Department of Endocrinology Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
European Neuroendocrine Tumor Society Center of Excellence, Rigshospitalet, Copenhagen, Denmark.
J Clin Endocrinol Metab. 2019 Dec 1;104(12):6129-6138. doi: 10.1210/jc.2019-01204.
Diagnosis and pathological classification of insulinomas are challenging.
To characterize localization of tumors, surgery outcomes, and histopathology in patients with insulinoma.
Patients with surgically resected sporadic insulinoma were included.
Eighty patients were included. Seven had a malignant tumor. A total of 312 diagnostic examinations were performed: endoscopic ultrasonography (EUS; n = 59; sensitivity, 70%), MRI (n = 33; sensitivity, 58%), CT (n = 55; sensitivity, 47%), transabdominal ultrasonography (US; n = 45; sensitivity, 40%), somatostatin receptor imaging (n = 17; sensitivity, 29%), 18F-fluorodeoxyglucose positron emission tomography/CT (n = 1; negative), percutaneous transhepatic venous sampling (n = 10; sensitivity, 90%), arterial stimulation venous sampling (n = 20; sensitivity, 65%), and intraoperative US (n = 72; sensitivity, 89%). Fourteen tumors could not be visualized. Invasive methods were used in 7 of these 14 patients and localized the tumor in all cases. Median tumor size was 15 mm (range, 7 to 80 mm). Tumors with malignant vs benign behavior showed less staining for insulin (3 of 7 vs 66 of 73; P = 0.015) and for proinsulin (3 of 6 vs 58 of 59; P < 0.001). Staining for glucagon was seen in 2 of 6 malignant tumors and in no benign tumors (P < 0.001). Forty-three insulinomas stained negative for somatostatin receptor subtype 2a.
Localization of insulinomas requires many different diagnostic procedures. Most tumors can be localized by conventional imaging, including EUS. For nonvisible tumors, invasive methods may be a useful diagnostic tool. Malignant tumors showed reduced staining for insulin and proinsulin and increased staining for glucagon.
胰岛素瘤的诊断和病理分类具有挑战性。
描述胰岛素瘤患者肿瘤定位、手术结果和组织病理学特征。
纳入接受手术切除的散发性胰岛素瘤患者。
共纳入 80 例患者，其中 7 例为恶性肿瘤。共进行了 312 次诊断检查：内镜超声检查（EUS；n = 59；敏感性 70%）、磁共振成像（MRI；n = 33；敏感性 58%）、计算机断层扫描（CT；n = 55；敏感性 47%）、经腹超声检查（n = 45；敏感性 40%）、生长抑素受体成像（n = 17；敏感性 29%）、18F-氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（n = 1；阴性）、经皮经肝静脉穿刺取样（n = 10；敏感性 90%）、动脉刺激静脉取样（n = 20；敏感性 65%）和术中超声检查（n = 72；敏感性 89%）。有 14 个肿瘤无法可视化。在这 14 例患者中的 7 例中使用了有创方法，所有病例均定位了肿瘤。肿瘤的中位大小为 15 毫米（范围 7 至 80 毫米）。具有恶性行为的肿瘤与具有良性行为的肿瘤相比，胰岛素（7 例中的 3 例与 73 例中的 66 例；P = 0.015）和前胰岛素（6 例中的 3 例与 59 例中的 58 例；P < 0.001）的染色较少。在 2 例恶性肿瘤中可见胰高血糖素染色，而在良性肿瘤中未见染色（P < 0.001）。43 个胰岛素瘤对生长抑素受体亚型 2a 呈阴性染色。
胰岛素瘤的定位需要多种不同的诊断程序。大多数肿瘤可以通过常规影像学检查，包括 EUS 进行定位。对于无法可视化的肿瘤，有创方法可能是一种有用的诊断工具。恶性肿瘤的胰岛素和前胰岛素染色减少，胰高血糖素染色增加。
