richard, KLEINER, David E, GORDEN, Phillip
Format: Article
Language:English
Subjects:
Adult
Aged
Biological and medical sciences
Endocrine pancreas. Apud cells (diseases)
Endocrinopathies
Female
Humans
Hypoglycemia - etiology
Insulinoma - mortality
Insulinoma - pathology
Insulinoma - therapy
Lymphatic Metastasis
Male
Medical sciences
Middle Aged
Neoplasm Metastasis
Time Factors
Tumors
Tumors. Hypoglycemia
Citations: Items that this one cites
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Summary:Malignant insulinoma occurs in a few patients with insulinoma. Due to the small sample of patients, there are little data regarding their clinical manifestation as well as the preferred treatment modalities. The aims of the current study were to summarize the National Institutes of Health experience during the last two decades and to conduct a critical review of the current literature. The authors identified 10 patients with metastatic insulinoma. The patients presented with four patterns of clinical behavior. First, four patients presented with lymph node metastasis and, after surgical excision, maintained a prolonged tumor-free survival. Second, four patients presented with metastatic disease to the liver, which appeared years after the initial diagnosis and presumed curative surgery. Third, one patient presented with a large alpha-fetoprotein-secreting liver mass. Finally, 9 of the 10 patients had a prolonged survival. Various treatment modalities were used to control hypoglycemia. Short-term benefits were most often achieved with embolization and diazoxide. Less successful modalities included radiofrequency ablation, radical debulking surgery, verapamil therapy, octreotide therapy, and chemotherapy. The current study, as well as others, suggested that metastatic insulinoma may have a variable natural history. After the initial surgical resection, the biology of the tumor, rather than any treatment modality, was most likely the major determinant of long-term survival.
ISSN:0008-543X
1097-0142
DOI:10.1002/cncr.21179