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Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head

Robotic Enucleation of an Intra-Pancreatic Insulinoma in the Pancreatic Head

Published on: January 3, 2020

[Malignant insulinoma].

Miklós Tóth¹, Nikolette Szücs, Zsuzsa Jakab

¹Semmelweis Egyetem, Általános Orvostudományi Kar, II. Belgyógyászati Klinika, Budapest. totmik@bel2.sote.hu

|March 1, 2011

Summary

This summary is machine-generated.

This case study details a metastatic neuroendocrine carcinoma of the pancreas. Despite treatment, the patient developed hypoglycemia due to insulin oversecretion, highlighting challenges in managing advanced neuroendocrine tumors.

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Published on: April 17, 2026

Area of Science:

Oncology
Endocrinology
Nuclear Medicine

Background:

Neuroendocrine tumors (NETs) are neoplasms originating from neuroendocrine cells.
Pancreatic NETs (PNETs) can exhibit aggressive behavior and metastasize.
Metastatic PNETs pose significant management challenges, particularly when associated with hormonal syndromes.

Observation:

A 56-year-old man presented with epigastric pain, found to have a pancreatic head tumor with liver metastasis.
Pathology revealed moderately differentiated neuroendocrine carcinoma with moderate proliferative activity (Ki-67).
Initial treatment with chemotherapy, interferon, and somatostatin analogue showed limited efficacy against rapidly progressing metastatic disease.

Findings:

Octreotide scintigraphy confirmed high somatostatin receptor expression on both primary and metastatic lesions.
⁹⁰Yttrium-DOTATOC peptide receptor radionuclide therapy (PRRT) yielded a mixed response over three sessions.
Late-stage disease progression led to severe hypoglycemia due to insulin oversecretion, confirmed by elevated insulin and C-peptide levels.
Diazoxide was poorly tolerated; chemoembolization provided only temporary relief.

Implications:

This case underscores the complex management of advanced, metastatic pancreatic neuroendocrine carcinoma.
Effective control of hormonal syndromes, such as hypoglycemia, is critical in advanced NETs.
PRRT can be a therapeutic option for somatostatin receptor-positive metastatic NETs, but outcomes can be variable.
Multimodality treatment approaches are often necessary for advanced neuroendocrine neoplasms.