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Insulinoma: 31 years of tumor localization and excision
Author(s) -
Zeng XianJue,
Zhong ShouXian,
Zhu Yu,
Fei LiMin,
Wu WeiJan,
Cai LiXing
Publication year - 1988
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.2930390413
Subject(s) - insulinoma , medicine , hypoglycemia , pancreas , venous blood , insulin , hyperinsulinism , adenoma , blood sugar , surgery , radiology , pathology , endocrinology , diabetes mellitus , insulin resistance
This report is based on 31 years of experience with 116 cases of hyperin sulinism. Six cases had hypertrophy of the islets of Langerhans, 3 had widespead metastasis from malignant insulinomas, and 107 were benign adenoma cases. An immunoreactive insulin to glucose ratio of 0.3 of the peripheral venous blood before operation is of great value in diagnosing hyperinsulinism. Intraoperatively, immunoreactive insulin assay of the portal blood (IRI) is very valuable in determining if an insulinoma re mains. The dividing line is 100μU·ml −1 . In localizing the tumor, “differ ential” PTPC is important before operation. During the operation, fine needle aspiration cytology may assist in ascertaining if the palpable tumor is an insulinoma. Multiple fine needle aspiration cytology examinations can sometimes reveal an insulinoma in an indurated pancreas. Portal vein blood IRI and blood sugar assays may serve to confirm if removal of the insulinoma is complete. Removal of the insulinoma controls hypoglycemia satisfactorily, but the brain damage incurred by prolonged hypoglycemia cannot be significantly altered. Removal of the tumor should be by enu cleation. and the raw surface of the pancreas should be drained not sutured.